Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury.

MedStar author(s):
Citation: Archives of Physical Medicine & Rehabilitation. 96(8 Suppl):S235-44, 2015 Aug.PMID: 26212400Institution: MedStar National Rehabilitation NetworkForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational Study | Research Support, N.I.H., Extramural | Research Support, U.S. Gov't, Non-P.H.S.Subject headings: *Brain Injuries/pp [Physiopathology] | *Brain Injuries/rh [Rehabilitation] | *Cognition Disorders/rh [Rehabilitation] | *Occupational Therapy/sn [Statistics & Numerical Data] | *Physical Exertion | *Physical Therapy Modalities/sn [Statistics & Numerical Data] | *Speech Therapy/sn [Statistics & Numerical Data] | Activities of Daily Living | Adult | Age Factors | Brain Injuries/ep [Epidemiology] | Cognition Disorders/ep [Epidemiology] | Cognition Disorders/pp [Physiopathology] | Cohort Studies | Comorbidity | Female | Humans | Injury Severity Score | Inpatients/sn [Statistics & Numerical Data] | Length of Stay | Male | Middle Aged | Prospective Studies | Rehabilitation Centers/sn [Statistics & Numerical Data] | Treatment Outcome | United States/ep [Epidemiology]Local holdings: Available online from MWHC library: 2000 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-9993
Name of journal: Archives of physical medicine and rehabilitationAbstract: 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.Copyright � 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.DESIGN: Prospective, multicenter, longitudinal cohort study.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).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.PARTICIPANTS: Patients (N=1946) receiving 138,555 therapy sessions.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).SETTING: Acute TBI rehabilitation programs.All authors: Barrett RS, Bogner J, Corrigan JD, Dijkers MP, Garmoe W, Horn SD, Seel RT, Smout RJDigital Object Identifier: Date added to catalog: 2016-01-13
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 26212400

Available online from MWHC library: 2000 - present, Available in print through MWHC library:1999-2007

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.Copyright � 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

DESIGN: Prospective, multicenter, longitudinal cohort study.

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).

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.

PARTICIPANTS: Patients (N=1946) receiving 138,555 therapy sessions.

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).

SETTING: Acute TBI rehabilitation programs.

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