Abstract
Objective
To investigate the role of participant level of effort (LoE) on outcome in post-acute
brain injury rehabilitation with the hypothesis that greater effort is associated
with more positive outcomes.
Design
Observational cohort study.
Setting
Comprehensive integrated rehabilitation program for brain injury within a skilled
nursing facility.
Participants
101 consecutive admissions with acquired brain injury.
Interventions
Individualized interdisciplinary brain injury rehabilitation; therapist rating of
participant LoE with Acquired Brain Injury Level of Effort Scale (ABI-LoES) during
physical therapy, occupational therapy, and speech and language pathology sessions.
Main Outcome Measures
Mayo-Portland Adaptability Inventory (MPAI-4); Supervision Rating Scale (SRS)
Results
Linear regression showed that discharge MPAI-4 Total T-scores were significantly associated
with mean ABI-LoES rating, admission MPAI-4 Total T-scores, age at admission, and
days from injury but not with standard deviation of ABI-LoES rating, sex, injury type,
length of stay, or treatment before or during the COVID pandemic. Discharge SRS scores
were significantly associated with mean ABI-LoES rating, admission SRS scores, and
age. A one-unit increase in mean ABI-LoES rating was associated with 5.1 unit lower
discharge MPAI-4 Total T-scores and 1.5 lower discharge SRS scores, after controlling
for other variables. Logistic regression showed the odds of achieving a Minimal Clinically
Important Difference on the MPAI-4 were 8.34 times higher with each one-unit increase
in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was
negatively associated with mean ABI-LoES rating (β= -0.07, t=-8.85, p<0.0001).
Conclusions
After controlling for nonmodifiable variables, average ABI-LoES rating is positively
associated with outcome. Initial level of disability is negatively associated with
mean ABI-LoES rating.
Key Words
List of abbreviations:
ABI (Acquired brain injury), ABI-LoES (Acquired Brain Injury Level of Effort Scale), CI (Confidence interval), CIRP/BI-SNF (Comprehensive Integrated Rehabilitation Program for Brain Injury within a Skilled Nursing Facility), IQR (Interquartile range), LoE (Level of effort), LOS (Length of stay), MCID (Minimal clinically important difference), MPAI-4 (Mayo-Portland Adaptability Inventory, 4th edition), MT (Music Therapy), OT (Occupational Therapy), PSM (Propensity score matching), PT (Physical Therapy), RT (Recreation Therapy), SLP (Speech and Language Pathology), SNF (Skilled nursing facility), SRS (Supervision Rating Scale)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 25,
2022
Received in revised form:
July 15,
2022
Received:
October 6,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
This research was supported in part by the Foundation for the Advancement of Brain Rehabilitation (FABR). The authors have no conflicts of interest to declare. Reprints will not be available.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
