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Pahlevani M, Taghavi M, Vanberkel P. A systematic literature review of predicting patient discharges using statistical methods and machine learning. Health Care Manag Sci 2024:10.1007/s10729-024-09682-7. [PMID: 39037567 DOI: 10.1007/s10729-024-09682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/29/2024] [Indexed: 07/23/2024]
Abstract
Discharge planning is integral to patient flow as delays can lead to hospital-wide congestion. Because a structured discharge plan can reduce hospital length of stay while enhancing patient satisfaction, this topic has caught the interest of many healthcare professionals and researchers. Predicting discharge outcomes, such as destination and time, is crucial in discharge planning by helping healthcare providers anticipate patient needs and resource requirements. This article examines the literature on the prediction of various discharge outcomes. Our review discovered papers that explore the use of prediction models to forecast the time, volume, and destination of discharged patients. Of the 101 reviewed papers, 49.5% looked at the prediction with machine learning tools, and 50.5% focused on prediction with statistical methods. The fact that knowing discharge outcomes in advance affects operational, tactical, medical, and administrative aspects is a frequent theme in the papers studied. Furthermore, conducting system-wide optimization, predicting the time and destination of patients after discharge, and addressing the primary causes of discharge delay in the process are among the recommendations for further research in this field.
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Affiliation(s)
- Mahsa Pahlevani
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada
| | - Majid Taghavi
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada
- Sobey School of Business, Saint Mary's University, 923 Robie, Halifax, B3H 3C3, NS, Canada
| | - Peter Vanberkel
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada.
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Coser O, Tamantini C, Soda P, Zollo L. AI-based methodologies for exoskeleton-assisted rehabilitation of the lower limb: a review. Front Robot AI 2024; 11:1341580. [PMID: 38405325 PMCID: PMC10884274 DOI: 10.3389/frobt.2024.1341580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Over the past few years, there has been a noticeable surge in efforts to design novel tools and approaches that incorporate Artificial Intelligence (AI) into rehabilitation of persons with lower-limb impairments, using robotic exoskeletons. The potential benefits include the ability to implement personalized rehabilitation therapies by leveraging AI for robot control and data analysis, facilitating personalized feedback and guidance. Despite this, there is a current lack of literature review specifically focusing on AI applications in lower-limb rehabilitative robotics. To address this gap, our work aims at performing a review of 37 peer-reviewed papers. This review categorizes selected papers based on robotic application scenarios or AI methodologies. Additionally, it uniquely contributes by providing a detailed summary of input features, AI model performance, enrolled populations, exoskeletal systems used in the validation process, and specific tasks for each paper. The innovative aspect lies in offering a clear understanding of the suitability of different algorithms for specific tasks, intending to guide future developments and support informed decision-making in the realm of lower-limb exoskeleton and AI applications.
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Affiliation(s)
- Omar Coser
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Rome, Italy
- Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christian Tamantini
- Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paolo Soda
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
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Nakaizumi D, Miyata S, Uchiyama K, Takahashi I. Development and Validation of a Decision Tree Analysis Model for Predicting Home Discharge in a Convalescent Ward: A Single Institution Study. Phys Ther Res 2024; 27:14-20. [PMID: 38690531 PMCID: PMC11057389 DOI: 10.1298/ptr.e10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/17/2023] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Accurately predicting the likelihood of inpatients' home discharge in a convalescent ward is crucial for assisting patients and families in decision-making. While logistic regression analysis has been commonly used, its complexity limits practicality in clinical settings. We focused on decision tree analysis, which is visually straightforward. This study aimed to develop and validate the accuracy of a prediction model for home discharge for inpatients in a convalescent ward using a decision tree analysis. METHODS The cohort consisted of 651 patients admitted to our convalescent ward from 2018 to 2020. We collected data from medical records, including disease classification, sex, age, duration of acute hospitalization, discharge destination (home or nonhome), and Functional Independence Measure (FIM) subitems at admission. We divided the cohort data into training and validation sets and developed a prediction model using decision tree analysis with discharge destination as the target and other variables as predictors. The model's accuracy was validated using the validation data set. RESULTS The decision tree model identified FIM grooming as the first single discriminator of home discharge, diverging at four points and identifying subsequent branching for the duration of acute hospitalization. The model's accuracy was 86.7%, with a sensitivity of 0.96, specificity of 0.52, positive predictive accuracy of 0.88, and negative predictive accuracy of 0.80. The area under the receiver operating characteristic curve was 0.75. CONCLUSION The predictive model demonstrated more than moderate predictive accuracy, suggesting its utility in clinical practice. Grooming emerged as a variable with the highest explanatory power for determining home discharge.
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Affiliation(s)
- Dai Nakaizumi
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Japan
| | - Shingo Miyata
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
| | - Keita Uchiyama
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
| | - Ikki Takahashi
- Department of Rehabilitation, Suzuki Clinic Orthopaedics River City, Japan
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Sergooris A, Verbrugghe J, Matheve T, Van Den Houte M, Bonnechère B, Corten K, Bogaerts K, Timmermans A. Clinical phenotypes and prognostic factors in persons with hip osteoarthritis undergoing total hip arthroplasty: protocol for a longitudinal prospective cohort study (HIPPROCLIPS). BMC Musculoskelet Disord 2023; 24:224. [PMID: 36964541 PMCID: PMC10039547 DOI: 10.1186/s12891-023-06326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Large heterogeneity exists in the clinical manifestation of hip osteoarthritis (OA). It is therefore not surprising that pain and disability in individuals with hip OA and after total hip arthroplasty (THA) cannot be explained by biomedical variables alone. Indeed, also maladaptive pain-related cognitions and emotions can contribute to pain and disability, and can lead to poor treatment outcomes. Traumatic experiences, mental disorders, self-efficacy and social support can influence stress appraisal and strategies to cope with pain, but their influence on pain and disability has not yet been established in individuals with hip OA undergoing THA. This study aims (1) to determine the influence of traumatic experiences and mental disorders on pain processing before and shortly after THA (2) to identify preoperative clinical phenotypes in individuals with hip OA eligible for THA, (3) to identify pre- and early postoperative prognostic factors for outcomes in pain and disability after THA, and (4) to identify postoperative clinical phenotypes in individuals after THA. METHODS This prospective longitudinal cohort study will investigate 200 individuals undergoing THA for hip OA. Phenotyping variables and candidate prognostic factors include pain-related fear-avoidance behaviour, perceived injustice, mental disorders, traumatic experiences, self-efficacy, and social support. Peripheral and central pain mechanisms will be assessed with thermal quantitative sensory testing. The primary outcome measure is the hip disability and osteoarthritis outcome score. Other outcome measures include performance-based measures, hip muscle strength, the patient-specific functional scale, pain intensity, global perceived effect, and outcome satisfaction. All these measurements will be performed before surgery, as well as 6 weeks, 3 months, and 12 months after surgery. Pain-related cognitions and emotions will additionally be assessed in the early postoperative phase, on the first, third, fifth, and seventh day after THA. Main statistical methods that will be used to answer the respective research questions include: LASSO regression, decision tree learning, gradient boosting algorithms, and recurrent neural networks. DISCUSSION The identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA. TRIAL REGISTRATION ClinicalTrials.gov: NCT05265858. Registered on 04/03/2022.
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Affiliation(s)
- Abner Sergooris
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium.
| | - Jonas Verbrugghe
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
| | - Thomas Matheve
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Maaike Van Den Houte
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
- Laboratory for Brain-Gut Axis Studies (LABGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, University of Leuven, Leuven, Belgium
| | - Bruno Bonnechère
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
| | - Kristoff Corten
- Department of Orthopaedics - Hip Unit, Ziekenhuis Oost-Limburg, Genk, Belgium
- Centre for Translational Psychological Research (TRACE), Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Katleen Bogaerts
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A - B-3590, Diepenbeek, Belgium
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Chen YW, Li YC, Huang CY, Lin CJ, Tien CJ, Chen WS, Chen CL, Lin KC. Predicting Arm Nonuse in Individuals with Good Arm Motor Function after Stroke Rehabilitation: A Machine Learning Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4123. [PMID: 36901133 PMCID: PMC10001502 DOI: 10.3390/ijerph20054123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Many stroke survivors demonstrate arm nonuse despite good arm motor function. This retrospective secondary analysis aims to identify predictors of arm nonusers with good arm motor function after stroke rehabilitation. A total of 78 participants were categorized into 2 groups using the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE) and the Motor Activity Log Amount of Use (MAL-AOU). Group 1 comprised participants with good motor function (FMA-UE ≥ 31) and low daily upper limb use (MAL-AOU ≤ 2.5), and group 2 comprised all other participants. Feature selection analysis was performed on 20 potential predictors to identify the 5 most important predictors for group membership. Predictive models were built with the five most important predictors using four algorithms. The most important predictors were preintervention scores on the FMA-UE, MAL-Quality of Movement, Wolf Motor Function Test-Quality, MAL-AOU, and Stroke Self-Efficacy Questionnaire. Predictive models classified the participants with accuracies ranging from 0.75 to 0.94 and areas under the receiver operating characteristic curve ranging from 0.77 to 0.97. The result indicates that measures of arm motor function, arm use in activities of daily living, and self-efficacy could predict postintervention arm nonuse despite good arm motor function in stroke. These assessments should be prioritized in the evaluation process to facilitate the design of individualized stroke rehabilitation programs to reduce arm nonuse.
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Affiliation(s)
- Yu-Wen Chen
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, 365, Mingde Road, Taipei 112, Taiwan
| | - Yi-Chun Li
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
- Department of Occupational Therapy, I-Shou University College of Medicine, 8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 824, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
| | - Chia-Jung Lin
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
| | - Chia-Jui Tien
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35, Keyan Road, Zhunan District, Miaoli 350, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fusing Street, Gueishan District, Taoyuan 333, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Gueishan District, Taoyuan 333, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, National Taiwan University College of Medicine, 17, F4, Xu-Zhou Road, Taipei 100, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan
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Chen YW, Lin KC, Li YC, Lin CJ. Predicting patient-reported outcome of activities of daily living in stroke rehabilitation: a machine learning study. J Neuroeng Rehabil 2023; 20:25. [PMID: 36823626 PMCID: PMC9948491 DOI: 10.1186/s12984-023-01151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Machine Learning is increasingly used to predict rehabilitation outcomes in stroke in the context of precision rehabilitation and patient-centered care. However, predictors for patient-centered outcome measures for activities and participation in stroke rehabilitation requires further investigation. METHODS This study retrospectively analyzed data collected for our previous studies from 124 participants. Machine Learning models were built to predict postintervention improvement of patient-reported outcome measures of daily activities (i.e, the Motor Activity Log and the Nottingham Extended Activities of Daily Living) and participation (i.e, the Activities of Daily Living domain of the Stroke Impact Scale). Three groups of 18 potential predictors were included: patient demographics, stroke characteristics, and baseline assessment scores that encompass all three domains under the framework of International Classification of Functioning, Disability and Health. For each target variable, classification models were built with four algorithms, logistic regression, k-nearest neighbors, support vector machine, and random forest, and with all 18 potential predictors and the most important predictors identified by feature selection. RESULTS Predictors for the four target variables partially overlapped. For all target variables, their own baseline scores were among the most important predictors. Upper-limb motor function and selected demographic and stroke characteristics were also among the important predictors across the target variables. For the four target variables, prediction accuracies of the best-performing models with 18 features ranged between 0.72 and 0.96. Those of the best-performing models with fewer features ranged between 0.72 and 0.84. CONCLUSIONS Our findings support the feasibility of using Machine Learning for the prediction of stroke rehabilitation outcomes. The study was the first to use Machine Learning to identify important predictors for postintervention improvement on four patient-reported outcome measures of activities and participation in chronic stroke. The study contributes to precision rehabilitation and patient-centered care, and the findings may provide insights into the identification of patients that are likely to benefit from stroke rehabilitation.
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Affiliation(s)
- Yu-Wen Chen
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xuzhou Rd., Taipei, Taiwan ,grid.412146.40000 0004 0573 0416Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Keh-chung Lin
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xuzhou Rd., Taipei, Taiwan ,grid.412094.a0000 0004 0572 7815Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung-Shan S. Rd., Taipei, Taiwan
| | - Yi-chun Li
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xuzhou Rd., Taipei, Taiwan ,grid.411447.30000 0004 0637 1806Department of Occupational Therapy, I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Jung Lin
- grid.19188.390000 0004 0546 0241School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xuzhou Rd., Taipei, Taiwan
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