Hopkins Rehabilitation Engagement Rating Scale Research Articles

Cognitive impairment predicts engagement in inpatient stroke rehabilitation.

Patient engagement during inpatient rehabilitation is an important component of rehabilitation therapy, as lower levels of engagement are associated with poorer outcomes. Cognitive deficits may impact patient engagement during inpatient stroke rehabilitation. Here, we assess whether patient performance on the cognitive tasks of the 30-min National Institute of Neurologic Disorders and Stroke - Canadian Stroke Network (NINDS-CSN) screening battery predicts engagement in inpatient stroke rehabilitation. Prospective data from 110 participants completing inpatient stroke rehabilitation at an academic medical center were utilized for the present analyses. Cognitive functioning was assessed at inpatient stroke rehabilitation admission using the NINDS-CSN cognitive battery. Patient engagement was evaluated at discharge from an inpatient rehabilitation unit using the Hopkins Rehabilitation Engagement Rating Scale. The results demonstrate that the NINDS-CSN cognitive battery, specifically subtests measuring executive functioning, attention and processing speed, predicts patient engagement in inpatient stroke rehabilitation. Cognitively impaired patients undergoing rehabilitation may benefit from modifications and interventions to increase engagement and improve functional outcomes.

Psychometric evaluation of the Hopkins Rehabilitation Engagement Rating Scale in postacute physical therapy services.

Evaluate the reliability and validity of the Hopkins Rehabilitation Engagement Scale (HRERS) in a postacute rehabilitation sample. We hypothesized that HRERS items would comprise a single factor, and would demonstrate adequate internal consistency and temporal stability, and significant relationships with key constructs. Research Method and Design: Retrospective medical record review between 2016 and 2017 of older veterans (N = 107) admitted to a community living center postacute care (CLC-PAC) rehabilitation hospital unit to address targeted physical therapy rehabilitation goals. Inclusion criteria included availability of two HRERS administrations at Time 1 (admission) and Time 2 (approximately one-month follow-up or physical therapist/CLC-PAC discharge). Across timepoints, HRERS items reflect a single factor of engagement, and the scale has good internal consistency at admission (Time 1, α = .759) and follow-up (Time 2, α = .877). The temporal stability of HRERS across ratings was r = .56 (p < .001). Increased pain rating (r = -.309, p < .01) and depressive symptoms (-.287, p < .01) at admission correlates with subsequent physical therapist (PT) engagement (HRERS Time 2). Low admission PT engagement correlates with less frequent PT attendance (r = -.242, p < .01) and greater number of consults placed during the CLC stay (r = -.222, p < .05). HRERS is a reliable and valid measure of PT engagement in older CLC-PAC Veterans. Findings support the administration of the HRERS at more than one timepoint during rehabilitation to inform interventions targeting select behavioral health factors such as pain and depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Level of Exercise Participation in Individuals with Traumatic Spinal Cord Injury During Inpatient Rehabilitation: A Cross-sectional Study.

The outcome of exercises depends on participants' level of exercise participation. We aimed to investigate the level of exercise participation in individuals with traumatic spinal cord injury during inpatient rehabilitation. All participants with traumatic spinal cord injury undergoing inpatient physiotherapy at a rehabilitation center were recruited. Participants with hearing/visual problems were excluded. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale were used to evaluate exercise participation levels. One-way ANOVA and unpaired t-test were used to compare level of participation between groups. Pearson's correlation and Chi-square tests were used to evaluate correlation and association. Thirty-five participants with mean age 37.1 ± 11.7 years completed the study. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale demonstrated a low level of exercise participation in 31.4 % and 42.9 % participants respectively. Participants with an incomplete injury had high exercise participation levels compared to complete injuries. There were significant group differences (p < 0.001, effect size = 0.8) between complete and incomplete injuries and among various levels of injuries. The level of exercise participation was significantly associated with injury levels and type (p < 0.001, Phi = 0.7 to 0.9). The exercise participation level was high for incomplete compared to complete injuries in Nepalese individuals with traumatic spinal cord injury. The demographic and socio-economical factors were not associated with level of exercise participation.

The effectiveness of a novel sleep clinical pathway in an inpatient musculoskeletal rehabilitation cohort: A pilot randomized controlled trial

ObjectiveSleep disturbance in hospital is common. This pilot randomized controlled trial assessed a sleep clinical pathway compared with standard care in improving sleep quality, engagement in therapy and length of stay in musculoskeletal inpatient rehabilitation.MethodsParticipants (n = 51) were randomized to standard care (“control”, n =29) or sleep clinical pathway (“intervention”, n = 22). Outcome measures included: Pittsburgh Sleep Quality Index (PSQI), Hopkins Rehabilitation Engagement Rating Scale (HRERS), Fatigue Severity Scale (FSS), Patient Satisfaction with Sleep Scale, and actigraphy. Assessment time-points were at admission and before discharge from rehabilitation.ResultsNo significant differences were found between groups for any outcome measure. As a cohort (n = 51), there were significant improvements from admission to discharge in sleep quality (PSQI (−2.31; 95% confidence interval (95% CI) −3.33 to −1.30; p <0.001)], fatigue (FSS (−8.75; 95% CI −13.15 to −4.34; p <0.001)], engagement with therapy (HRERS-Physiotherapists (+1.37; 95% CI 0.51–3.17; p =0.037), HRERS-Occupational Therapists (+1.84; 95% CI 0.089–2.65; p = 0.008)), and satisfaction with sleep (+0.824; 95% CI 0.35–1.30; p = 0.001). Actigraphy findings were equivocal.ConclusionThe sleep clinical pathway did not improve sleep quality compared with standard care. Larger studies and studies with alternate methodology such as “cluster randomization” are needed.LAY ABSTRACTSleep disturbance in hospital is common. This study examined the effectiveness of “sleep clinical pathways” to help sleep in rehabilitation ward patients after hip and knee replacements. Fifty-one patients were divided randomly into 2 groups. One group received usual care, whilst the other group received care from doctors who were guided by these “pathways”. The pathways prompted the doctors to look for conditions that could affect sleep and gave them suggestions on how to manage these conditions. However, the results showed that using these pathways did not improve the sleep of patients compared with the usual care control group. Sleep improved in all patients over the course of the study.

The Hopkins Rehabilitation Engagement Rating Scale - Reablement Version (HRERS-RV): Development and psychometric properties.

Patient or user engagement with health and social care interventions is receiving increased attention and interest within practice settings and research. An English evaluation of three reablement services wished to include a measure of user-engagement so as to explore its association with outcomes. As no measure of reablement engagement existed, an existing measure designed for use with physical rehabilitation patients (the Hopkins Rehabilitation Engagement Rating Scale) was adapted and its psychometric properties were tested. The adapted version was completed by reablement staff at the time an individual (n=129) was discharged from one of the three reablement services. Outcomes data (Barthel Index, Nottingham Extended Activities of Daily Living Scale, General Health Questionnaire-12) collected by the evaluation study at baseline (that is, at entry into reablement), discharge and 6months postdischarge was used for some psychometric testing. Internal consistency and construct, predictive and discriminant validity were investigated. The adapted scale measured a single construct and had good internal consistency. Tests of predictive and discriminant validity were positive. Findings from a separate, small-scale (n=31) test-retest study offer an early indication that this is acceptable. There was, however, evidence of a ceiling effect and we consider ways this may be ameliorated. The Hopkins Rehabilitation Engagement Rating Scale - Reablement Version offers a means by which user engagement in reablement can be measured using a staff-completed instrument. The association between engagement and reablement outcomes, revealed when testing for predictive validity, supports the argument for greater attention and investment in research on user engagement in reablement. More broadly, researching engagement within the context of an intervention often delivered by multiple practitioners offers the opportunity to further understand this concept which, in the past, has particularly focused on interventions delivered by a single practitioner. In addition, future work should include developing a companion measure completed by service users.

The effectiveness of a sleep clinical pathway in an inpatient musculoskeletal rehabilitation cohort: A randomised controlled trial

Sleep is important for health, quality of life and general well-being. Poor sleep in hospitalized patients is common and can affect recovery, engagement, and prolong hospital stay. The assessment and management of sleep in hospitalised patients is poorly understood. The inpatient rehabilitation setting may present an opportunity for better management of sleep disorders. Clinical pathways may be useful for the management of sleep disorders in a rehabilitation setting. To assess the effectiveness of a sleep clinical pathway compared to standard care in improving sleep quality, patient engagement in therapy and length of stay in an inpatient rehabilitation setting. Rehabilitation inpatients with a musculoskeletal diagnosis ( n = 51) were randomized to standard care (“control” n = 29) and sleep clinical pathway (“intervention” n = 22). Outcome measures included: Pittsburgh Sleep Quality Index (PSQI), Hopkins Rehabilitation Engagement Rating Scale (HRERS), Fatigue Severity Scale (FSS), Patient Satisfaction with Sleep Scale, and Actigraphy. Assessment time-points were at admission and upon discharge from rehabilitation. There were no significant differences between groups for any outcome measures. As a cohort ( n = 51), there were significant improvements from admission to discharge in sleep quality [PSQI (−2.31; 95% CI: −3.33 to −1.30 P = <0.001)], fatigue [FSS (−8.75; 95% CI: −13.15 to −4.34; P ≤ 0.001)], engagement with therapy [HRERS-Physiotherapists (+1.37; 95% CI: 0.51–3.17; P = 0.037), HRERS-Occupational Therapists (+1.84; 95% CI: 0.089–2.65; P = 0.008)], and Satisfaction with sleep (+0.824; 95% CI: 0.35–1.30; P = 0.001). Actigraphy results showed that all patients reported more sleep than what was measured. A sleep clinical pathway did not improve sleep quality compared with standard care. Larger studies and studies with alternate methodology such as “cluster randomization” are needed.

Characteristics of individuals seeking activity-based restorative therapy following spinal cord injury: A focus on hope.

There is a lack of evidence regarding the psychosocial characteristics of individuals with spinal cord injury (SCI) undergoing activity-based restorative therapy (ABRT) treatment. This study seeks to describe the hopefulness of a sample of ABRT participants and describe the relationship between hopefulness and level of rehabilitation engagement. A prospective cross-sectional cohort study was conducted using a convenience sample of 73 individuals with SCI (mean time since injury = 66.6 months) seeking out-patient, post-acute rehabilitation at a metropolitan ABRT center. Outcome measures included a demographic survey, The Hope Scale, the Patient Health Questionare-9 and the Hopkins Rehabilitation Engagement Rating Scale. The ABRT group reported higher levels of hope (M = 54.78, SD = 7.13) than have been reported in a sample of individuals with SCI seeking traditional rehabilitation in the acute (M = 24.58, SD = 4.06) setting. Rehabilitation engagement was not related to hopefulness in the ABRT group. The ABRT group demonstrated high levels of hopefulness. The difference in hopefulness noted between this group and previous studies could be due to the time elapsed since injury, the presence of choice in the rehabilitation process, or the possibility that individuals who chose to participate in ABRT may have inherently different hopefulness characteristics than the broader SCI population.

Relationship of Hopkins Rehabilitation Engagement Rating Scale to Baseline Cognition and FIM Change in Acute Inpatient Stroke Rehabilitation

Relationship of Hopkins Rehabilitation Engagement Rating Scale to Baseline Cognition and FIM Change in Acute Inpatient Stroke Rehabilitation

The role of psychological facilitators and barriers to therapeutic engagement in acute, inpatient rehabilitation.

Lequerica and Kortte (2010) proposed a model of therapeutic engagement in rehabilitation that indicates there are facilitators and barriers to an individual's engagement in rehabilitation. The current study examines potential personal variables that may play a role in rehabilitation engagement. In this prospective cohort design, 206 adults from 3 inpatient acute rehabilitation hospitals completed the Hopkins Rehabilitation Engagement Rating Scale, Hope Scale, Benefit Finding Scale, Positive and Negative Affect Schedule, Brief Symptom Inventory, and Denial of Illness Scale. Among potential facilitators (hope, benefit-finding, positive affect), positive affect was the only variable that accounted for a significant variance (β = .24, p < .01) in rehabilitation engagement. Among potential barriers (depressive symptoms, negative affect, denial of illness), only denial of illness accounted for a significant variance (β = -.24, p < .01) in rehabilitation engagement. The present findings suggest that specific facilitators (positive affect) and barriers (denial of illness) relate to therapeutic engagement in rehabilitation. Interventions that increase positive affect and address denial of illness may provide novel avenues to increase therapeutic engagement. (PsycINFO Database Record

Health Behavior Change Counseling in Surgery for Degenerative Lumbar Spinal Stenosis. Part II: Patient Activation Mediates the Effects of Health Behavior Change Counseling on Rehabilitation Engagement

ObjectiveTo determine the effect of health behavior change counseling (HBCC) on patient activation and the influence of patient activation on rehabilitation engagement, and to identify common barriers to engagement among individuals undergoing surgery for degenerative lumbar spinal stenosis. DesignProspective clinical trial. SettingAcademic medical center. ParticipantsConsecutive lumbar spine surgery patients (N=122) defined in our companion article (Part I) were assigned to a control group (did not receive HBCC, n=59) or HBCC group (received HBCC, n=63). InterventionBrief motivational interviewing–based HBCC versus control (significance, P<.05). Main Outcome MeasuresWe assessed patient activation before and after intervention. Rehabilitation engagement was assessed using the physical therapist–reported Hopkins Rehabilitation Engagement Rating Scale and by a ratio of self-reported physical therapy and home exercise completion. Common barriers to rehabilitation engagement were identified through thematic analysis. ResultsPatient activation predicted engagement (standardized regression weight, .682; P<.001). Postintervention patient activation was predicted by baseline patient activation (standardized regression weight, .808; P<.001) and receipt of HBCC (standardized regression weight, .444; P<.001). The effect of HBCC on rehabilitation engagement was mediated by patient activation (standardized regression weight, .079; P=.395). One-third of the HBCC group did not show improvement compared with the control group. Thematic analysis identified 3 common barriers to engagement: (1) low self-efficacy because of lack of knowledge and support (62%); (2) anxiety related to fear of movement (57%); and (3) concern about pain management (48%). ConclusionsThe influence of HBCC on rehabilitation engagement was mediated by patient activation. Despite improvements in patient activation, one-third of patients reported low rehabilitation engagement. Addressing these barriers should lead to greater improvements in rehabilitation engagement.

Patient Activation and Adherence to Physical Therapy in Persons Undergoing Spine Surgery

Prospective longitudinal study. To determine the association between baseline patient activation and participation in postoperative physical therapy in a cohort of individuals after lumbar spine surgery. The Patient Activation Measure is a recently developed tool to assess patient activation. Patient activation is defined as an individual's propensity to engage in adaptive health behavior that may, in turn, lead to improved patient outcomes. It has not previously been used in spine research. We assessed baseline patient activation levels in individuals presenting for surgery of the lumbar spine via the Patient Activation Measure. Differences in patient characteristics across patient-activation quartiles were assessed using analysis of variance. After surgery, we assessed attendance (self-reported weekly) and engagement in physical therapy (at the last visit, using the Hopkins Rehabilitation Engagement Rating Scale) and determined the ratio of sessions attended to sessions prescribed. The influence of baseline patient activation, in the setting of other patient characteristics, to predict attendance and engagement with physical therapy was examined using linear regression methods. Scores on the Patient Activation Measure were positively correlated with participation (r = 0.53) and engagement (r = 0.75) in physical therapy. Individuals with low activation were more likely to report low self-efficacy for physical therapy, low hope, and external locus of control compared with those with high activation. Increased patient activation is associated with improved adherence with physical therapy as reflected in attendance and engagement.

The Hopkins Rehabilitation Engagement Rating Scale: Development and Psychometric Properties

Kortte KB, Falk LD, Castillo RC, Johnson-Greene D, Wegener ST. The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties. Objective To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. Design We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure’s internal consistency, interrater reliability, construct validity, and criterion validity. Setting Acute inpatient rehabilitation in 3 metropolitan hospitals. Participants A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. Interventions Not applicable. Main Outcome Measures The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine’s Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. Results The HRERS has good internal consistency (α=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression ( r=−.24, P<.01), higher ratings of denial of illness ( r=−.30, P<.001), and self-rated negative affect ( r=−.23, P<.01), and correlated positively with self-rated positive affect ( r=.36, P<.001) and level of functioning 3 months postdischarge ( r=.22, P<.01). Conclusions The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.