Overview and inter-rater reliability of an incident-based rating scale for aggressive behaviour following traumatic brain injury: The Overt Aggression Scale–Modified for Neurorehabiltation–Extended (OAS-MNR-E)

Abstract

Primary objective: The presentation and evaluation of the Overt Aggression Scale–Modified for Neurorehabilitation–Extended (OAS-MNR-E).

Research design: Inter-rater reliability study using data collection procedures mirroring clinical practice.

Methods and procedures: Fifteen clinical staff representing five different disciplines received a 30-minute orientation to the study and a 30-minute overview of the OAS-MNR-E. There were 34 patients who engaged in a rateable behaviour and were observed by two raters. There were 199 observed aggressive behaviours during the 6-week study period.

Main outcomes and results: All sub-scales of the OAS-MNR-E had high percentage agreement (>92%) and the kappa statistic was uniformly excellent (>0.77). Multiple ratings within a sub-scale resulted in lower reliabilities. Incidents with multiple interventions were of longer duration. Interventions were on average more intrusive when used in combination than when used singly.

Conclusions: The OAS-MNR-E can be easily incorporated into facility routines and is reliable. The rating tool reported here can provide data that assists in programme design, evaluation and treatment planning.

• Traumatic brain injury
• Overt Aggression Scale
• incident rating
• direct-care staff