An Observational Cohort Study of the Role of Level of Effort in Post-acute Brain Injury Rehabilitation.

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: 101 consecutive admissions with acquired brain injury.

INTERVENTIONS: Individualized interdisciplinary brain injury rehabilitation; therapist rating of participant LoE with Acquired Brain Injury Level of Effort Scale (ABI-LoES) 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 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 pandemic. Discharge SRS scores were significantly associated with mean ABI-LoES rating, admission SRS scores, and age. A one-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 the odds of achieving a Minimal Clinically Important Difference on the MPAI-4 were 8.34 times higher with each one-unit increase in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was negatively associated with mean ABI-LoES rating (β= -0.07, t=-8.85, p<0.0001).

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.