Nonrandomized studies of rehabilitation for traumatic brain injury: Can they determine effectiveness?
Nonrandomized studies of rehabilitation for traumatic brain injury: Can they determine effectiveness?
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DOI：
10.1053/apmr.2002.34556
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发表时间：
2002-09-01
影响因子：
4.3
通讯作者：
Dikmen, SS
中科院分区：
文献类型：
--
作者：
Powell, JM;Temkin, NR;Dikmen, SS
目的：目的：探讨非随机设计研究创伤性脑损伤（TBI）康复效果的可行性。设计：采用回归方法进行混杂控制的观察队列。设置：I级创伤中心。参与者：365名出院到住院康复或家庭的TBI患者的对比系列干预：不适用。主要结果测量：格拉斯哥结果量表（GOS）、疾病影响概况（SIP）、负担清单和感知生活质量（PQOL）。感兴趣的预测因素：结果：出院后进行康复治疗与GOS（P= 0.03）和SIP（P= 0.57）功能较差、负担量表（P= 0.14）增加和PQOL（P= 0.20）改善相关。类似的结果被发现较长的住院rehabilitation.Conclusions：结果似乎是因为一个混杂效应，而不是康复。该研究设计无法控制因出院安置和康复LOS的临床决策的未测量或难以测量方面而导致的混淆。此外，典型的严重性指数不足以控制损伤的严重性和恢复。调查TBI康复的匹配设计也存在混淆控制不足的风险。
Objective: To examine the feasibility of investigating rehabilitation effectiveness for traumatic brain injury (TBI) with a nonrandomized design.Design: Observational cohort with confounder control by regression methodology.Setting: Level I trauma center.Participants: Consecutive series of 365 individuals with TBI discharged to inpatient rehabilitation or home (78% follow-up).Interventions: Not applicable.Main Outcome Measures: The Glasgow Outcome Scale (GOS), Sickness Impact Profile (SIP), Burden Inventory, and Perceived Quality of Life (PQOL). The predictors of interest: discharge to comprehensive inpatient rehabilitation or home and inpatient rehabilitation length of stay (LOS).Results: Discharge to rehabilitation was associated with poorer functioning on the GOS (P=.03) and SIP (P=.57), an increase on the Burden Inventory (P=.14), and improved PQOL (P=.20). Similar results were found for longer lengths of inpatient rehabilitation.Conclusions: The results appear to be because of a confounding effect rather than rehabilitation. The study design could not control for confounding that resulted from unmeasured or difficult to measure aspects of the clinical decisions for discharge placement and rehabilitation LOS. Furthermore, typical severity indices were inadequate to control for injury severity and recovery. Matching designs that investigate TBI rehabilitation are also at risk for inadequate confounder control.