Development of a clinical screening tool to differentiate levels of challenging patient behaviour

Abstract

Aims This article describes the design of a systematic interdisciplinary clinical tool developed to differentiate levels of challenging behaviour (CB) in patients following a traumatic or acquired brain injury in order to facilitate decisions regarding rehabilitation and management needs. Methods A ‘top-down and bottom-up’ approach was used, based on clinical case examples and adaptations from the Overt Aggression Scale – Modified for Neurorehabilitation (OAS-MNR) (Alderman et al, 1997). Inter-rater reliability, face and content validity were tested through opportunistic sampling and blind re-screening of 20 patients on a post-acute neurorehabilitation ward. Findings Inter-rater reliability for overall decision on suitability for inpatient neurorehabilitation referral was significant (V = 0.84; P = 0.03); with significant inter-rater reliability within CB ratings. Ninety-three percent of staff were able to make an agreed decision regarding overall level of CB; there was a 95% concordance between staff using the tool; 90% of expert neurorehabilitation staff agreed with the decision from the tool, indicating a high degree of feasibility and clinical utility. Conclusions Changes were made to improve the tool's overall clinical usefulness. Findings indicate it is accessible for ward staff, and appropriate for use as a decision and management aid for patients presenting with a range of CBs. Further exploration of psychometric properties across settings and aetiology of CB is recommended.