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: Consecutive admissions with acquired brain injury (N=101). INTERVENTIONS: Individualized interdisciplinary brain injury rehabilitation; therapist rating of participant LoE with Acquired Brain Injury LoE Scale (ABI-LoES) during physical therapy, occupational therapy, and speech and language pathology sessions. MAIN OUTCOME MEASURES: Mayo-Portland Adaptability Inventory, fourth edition (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-19 pandemic. Discharge SRS scores were significantly associated with mean ABI-LoES rating, admission SRS scores, and age. A 1-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 that the odds of achieving a minimal clinically important difference on the MPAI-4 were 8.34 times higher with each 1-unit increase in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was negatively associated with mean ABI-LoES rating (ß=-0.07, t=-8.85, P<.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.
ABSTRACT
Research Objectives To investigate the role of participant level of effort (LoE) on outcome in residential brain rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. Design Observational cohort study. Setting Comprehensive integrated brain rehabilitation program within a skilled nursing facility. Participants 101 consecutive admissions with acquired brain injury. Interventions Individualized interdisciplinary brain rehabilitation;therapist rating of participant LoE 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 scores were significantly associated with mean LoE rating, admission MPAI-4 scores, age at admission, and days from injury (Adj R2 = 0.72;F=65.28;p< 0.0001) but not with LoE variability, sex, type of injury, length of stay, or treatment before or during the COVID pandemic. Discharge SRS scores were significantly associated with mean LoE rating, admission SRS scores, and age. After controlling for other variables, a one-unit increase in mean LoE rating was associated with an improvement of 5.1 in discharge Total MPAI-4 score and 1.5 in discharge SRS score. 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 LoE increase. Admission MPAI-4 was negatively associated with mean LoE (β= -0.07, t=-8.85, p< 0.0001). Exploratory propensity score analysis suggests a potential causal effect of mean LoE on outcome. Conclusions Average LoE is positively associated with and, pending further study, may be causally related to outcome. Age, time since injury, and initial level of disability are also associated with outcome;initial level of disability is negatively associated with LoE. Author(s) Disclosures The authors have no conflicts of interest to disclose.
ABSTRACT
Rehabilitation after significant acquired brain injury (ABI) to address complex independent activities of daily living and return to family and community life is offered primarily after initial hospitalization in outpatient day treatment, group home, skilled nursing, and residential settings and in the home and community of the person served. The coronavirus 2019 pandemic threatened access to care and the health and safety of staff, persons served, and families in these settings. This article describes steps taken to contain this threat by 7 leading posthospital ABI rehabilitation organizations. Outpatient and day treatment facilities were temporarily suspended. In other settings, procedures for isolation, transportation, cleaning, exposure control, infection control, and use of personal protective equipment (PPE) were reinforced with staff. Visitation and community activities were restricted. Staff and others required to enter facilities were screened with symptom checklists and temperature checks. Individuals showing symptoms of infection were quarantined and tested, as possible. New admissions were carefully screened for infection and often initially quarantined. Telehealth played a major role in reducing direct interpersonal contact while continuing to provide services both to outpatients and within facilities. Salary, benefits, training, and managerial support were enhanced for staff. Despite early outbreaks, these procedures were generally effective, with preliminary initial infections rates of only 1.1% for persons served and 2.1% for staff. Reductions in admissions, services, and unanticipated expenses (eg, PPE, more frequent and thorough cleaning) had a major negative financial effect. Providers continue to be challenged to adapt rehabilitative approaches and to reopen services.