Agitation in acquired brain injury: impact on acute rehabilitation therapies.
OBJECTIVE
To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation.


METHODS
Cross-sectional, correlational.


METHODS
Urban, inpatient rehabilitation facility in the midwestern United States.


METHODS
Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital.


METHODS
Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure.


RESULTS
Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio.


CONCLUSIONS
Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion.
Lequerica
Anthony H
AH
Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA.
Rapport
Lisa J
LJ
Loeher
Kristen
K
Axelrod
Bradley N
BN
Vangel
Stephen J
SJ
Hanks
Robin A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000145:classification / Q000150:complications* / Q000534:rehabilitation; D003071:Cognition / Q000502:physiology; D003221:Confusion / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D010349:Patient Compliance; D011595:Psychomotor Agitation / Q000145:classification / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome