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.

DESIGN

Cross-sectional, correlational.

SETTING

Urban, inpatient rehabilitation facility in the midwestern United States.

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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.