Journal
DISABILITY AND REHABILITATION
Volume 43, Issue 1, Pages 33-41Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/09638288.2019.1613682
Keywords
Neuropsychological assessment; therapy engagement; functional outcomes; prediction; acquired brain injury
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Funding
- Wayne State University Graduate School
- Foundation for Rehabilitation Psychology Dissertation Award
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The study found that therapy engagement is a crucial factor in successful rehabilitation outcomes and can mediate the relationship between neuropsychological performance and functional outcomes. Cognitive deficits associated with brain injury can hinder full engagement in therapy, leading to diminished potential gains in functional recovery. Neuropsychological assessment can help identify characteristics underlying therapy engagement to optimize personalized treatment plans.
Purpose: The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Materials and method: Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement. Results: Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Conclusions: Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans.
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