OBJECTIVE To examine the impact of agitation, cognitive impairment, fatigue and pain on physical therapy participation and outcomes during Post Traumatic Amnesia (PTA) following traumatic brain injury (TBI). DESIGN Prospective longitudinal study. SETTING Inpatient Rehabilitation Hospital. PARTICIPANTS 77 participants with moderate-to-severe TBI, deemed to be in PTA using the Westmead Post-Traumatic Amnesia Scale. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) The Pittsburgh Rehabilitation Participation Scale (PRPS) and time in therapy (minutes) were recorded twice daily following routine physical therapy sessions during PTA. The Functional Independence Measure Motor (select items related to physical therapy) score rated on admission and following emergence from PTA was used to calculate FIM-Motor change. RESULTS Agitation was associated with lower participation in therapy. The presence of agitation and pain both predicted lower FIM-motor change at emergence from PTA. Higher levels of cognitive impairment and fatigue were also associated with lower participation and less time in therapy. CONCLUSIONS During PTA, the presence of agitation, fatigue, pain and cognitive impairment impede rehabilitation success. This study strengthens the case for implementing environmental and behavioural recommendations, such as conducting therapy earlier in the day within a familiar space (i.e. on the ward) and tailoring session duration to patient needs. This is with the aim of minimizing fatigue, agitation and pain, while promoting cognitive recovery and arousal during PTA in order to maximise physical gains. Further research is warranted to examine the factors associated with rehabilitation success across other therapeutic disciplines.

中文翻译：

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创伤后健忘症期间影响物理治疗参与的因素

目的 研究外伤性脑损伤 (TBI) 后创伤后遗忘 (PTA) 期间激越、认知障碍、疲劳和疼痛对物理治疗参与和结果的影响。设计前瞻性纵向研究。设置住院康复医院。参与者 77 名中度至重度 TBI 的参与者，使用 Westmead 创伤后遗忘量表被认为是 PTA。干预 不适用。主要结果测量 在 PTA 期间进行常规物理治疗后，每天记录两次匹兹堡康复参与量表 (PRPS) 和治疗时间（分钟）。入院时和从 PTA 出现后评定的功能独立性测量运动（选择与物理治疗相关的项目）评分用于计算 FIM 运动变化。结果 激越与较低的治疗参与度相关。躁动和疼痛的存在都预示着从 PTA 出现时较低的 FIM 运动变化。较高水平的认知障碍和疲劳也与较低的参与度和较少的治疗时间有关。结论 在 PTA 期间，躁动、疲劳、疼痛和认知障碍的存在阻碍了康复的成功。这项研究加强了实施环境和行为建议的理由，例如在当天早些时候在熟悉的空间（即在病房）内进行治疗，并根据患者的需求调整治疗时间。这是为了最大限度地减少疲劳、激动和疼痛，同时促进 PTA 期间的认知恢复和唤醒，以最大限度地提高身体素质。