title: Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury.
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.
  
  
  METHODS
  Prospective, multicenter, longitudinal cohort study.
  
  
  METHODS
  Acute TBI rehabilitation programs.
  
  
  METHODS
  Patients (N=1946) receiving 138,555 therapy sessions.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA. Electronic address: ron_seel@shepherd.org.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Seel
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bogner
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
authors.affiliation: Medstar National Rehabilitation Hospital, Washington, DC.
authors.forename: William
authors.initials: W
authors.lastname: Garmoe
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000453:epidemiology / Q000503:physiopathology* / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D005082:Physical Exertion; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D013070:Speech Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Amnesia, anterograde; Craniocerebral trauma; Psychomotor agitation; Rehabilitation