From the On With Life, Ankeny, IA.
Department of Biostatistics, The University of Iowa, Iowa City, IA.
Arch Phys Med Rehabil. 2023 Feb;104(2):211-217. doi: 10.1016/j.apmr.2022.07.013. Epub 2022 Aug 5.
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.
Observational cohort study.
Comprehensive integrated rehabilitation program for brain injury within a skilled nursing facility.
Consecutive admissions with acquired brain injury (N=101).
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.
Mayo-Portland Adaptability Inventory, fourth edition (MPAI-4); Supervision Rating Scale (SRS).
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 (β=-0.07, t=-8.85, P<.0001).
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.
研究参与者努力程度（LoE）对急性脑损伤后康复结果的影响，假设努力程度与更好的结果相关。
观察性队列研究。
在熟练护理设施内进行的综合综合脑损伤康复计划。
连续入组的获得性脑损伤患者（N=101）。
个体化的跨学科脑损伤康复；在物理治疗、职业治疗和言语治疗期间，使用获得性脑损伤 LoE 量表（ABI-LoES）对患者的 LoE 进行治疗师评定。
明尼苏达适应行为评定量表第四版（MPAI-4）；监督评分量表（SRS）。
线性回归显示，出院 MPAI-4 总 T 评分与 ABI-LoES 评分的平均值、入院 MPAI-4 总 T 评分、入院年龄和受伤后天数显著相关，但与 ABI-LoES 评分的标准差、性别、损伤类型、住院时间或 COVID-19 大流行期间或之前的治疗无关。出院 SRS 评分与 ABI-LoES 评分的平均值、入院 SRS 评分和年龄显著相关。在控制其他变量后，ABI-LoES 评分的平均值每增加 1 个单位，出院 MPAI-4 总 T 评分降低 5.1 个单位，出院 SRS 评分降低 1.5 个单位。Logistic 回归显示，在控制其他变量后，ABI-LoES 评分的平均值每增加 1 个单位，患者在 MPAI-4 上达到最小临床重要差异的可能性就增加 8.34 倍。入院 MPAI-4 与 ABI-LoES 评分的平均值呈负相关（β=-0.07，t=-8.85，P<.0001）。
在控制不可变变量后，平均 ABI-LoES 评分与结果呈正相关。初始残疾程度与 ABI-LoES 评分的平均值呈负相关。
