Appendix 1.

Rehabilitation Intensity of Therapy Scale: level of effort ratings and behavioral anchors

Effort Rating	Behavioral Anchor
7 (superior)	Patient sustains full attention and goal-directed activity throughout the entire therapy session. The patient consistently initiates activity; seeks performance feedback and/or self-monitors performance; adjusts activity based on feedback; and requests more challenging activities. The patient perseveres with therapy tasks, even when activities are extremely physically or mentally challenging.
6 (very good)	Patient sustains full attention and goal-directed activity throughout the entire therapy session. The patient sometimes initiates activity, may seek performance feedback, and adjusts activity based on feedback. The patient perseveres with therapy tasks that are physically or mentally challenging without encouragement or prompting.
5 (above average)	Patient sustains full attention and goal-directed activity during most of the therapy session. The patient rarely initiates activity or seeks performance feedback but consistently adjusts activity when performance feedback is provided. The patient perseveres with therapy tasks that are physically or mentally challenging with some encouragement or prompting.
4 (average)	Patient is generally attentive, follows instructions, and works toward goals during the therapy session. The patient relies on the therapist to direct all tasks. The patient does not seek feedback but sometimes adjusts activity when performance feedback is provided. The patient requires prompting and/or encouragement to continue with therapy tasks that are physically or mentally challenging.
3 (below average)	Patient is inconsistently attentive and may require repetition of instructions and/or redirection toward therapy session goals. The patient is generally unresponsive to performance feedback and rarely adjusts activity when feedback is provided. The patient gives up easily when therapy tasks become physically or mentally challenging.
2 (minimal)	Patient is inconsistently attentive and requires frequent repetition of instructions and/or redirection toward therapy session goals. The patient may refuse to comply with the therapist's instructions and/or requests and may end the session early. The patient does not attempt therapy tasks that are physically or mentally challenging.
1 (absence of effort)	Patient is rarely attentive and is engaged in virtually no goal-oriented activity. The patient either refuses or is unable to comply with the therapist's instructions and/or requests, which may lead to early termination of the session.