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.