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Mirzadeh SI, Arefeen A, Ardo J, Fallahzadeh R, Minor B, Lee JA, Hildebrand JA, Cook D, Ghasemzadeh H, Evangelista LS. Use of machine learning to predict medication adherence in individuals at risk for atherosclerotic cardiovascular disease. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 26:100328. [PMID: 37169026 PMCID: PMC10168531 DOI: 10.1016/j.smhl.2022.100328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Medication nonadherence is a critical problem with severe implications in individuals at risk for atherosclerotic cardiovascular disease. Many studies have attempted to predict medication adherence in this population, but few, if any, have been effective in prediction, sug-gesting that essential risk factors remain unidentified. Objective This study's objective was to (1) establish an accurate prediction model of medi-cation adherence in individuals at risk for atherosclerotic cardiovascular disease and (2) identify significant contributing factors to the predictive accuracy of medication adherence. In particular, we aimed to use only the baseline questionnaire data to assess medication adherence prediction feasibility. Methods A sample of 40 individuals at risk for atherosclerotic cardiovascular disease was recruited for an eight-week feasibility study. After collecting baseline data, we recorded data from a pillbox that sent events to a cloud-based server. Health measures and medication use events were analyzed using machine learning algorithms to identify variables that best predict medication adherence. Results Our adherence prediction model, based on only the ten most relevant variables, achieved an average error rate of 12.9%. Medication adherence was closely correlated with being encouraged to play an active role in their treatment, having confidence about what to do in an emergency, knowledge about their medications, and having a special person in their life. Conclusions Our results showed the significance of clinical and psychosocial factors for predicting medication adherence in people at risk for atherosclerotic cardiovascular diseases. Clini-cians and researchers can use these factors to stratify individuals to make evidence-based decisions to reduce the risks.
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Affiliation(s)
- Seyed Iman Mirzadeh
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Asiful Arefeen
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
- Corresponding author: (A. Arefeen)
| | - Jessica Ardo
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Ramin Fallahzadeh
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Bryan Minor
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Janett A. Hildebrand
- Department of Nursing at the School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - Diane Cook
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Hassan Ghasemzadeh
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
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Casida JM, Pavol M, Budhathoki C, Craddock H, Schroeder SE, Hoff D, Tiburcio M, Ewald G. A pilot clinical trial of a self-management intervention in patients with a left ventricular assist device. J Artif Organs 2021; 25:91-104. [PMID: 34342807 DOI: 10.1007/s10047-021-01289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
Self-management is a health behavior known to predict treatment outcomes in patients with multiple co-morbidities and/or chronic conditions. However, the self-management process and outcomes in the left-ventricular assist device (LVAD) population are understudied. This pilot randomized control trial (RCT) evaluated the feasibility of a novel "smartphone app-directed and nurse-supported self-management intervention" in patients implanted with durable LVADs. Assessments included behavioral (self-efficacy and adherence), clinical (complications), and healthcare utilization (unplanned clinic, emergency room (ER) visits, and re-hospitalization) outcomes, completed at baseline (pre-hospital discharge) and months 1, 3, and 6 post-hospital discharge. Intervention patients (n = 14) had favorable patterns/trends of results across study outcomes than control patients (n = 16). Notably, intervention patients had much lower complications and healthcare utilization rates than controls. For example, intervention patients had 2 (14.3%) driveline infections in 6 months while control patients had 3 (19.0%). Additionally, at month 3, intervention patients had 0% ER visits versus 36% of control patients. At month 6, the mean cumulative number of re-hospitalizations for the control group was higher (0.9 ± 0.93) than intervention (0.3 ± 0.61) group. Despite the small sample size and limitations of feasibility/pilot studies, our outcomes data appeared to favor the novel intervention. Lessons learned from this study suggest the intervention should be implemented for 6 months post-hospital discharge. Further research is needed including large and rigorous multi-center RCTs to generate knowledge explaining the mechanism of the effect of self-management on LVAD treatment outcomes.
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Affiliation(s)
- Jesus M Casida
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Marykay Pavol
- New York-Presbyterian Columbia University Medical Center, New York, NY, USA.
| | | | - Heidi Craddock
- Barnes-Jewish Hospital Washington University, St. Louis, MO, USA
| | | | - Danyelle Hoff
- Barnes-Jewish Hospital Washington University, St. Louis, MO, USA
| | - Millie Tiburcio
- New York-Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Gregory Ewald
- Barnes-Jewish Hospital Washington University, St. Louis, MO, USA
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Bellaviti G, Balsamo F, Iosa M, Vella D, Pistarini C. Influence of systemic infection and comorbidities on rehabilitation outcomes in severe acquired brain injury. Eur J Phys Rehabil Med 2020; 57:69-77. [PMID: 33165309 DOI: 10.23736/s1973-9087.20.05939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Severe infectious complications are a frequent problem in patients with disability due to a severe acquired brain injury. Previous studies reported that the rehabilitation outcome is significantly lower in patients colonized or infected. However, these results could be influenced by comorbidities of those patients admitted in rehabilitation hospital with a lower functional status. AIM To explore the influence of systemic infection, in particular concerning multidrug resistant bacteria and analyze the role of comorbidities, as a risk factor for the development of systemic infection, on rehabilitation outcomes in patients with severe brain injury. DESIGN This research is a cohort, prospective-observational study, comparing patients with and without systemic infections, in terms of rehabilitation outcomes. SETTING An Italian Intensive Care Rehabilitation Department. POPULATION A group of 221 patients (mean age: 59 years, range: 16-93 years, 127 males, 94 females) with severe acquired brain injury admitted to rehabilitation hospital. METHODS We compared the rehabilitation outcomes between patients with and without a systemic infection (at least a positive blood culture) during the rehabilitation period. A secondary analysis was performed on 70 patients with infection versus 70 patients without infection, matched for functional status at admission. The used clinical scores were: Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Coma Recovery Scale Revised (CRS-R), Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), Levels of Cognitive Functioning (LCF) administered at admission and discharge. Length of hospitalization and the role of comorbidities were also considered. RESULTS The group of patients with systemic infection (in particular due to Gram-negative bacteria) had a significantly lower outcome for 5 out 6 clinical scales and with a more than doubled length of hospitalization (P<0.001). However, these patients with, at least, a positive blood culture resulted having lower functional status at admission. In the secondary analysis, worst outcome was found in patients with positive blood culture in terms of FIM (P=0.033), GOS (P=0.048), and CRS-R (P=0.001). CONCLUSIONS Systemic infections during rehabilitation increased the length of hospitalization and reduce the rehabilitative outcomes, even when the analysis was performed on groups matched for the functional status at admission. Moreover, the cardiological and endocrine metabolic comorbidities seem to influence the outcome, without representing a further risk factor for systemic infection. CLINICAL REHABILITATION IMPACT The impact of infections during rehabilitation inpatient should be more taken into account, with specific procedures and suitable environments to avoid the diffusions of infections.
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Affiliation(s)
- Gianluca Bellaviti
- Neurorehabilitation Division, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy -
| | - Francesca Balsamo
- Neurorehabilitation Division, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Novara, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Danila Vella
- Laboratory of Informatics and Systems Engineering for Clinical Research, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Caterina Pistarini
- Head of Severe Brain Injury Rehabilitation Unit, ICS Maugeri SPA SB, Institute of Nervi, IRCCS, Genoa, Italy
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Whitson HE, Hajduk AM, Song X, Geda M, Tsang S, Brush J, Chaudhry SI. Comorbid vision and cognitive impairments in older adults hospitalized for acute myocardial infarction. JOURNAL OF COMORBIDITY 2020; 10:2235042X20940493. [PMID: 32728552 PMCID: PMC7366400 DOI: 10.1177/2235042x20940493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Older patients presenting with acute myocardial infarction (AMI) often have
comorbidities. Our objective was to examine how outcomes differ by cognitive and
vision status in older AMI patients. We use data from a prospective cohort study
conducted at 94 hospitals in the United States between January 2013 and October
2016 that enrolled men and women aged ≥75 years with AMI. Cognitive impairment
(CI) was defined as telephone interview for cognitive status (TICS) score
<27; vision impairment (VI) and activities of daily living (ADLs) were
assessed by questionnaire. Of 2988 senior AMI patients, 260 (8.7%) had CI but no
VI, 858 (28.7%) had VI but no CI, and 251 (8.4%) had both CI/VI. Patients in the
VI/CI group were most likely to exhibit geriatric syndromes. More severe VI was
associated with lower (worse) scores on the TICS (β −1.53, 95%
confidence interval (CI) −1.87 to −1.18). In adjusted models, compared to
participants with neither impairment, participants with VI/CI were more likely
to die (hazard ratio 1.61, 95% CI 1.10–2.37) and experience ADL decline (odds
ratio 2.11, 95% CI 1.39–3.21) at 180 days. Comorbid CIs and VIs were associated
with high rates of death and worsening disability after discharge among seniors
hospitalized for AMI. Future research should evaluate protocols to accommodate
these impairments during AMI presentations and optimize decision-making and
outcomes.
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Affiliation(s)
- Heather E Whitson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Alexandra M Hajduk
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Xuemei Song
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Mary Geda
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Sui Tsang
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | | | - Sarwat I Chaudhry
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
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Qu Z, Gwiasda J, Schrem H, Kaltenborn A, Harries L, Beneke J, Amelung V, Krauth C. Evaluation of published assessment tools for comorbidity in liver transplantation: a systematic review protocol. BMJ Open 2018; 8:e021181. [PMID: 29961024 PMCID: PMC6042588 DOI: 10.1136/bmjopen-2017-021181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/18/2018] [Accepted: 05/11/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Liver transplantation is considered the best therapy option for end-stage liver disease. Different factors including recipient comorbidity at time of transplantation are supposed to have substantial impact on outcomes. Although several studies have focused on comorbidity assessment indices for liver transplant recipients, there is no systematic review available on the methodological details and prognostic accuracy of these instruments. The aim of this study is to systematically review recipient comorbidity assessment indices in the context of liver transplantation. METHODS AND ANALYSIS PubMed, Embase, Web of Science and PsyINFO databases will be searched. Studies describing, using or evaluating specific assessment tools to predict the effect of comorbidity on clinical outcomes after liver transplantation will be included. The selection will be conducted independently by two reviewers. The study characteristics and methodological information on published comorbidity assessment tools will be extracted into a predefined structural table. This approach will be deployed to systematically extract information on the validity, reliability and practical feasibility of investigated comorbidity assessment tools for comparative evaluation. Narrative information synthesis will be conducted, and additional meta-analytical comparison will be performed, if appropriate. ETHICS AND DISSEMINATION All data are collected from published literature. Thus, formal ethics review for the research is not required. The findings of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences. The results of this systematic review will be highly relevant for further research on prognostic models, clinical decision making and optimisation of donor organ allocation. PROSPERO REGISTRATION NUMBER CRD42017074609.
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Affiliation(s)
- Zhi Qu
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Jill Gwiasda
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Lena Harries
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Jan Beneke
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Volker Amelung
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
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Matcham F, Davies R, Hotopf M, Hyrich KL, Norton S, Steer S, Galloway J. The relationship between depression and biologic treatment response in rheumatoid arthritis: An analysis of the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2018; 57:835-843. [DOI: 10.1093/rheumatology/kex528] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Academic Rheumatology, King’s College London, London, UK
| | - Sophia Steer
- Department of Academic Rheumatology, King’s College London, London, UK
| | - James Galloway
- Department of Academic Rheumatology, King’s College London, London, UK
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Buck HG, Stromberg A, Chung ML, Donovan KA, Harkness K, Howard AM, Kato N, Polo R, Evangelista LS. A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes. Int J Nurs Stud 2018; 77:232-242. [PMID: 29128777 PMCID: PMC7059555 DOI: 10.1016/j.ijnurstu.2017.10.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Having support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes. OBJECTIVE To examine the components, context, and outcomes of dyadic self-care interventions. DESIGN A systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. DATA SOURCES PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples. REVIEW METHODS We used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions. RESULTS Eighteen papers - 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed. Intervention components fell into three groups - education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes - face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes. CONCLUSIONS We found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice.
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Affiliation(s)
- Harleah G Buck
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA.
| | - Anna Stromberg
- Department of Medical and Health Sciences, Division of Nursing and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Misook L Chung
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | | | - Karen Harkness
- McMaster University, Cardiac Care Network, Ontario, Canada
| | - Allison M Howard
- University of South Florida, Shimberg Health Sciences Library, Tampa, FL, USA
| | - Naoko Kato
- Department of Medical and Health Sciences, Division of Nursing and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Randall Polo
- University of South Florida, Shimberg Health Sciences Library, Tampa, FL, USA
| | - Lorraine S Evangelista
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, 92697, USA
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A Systematic Review of Comorbidity Measurement Methods for Patients With Nontraumatic Brain Injury in Inpatient Rehabilitation Settings. Am J Phys Med Rehabil 2017; 96:816-827. [PMID: 28682841 DOI: 10.1097/phm.0000000000000747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review summarizes comorbidity measurements used on patients with nontraumatic brain injury in inpatient rehabilitation and describes findings on measurement validation and comorbidity profiles. MEDLINE and MEDLINE In-Process, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, Health, and Psychosocial Measurement Instruments were searched. Two reviewers screened results according to predefined inclusion and exclusion criteria. Population, statistical methods, comorbidity measurement, justification of its use, and results involving comorbidity were extracted using a standard table. Of 9476 articles retrieved, 16 were included. Comorbidity has been measured using various methods including the following: number and type within various classification systems, such as the International Disease Classification system, the Charlson comorbidity index, Centers for Medicare and Medicaid Services comorbidity tiers and patient comorbidity and complexity level values and subsets of diagnoses within nonadministrative data studies. No studies have assessed the predictive ability of the comorbidity measurements for inpatient rehabilitation outcomes in this population. Because comorbidities are common among the nontraumatic brain injury population, the predictive validity of comorbidity measurements should be assessed to determine the most appropriate measure to predict or risk adjust rehabilitation outcomes, which has implications for the development of clinical guidelines, and to inform health service research, planning, and delivery.
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9
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Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, O'Connor P, Reingold S, Cohen JA. The challenge of comorbidity in clinical trials for multiple sclerosis. Neurology 2016; 86:1437-1445. [PMID: 26888986 PMCID: PMC4831041 DOI: 10.1212/wnl.0000000000002471] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/01/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We aimed to provide recommendations for addressing comorbidity in clinical trial design and conduct in multiple sclerosis (MS). METHODS We held an international workshop, informed by a systematic review of the incidence and prevalence of comorbidity in MS and an international survey about research priorities for studying comorbidity including their relation to clinical trials in MS. RESULTS We recommend establishing age- and sex-specific incidence estimates for comorbidities in the MS population, including those that commonly raise concern in clinical trials of immunomodulatory agents; shifting phase III clinical trials of new therapies from explanatory to more pragmatic trials; describing comorbidity status of the enrolled population in publications reporting clinical trials; evaluating treatment response, tolerability, and safety in clinical trials according to comorbidity status; and considering comorbidity status in the design of pharmacovigilance strategies. CONCLUSION Our recommendations will help address knowledge gaps regarding comorbidity that interfere with the ability to interpret safety in monitored trials and will enhance the generalizability of findings from clinical trials to "real world" settings where the MS population commonly has comorbid conditions.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH.
| | - Aaron Miller
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Pia Sormani
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Alan Thompson
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Emmanuelle Waubant
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Trojano
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Paul O'Connor
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Stephen Reingold
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Jeffrey A Cohen
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
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Khuu W, Chan V, Colantonio A. A systematic review protocol for measuring comorbidity in inpatient rehabilitation for non-traumatic brain injury. Syst Rev 2015; 4:14. [PMID: 25634135 PMCID: PMC4328947 DOI: 10.1186/2046-4053-4-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidity can affect health-care utilization and outcomes, and the results and interpretation of risk adjustment studies that attempt to predict rehabilitation utilization and outcomes are influenced by the choice of comorbidity measurement. Although the identification of an appropriate measurement has been conducted in some populations and outcomes, this information is currently lacking for the non-traumatic brain injury (nTBI) population in inpatient rehabilitation settings. As such, this is a systematic review protocol to survey the methods used to measure comorbidities in the rehabilitation setting for patients with nTBI. METHODS/DESIGN MEDLINE, MEDLINE In-Process, Embase, The Cochrane Database of Systematic Reviews, PsycINFO, and Health and Psychosocial Instruments will be systematically searched using the concepts 'nTBI,' 'comorbidity,' and 'rehabilitation.' Grey matters and the reference list of eligible articles will also be searched. Study selection will be performed independently by two reviewers based on predetermined eligibility criteria through two rounds of screening using, first, the title and abstract, followed by full-text. Extracted information will include study purpose, design, and setting; data source and type; outcomes variables; statistical methods; comorbidity measurement method, rationale, justification, or validation; and results involving comorbidity. The data will be tabulated and narratively synthesized. Meta-analyses will be performed if appropriate. SYSTEMATIC REVIEW REGISTRATION This protocol has not been registered with PROSPERO. DISCUSSION This protocol provides a systematic method for surveying current practice as well as monitoring the progress on comorbidity measurement methodology and effects of comorbidity on rehabilitation outcomes for patients with nTBI. The selection of an appropriate comorbidity measurement method has implications for the interpretation of both descriptive and risk adjustment studies, and thus, the validity of evidence used to inform planning and delivery of services.
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Affiliation(s)
- Wayne Khuu
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3 M7, Canada.
| | - Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1 V7, Canada.
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3 M7, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1 V7, Canada.
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