Psychometric Evaluation of the Hopkins Rehabilitation Engagement Rating Scale in Postacute Physical Therapy Services

Purpose/Objective: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). Results: Across timepoints, HRERS items reflect a single factor of engagement, and the scale has good internal consistency at admission (Time 1, alpha = .759) and follow-up (Time 2, alpha = .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). Conclusions/Implications: 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. Impact and Implications The Hopkins Rehabilitation Engagement Rating Scale (HRERS) is a reliable and valid outcome tool for use in postacute care (PAC) physical therapy services, with results extending its use beyond acute to postacute rehabilitation settings and in older veterans. Adapting the HRERS for use upon PAC admission revealed that medical acuity and behavioral health factors exert a distinct influence on HRERS scores during a postacute rehabilitation stay and may serve as potential targets of intervention. Inclusion of the HRERS as part of standard clinical care upon PAC admission may alert interdisciplinary team members to poor engagement and attendance.