Inflection points in longitudinal models: Tracking recovery and return to play following concussion.
Inflection points in longitudinal models: Tracking recovery and return to play following concussion.
复制标题
纵向模型中的拐点：跟踪脑震荡后的恢复和重返比赛。
DOI：
10.1111/sms.13239
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发表时间：
2018
影响因子：
4.1
通讯作者：
King,LA
中科院分区：
文献类型：
--
作者：
Parrington,L;Fino,NF;Fino,PC;Murchison,CF;Chesnutt,JC;King,LA
重返比赛（RTP）过程可能发生在跟踪脑震荡后恢复的纵向研究期间。这个因素在统计设计中经常被忽略，可能会影响统计模型的拟合和整体解释。本文展示了两种线性混合模型设计之间的结果和解释之间的差异：(1) 组间纵向 (GROUP) 分析和 (2) 使用拐点来解释 RTP 期间变化的组间纵向模型（RTP 分析）。这些分析是根据脑震荡后 8 周内收集的 23 名脑震荡运动员和 25 名对照者的仪器平衡数据进行的。总摇摆面积和内侧加速度范围被用作结果测量。在这两种结果测量的组设计中均未发现重大发现。相反，RTP 分析揭示了时间 (P=.007) 和 RTP 变化 (P=.007) 以及组*时间 (P=.028) 和组*RTP 变化 (P=.022) 相互作用对总摇摆面积的显着影响，以及组 (P=.011)、时间 (P=.010) 和 RTP 变化 (P=.014) 以及组*时间 (P= .013) 和组*RTP 改变内侧加速度范围的交互作用 (P=.013)。对于这两种结果，RTP 模型在似然比比较方面明显更好地拟合数据 (P≤.027)。这些结果表明，在统计设计中考虑拐点可能有助于理解在临床上有意义的时间点周围发生的情况。统计模型的选择对结果的解释有相当大的影响，并引发了关于当存在 RTP 等重要临床时间点时分析纵向数据集的最佳方法的讨论。
The return to play (RTP) process may occur during longitudinal studies tracking recovery after concussion. This factor, which is often omitted within statistical designs, could affect the fit and overall interpretation of the statistical model. This article demonstrates the difference in results and interpretation between 2 linear mixed‐model designs: (1) a between‐group longitudinal (GROUP) analysis and (2) a between‐group longitudinal model that used an inflection point to account for changes around the time of RTP (RTP analysis). These analyses were conducted on instrumented balance data collected on 23 concussed athletes and 25 controls over 8 weeks following concussion. Total sway area and the range of mediolateral acceleration were used as outcome measures. No significant findings were found in the GROUP design for either outcome measure. In contrast, the RTP analysis revealed significant effects of time (P= .007) and RTP change (P= .007), and group*time (P= .028) and group*RTP change (P= .022) interactions for total sway area, and effects of group (P= .011), time (P= .010), and RTP change (P= .014), and group*time (P= .013) and group*RTP change interactions (P= .013) for range of mediolateral acceleration. For both outcomes, the RTP model fit the data significantly better on comparison of likelihood ratios (P≤ .027). These results suggest that allowing for an inflection point in the statistical design may assist understanding of what happens around clinically meaningful time points. The choice of statistical model had a considerable effect on the interpretation of findings, and provokes discussion around the best method for analyzing longitudinal datasets when important clinical time points like RTP exist.