Abstract
Objective
To describe patients' level of effort in occupational, physical, and speech therapy
sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate
how age, injury severity, cognitive impairment, and time are associated with effort.
Design
Prospective, multicenter, longitudinal cohort study.
Setting
Acute TBI rehabilitation programs.
Participants
Patients (N=1946) receiving 138,555 therapy sessions.
Interventions
Not applicable.
Main Outcome Measures
Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy
Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic
amnesia (PTA), and Agitated Behavior Scale (ABS).
Results
The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy
sessions closely conformed to a normative distribution for all 3 disciplines. Mean
Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were
higher in the discharge week than in the admission week (P<.001). For patients who completed 2, 3, or 4 weeks of rehabilitation, differences
in effort ratings (P<.001) were observed between 5 subgroups stratified by admission FIM cognitive scores
and over time. In linear mixed-effects modeling, age and Comprehensive Severity Index
brain injury severity score at admission, days from injury to rehabilitation admission,
days from admission, and daily ratings of PTA and ABS score were predictors of level
of effort (P<.0001).
Conclusions
Patients' level of effort can be observed and reliably rated in the TBI inpatient
rehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients
who sustain TBI show varying levels of effort in rehabilitation therapy sessions,
with effort tending to increase over the stay. PTA and agitated behavior are primary
risk factors that substantially reduce patient effort in therapies.
Keywords
List of abbreviations:
ABS (Agitated Behavior Scale), CI (confidence interval), ICC (intraclass correlation coefficient), IR (inpatient rehabilitation), LOS (length of stay), OT (occupational therapy), PT (physical therapy), PTA (posttraumatic amnesia), ST (speech therapy), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the National Institutes of Health, National Center for Medical Rehabilitation Research (grant no. 1R01HD050439-01), and the National Institute on Disability and Rehabilitation Research (grant no. H133A080023).
However, the contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
