Article

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS