Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research
Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research
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DOI：
10.1044/2020_ajslp-20-00081
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发表时间：
2021-04-01
影响因子：
2.6
通讯作者：
Duff, Melissa C.
中科院分区：
文献类型：
--
作者：
Covington, Natalie, V;Duff, Melissa C.
目的：在创伤性脑损伤（TBI）的基础科学和干预研究中，患者人群的异质性经常被认为是一种限制，通常被解释为降低研究结果普遍性的确定性的因素，并作为研究结果相互矛盾的来源。从历史上看，大部分TBI康复和认知研究都依赖于病例对照研究，样本量较小。在这种情况下，异质性确实是一个重要的限制。然而，在这里，我们认为，异质性的病人档案是一个标志性的特点TBI，因此不能避免或忽视。我们认为，这种固有的异质性必须得到承认，并占研究设计之前。幸运的是，统计方法和计算能力的进步使研究人员能够利用异质性，而不是受到它的约束。方法：在这篇文章中，我们回顾了异质性的来源，有助于TBI研究的挑战，突出了统计分析和其他领域的方法学进步具有高度异质性（例如，精神病学），可能是卓有成效地应用于TBI的异质性分解，并提供了一个例子，从我们的研究小组将这种approach.Conclusion：只有通过采用新的方法学的方法，我们可以推进TBI后的康复科学的方式，将影响临床实践和决策，使我们能够理解和应对的范围内的个体差异，这是在这个人群中的一个标志。
Purpose: In both basic science and intervention research in traumatic brain injury (TBI), heterogeneity in the patient population is frequently cited as a limitation and is often interpreted as a factor reducing certainty in the generalizability of research findings and as a source of conflicting findings across studies. Historically, much of TBI research in rehabilitation and cognition has relied upon case-control studies, with small to modest sample sizes. In this context, heterogeneity is indeed a significant limitation. Here, however, we argue that heterogeneity in patient profiles is a hallmark characteristic of TBI and therefore cannot be avoided or ignored. We argue that this inherent heterogeneity must be acknowledged and accounted for prior to study design. Fortunately, advances in statistical methods and computing power allow researchers to leverage heterogeneity, rather than be constrained by it.Method: In this article, we review sources of heterogeneity that contribute to challenges in TBI research, highlight methodological advances in statistical analysis and in other fields with high degrees of heterogeneity (e.g., psychiatry) that may be fruitfully applied to decomposing heterogeneity in TBI, and offer an example from our research group incorporating this approach.Conclusion: Only by adopting new methodological approaches can we advance the science of rehabilitation following TBI in ways that will impact clinical practice and inform decision making, allowing us to understand and respond to the range of individual differences that are a hallmark in this population.