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Pommerich UM, Stubbs PW, Eggertsen PP, Fabricius J, Nielsen JF. Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable: a systematic review. J Clin Epidemiol 2023; 156:53-65. [PMID: 36764467 DOI: 10.1016/j.jclinepi.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES To identify and summarize validated multivariable prognostic models for the Functional Independence Measure® (FIM®) at discharge from post-acute inpatient rehabilitation in adults with acquired brain injury (ABI). METHODS This review was conducted based on the recommendations of the Cochrane Prognosis Methods Group and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were systematically searched in May 2021 and updated in April 2022. Main inclusion criteria were: a) adult patients with ABI, b) validated multivariable prognostic model, c) time of prognostication within 1-week of admission to post-acute rehabilitation, and d) outcome was the FIM® at discharge from post-acute rehabilitation. RESULTS The search yielded 3,169 unique articles. Three articles fulfilled the inclusion criteria, accounting for n = 6 internally and n = 2 externally validated prognostic models. Discrimination was estimated as an area under the curve between 0.76 and 0.89. Calibration was deemed to be assessed insufficiently. The included models were judged to be of high risk of bias. CONCLUSION Current prognostic models for the FIM® in post-acute rehabilitation for patients with ABI lack the methodological rigor to support clinical use outside the development setting. Future studies addressing functional independence should ensure appropriate model validation and conform to uniform reporting standards for prognosis research.
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Affiliation(s)
- Uwe M Pommerich
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Ultimo 2007, Australia
| | - Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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Koumo M, Goda A, Maki Y, Yokoyama K, Yamamoto T, Hosokawa T, Ishibashi R, Katsura J, Yanagibashi K. Clinical Items for Geriatric Patients with Post-Stroke at Discharge or Transfer after Rehabilitation Therapy in a Chronic-Phase Hospital: A Retrospective Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081577. [PMID: 36011234 PMCID: PMC9408440 DOI: 10.3390/healthcare10081577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Clinical factors related to destination after rehabilitation therapy for geriatric patients with post-stroke in chronic-phase hospitals have not been elucidated. This study analyzed the clinical characteristics of geriatric patients with post-stroke at discharge/transfer after rehabilitation therapy in a chronic-phase hospital. Fifty-three patients (20 men, 33 women; mean age 81.36 ± 8.14 years) were recruited (the period analyzed: October 2013−March 2020). Clinical data were statistically analyzed among patients discharged to homes or facilities for older adults or transferred to another hospital. In addition, we analyzed the clinical items at discharge and transfer after rehabilitation therapy using a decision tree analysis. Twelve patients were discharged, eighteen were discharged to facilities for older adults, and twenty-three were transferred to another hospital. There were significant differences in the modified Rankin Scale, admission dates, functional independence measure (FIM) score, and Barthel Index score in the three groups (p < 0.05). Patients with motor subtotal functional independence scores of ≥14 (chronologically improved ≥5) after rehabilitation therapy for <291 days were more likely to be discharged home. Patients in a chronic-phase hospital who improved within a limited period were discharged to their homes, whereas those who were bedridden tended to be transferred to another hospital.
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Affiliation(s)
- Masatoshi Koumo
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan
- Correspondence: ; Tel.: +81-(0)75-574-4313
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone 522-0054, Japan
| | - Kouta Yokoyama
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Tetsuya Yamamoto
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Tsumugi Hosokawa
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka 530-0025, Japan
| | - Junichi Katsura
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Ken Yanagibashi
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
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Usefulness of the prediction method based on a logarithmic model for functional recovery in stroke patients: in case of using the motor-Functional Independence Measure score. Int J Rehabil Res 2017; 40:134-137. [DOI: 10.1097/mrr.0000000000000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matsugi A, Tani K, Yoshioka N, Yamashita A, Mori N, Oku K, Murakami Y, Nomura S, Tamaru Y, Nagano K. Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score. J Phys Ther Sci 2016; 28:2737-2741. [PMID: 27821925 PMCID: PMC5088116 DOI: 10.1589/jpts.28.2737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/09/2016] [Indexed: 12/01/2022] Open
Abstract
[Purpose] This study investigated whether it is possible to predict return to home at
discharge from a rehabilitation hospital in Japan using the home care score of patients
with cerebrovascular or osteoarticular disease and low activities of daily living at
admission. [Subjects and Methods] The home care score and functional independent
measurement were determined for 226 patients at admission and at discharge from five
hospitals, and receiver operating characteristic analyses were conducted. [Results] The
home care score cutoff point for the prediction of return to home at admission and at
discharge was 11, and the area under the curve was more than 0.8. The area under the curve
of the home care score was 0.77 for patients with low activities of daily living and
within this group, the probability of return to home was approximately 50%, as predicted
by the functional independent measurement. The home care score increased after receiving
intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for
the prediction of return to home from a rehabilitation hospital, although prediction using
the functional independent measurement is difficult for patients with low activities of
daily living. Moreover, comprehensive interventions provided by the rehabilitation
hospitals improve the ability to provide home care of the patient’s family, which is
assessed by the home care score.
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Affiliation(s)
| | - Keisuke Tani
- Graduate School of Human and Environmental Studies, Kyoto University, Japan
| | - Nami Yoshioka
- Department of Rehabilitation, Bobath Memorial Hospital, Japan
| | - Akira Yamashita
- Department of Rehabilitation, Bobath Memorial Hospital, Japan
| | - Nobuhiko Mori
- Department of Rehabilitation, Wakayama Medical University, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | | | - Shohei Nomura
- Department of Rehabilitation, Pegasus Rehabilitation Hospital, Japan
| | - Yoshiki Tamaru
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | - Kiyoshi Nagano
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
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Prediction of Advisability of Returning Home Using the Home Care Score. Rehabil Res Pract 2015; 2015:501042. [PMID: 26491568 PMCID: PMC4602329 DOI: 10.1155/2015/501042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care.
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Ouellette D, Timple C, Kaplan S, Rosenberg S, Rosario E. Predicting discharge destination with admission outcome scores in stroke patients. NeuroRehabilitation 2015; 37:173-9. [DOI: 10.3233/nre-151250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sprint G, Cook DJ, Weeks DL, Borisov V. Predicting Functional Independence Measure Scores During Rehabilitation with Wearable Inertial Sensors. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2015; 3:1350-1366. [PMID: 27054054 PMCID: PMC4819996 DOI: 10.1109/access.2015.2468213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Evaluating patient progress and making discharge decisions regarding inpatient medical rehabilitation rely upon standard clinical assessments administered by trained clinicians. Wearable inertial sensors can offer more objective measures of patient movement and progress. We undertook a study to investigate the contribution of wearable sensor data to predict discharge functional independence measure (FIM) scores for 20 patients at an inpatient rehabilitation facility. The FIM utilizes a 7-point ordinal scale to measure patient independence while performing several activities of daily living, such as walking, grooming, and bathing. Wearable inertial sensor data were collected from ecological ambulatory tasks at two time points mid-stay during inpatient rehabilitation. Machine learning algorithms were trained with sensor-derived features and clinical information obtained from medical records at admission to the inpatient facility. While models trained only with clinical features predicted discharge scores well, we were able to achieve an even higher level of prediction accuracy when also including the wearable sensor-derived features. Correlations as high as 0.97 for leave-one-out cross validation predicting discharge FIM motor scores are reported.
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Affiliation(s)
- Gina Sprint
- Department of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, 99163 USA
| | - Diane J. Cook
- Department of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, 99163 USA
| | | | - Vladimir Borisov
- Voiland School of Chemical and Bioengineering, Washington State University, Pullman, WA, 99163 USA
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Imura T, Nagasawa Y, Inagawa T, Imada N, Izumi H, Emoto K, Tani I, Yamasaki H, Ota Y, Oki S, Maeda T, Araki O. Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients. J Phys Ther Sci 2015; 27:1383-6. [PMID: 26157225 PMCID: PMC4483403 DOI: 10.1589/jpts.27.1383] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/11/2015] [Indexed: 12/13/2022] Open
Abstract
[Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes
and activities of daily living function remains unclear. We evaluated the most appropriate
diffusion tensor parameters and methodology to determine whether the region of interest-
or tractography-based method was more useful for predicting motor outcomes and activities
of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor
imaging data within 10 days after stroke onset were collected and analyzed for 25
patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers,
and apparent diffusion coefficient were used as diffusion tensor parameters. Motor
outcomes and activities of daily living function were evaluated on the same day as
diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy
value of the affected corticospinal tract significantly correlated with the motor outcome
and activities of daily living function within 10 days post-onset and at 1 month
post-onset. Tthere were no significant correlations between other diffusion tensor
parameters and motor outcomes or activities of daily living function. [Conclusion] The
fractional anisotropy value of the affected corticospinal tract obtained using the
tractography-based method was useful for predicting motor outcomes and activities of daily
living function in stroke patients.
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Affiliation(s)
- Takeshi Imura
- Department of Rehabilitation, Araki Neurosurgical Hospital: 2-8-7 Kogokita, Hiroshima, Hiroshima, Japan
| | - Yuki Nagasawa
- Department of Rehabilitation, Araki Neurosurgical Hospital: 2-8-7 Kogokita, Hiroshima, Hiroshima, Japan
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital: 2-8-7 Kogokita, Hiroshima, Hiroshima, Japan
| | - Hiroaki Izumi
- Department of Radiology, Araki Neurosurgical Hospital, Japan
| | - Katsuya Emoto
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
| | - Itaru Tani
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
| | | | - Yuichiro Ota
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
| | - Shuichi Oki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
| | - Tadanori Maeda
- Department of Radiology, Araki Neurosurgical Hospital, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Japan
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