The Feasibility, Reliability, and Clinical Utility of the Agitated Behavior Scale in Brain-Injured Rehabilitation Patients


  • Shelly Amato MSN RN CRRN,

  • Marian Resan RN CRRN,

  • Lorraine Mion PhD RN FAAN


Patients with traumatic brain injury often experience physical and cognitive impairments as well as agitation requiring additional care to maintain a safe and therapeutic environment.


The aim of this study was to determine the feasibility, reliability and clinical utility of the Agitated Behavior Scale (ABS) as part of routine rehabilitation nursing assessment.


A prospective descriptive study was conducted on a brain injury rehabilitation unit consisting of a sample of 51 patients who were consecutively admitted over 4 months to a rehabilitation unit.


Results showed that the tool was completed on the majority of nursing shifts, had high interrater agreement, and distinguished patients who were on constant observation or physically restrained.

Conclusion and Clinical Relevance

The ABS can be used as an objective measure for nurses to guide the initiation and evaluate the effectiveness of various care strategies.