The Overt Behavior Scale-In Session: A behavioral assessment tool for individuals with acquired brain injury in the inpatient rehabilitation setting.

BACKGROUND

Challenging behavior (CB) following acquired brain injury (ABI) has a direct impact on safety, the rehabilitation process, and societal participation. Early behavior management in inpatient rehabilitation (IPR) settings guided by appropriate assessment tools is critical for maximizing gains in IPR and successful community integration of individuals with CB following ABI.

OBJECTIVE

To assess the validity and reliability of the Overt Behavior Scale-In Session (OBS-INS), a behavioral assessment tool created for the measurement of CB following ABI in IPR.

DESIGN

Mixed-methods study.

SETTING

An IPR facility that specializes in brain injury rehabilitation.

PARTICIPANTS

Nineteen of 54 adults ( ≥18 years of age) admitted under the services of the primary investigator following ABI (8 sustained a traumatic brain injury, 10 sustained a cerebral vascular accident, and 1 sustained an anoxic brain injury) participated in the validation of the OBS-INS. Twenty trained clinicians participated in assessing the reliability of this measure.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: OBS-INS Clinical Weighted Severity ratings were compared to the Agitated Behavior Scale (ABS), Disability Rating Scale (DRS), and the Berg Balance Scale for convergent and divergent validity. Inter- and intrarater reliability were determined following video-rating sessions with trained clinicians. Clinicians also completed a study-specific questionnaire determining the utility of the OBS-INS in improving interdisciplinary communication, intervention selection, and discharge planning.

RESULTS

A strong positive correlation was found between the OBS-INS CWS and ABS scores (rs = .815, p < .001) with a strong correlation between the OBS-INS CWS and DRS discharge scores (rs = .409). Interrater reliability (intraclass correlation coefficient = 0.982; [.929-1.00]) was excellent, and intrarater reliability (rs = .825, p < .001) was strong. Most clinicians (85%) reported that the OBS-INS was effective in measuring CB following ABI and was beneficial for interdisciplinary communication.

CONCLUSION

The OBS-INS is a valid and reliable tool for assessing CB in individuals with ABI in IPR and promotes effective interdisciplinary communication.