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: 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 clini-cally 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 (beta=-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 dis-ability is negatively associated with mean ABI-LoES rating. Archives of Physical Medicine and Rehabilitation 2023;104:211-7 (c) 2022 by the American Congress of Rehabilitation Medicine.