Effectiveness and Patient Selection in Post-Hospital Brain Injury Rehabilitation

描述（由申请人提供）：本研究对一个大型数据库（3000多个独特病例）进行回顾性分析，该数据库来自美国11个康复服务机构提供的多个不同的PHBIR项目。该数据库由美国国家神经疾病和中风研究所（NINDS）资助开发。项目在数据库中分为强化（旨在改善功能）和支持（旨在保持功能增益）两类，可以在住宅（参与者住在设施中）或非住宅环境中提供。拟议研究的长期目标是通过分析现实世界的规划方法和结果来改善PHBIR实践的证据基础。目的是：(1)确认强化PHBIR项目比支持性项目产生更好的结果，(2)确定从各种项目类型中获益最多的患者的特征。核心假设是，强化课程更有效，并且可以确定从特定课程类型中获益最多的个人特征。这一系列研究的基本原理是，通过提供一种标准化的评估方法来指导PHBIR建议，确定对特定类型的脑损伤患者最有益的特定类型的PHBIR计划，将改善PHBIR的实践。主要的结果变量将是梅奥-波特兰适应性量表（MPAI-4），这是一种广泛使用的测量方法，具有完善的心理测量特性。数据分析将包括(1)项目反应理论分析，为该样本开发MPAI-4变量的参数等效度量，(2)强化方案与支持方案结果的统计比较，(3)聚类分析，识别不同的MPAI-4特征，表明残疾模式，(4)各种收敛方法，建立MPAI-4的最小临床重要差异（MCID），(5)对人口统计学、损伤相关、项目相关和MPAI-4严重性和模式数据进行线性和逻辑回归分析，以确定哪种类型的患者从哪种类型的项目中获益最多。大样本将允许适当分析的交叉验证。使用外部有效的、可推广的研究方法来完成研究目标的影响是提供实用的、基于证据的、目前无法获得的信息，这些信息可以转化为标准化的评估，以指导PHBIR的实践。

DESCRIPTION (provided by applicant): This study proposes retrospective analyses of a large database (3000+ unique cases) for post- hospital brain injury rehabilitation (PHBIR) programs from a number of diverse PHBIR programs offered by 11 rehabilitation provider organizations throughout the U.S. This database was developed with funding from the National Institute for Neurologic Diseases and Stroke (NINDS). Programs are classified in the database as intensive (aimed to improve function) or supportive (aimed to maintain functional gains) and may be offered either in residential (participants live at the facility) or nonresidential settings. The lng-term goal of the proposed research is to improve the evidence base for the practice of PHBIR through the analysis of real world programmatic methods and outcomes. The objectives are (1) to confirm that intensive PHBIR programs produce superior outcomes to supportive programs, and (2) to determine the characteristics of patients who benefit the most from various program types. Central hypotheses are that intensive programs are more effective and that the characteristics of individuals who benefit most from specific program types can be identified. The rationale for this line of research is that identifying the specific types of PHBIR programs that are of greatest benefit to specific types of patients with brain injury will improve the practce of PHBIR by providing a standardized evaluation method to guide PHBIR recommendations. The primary outcome variable of interest will be the Mayo-Portland Adaptability Inventory (MPAI-4), a widely used measure with sound, well- established psychometric properties. Data analyses will include (1) item-response theory analyses to develop parametric equivalent metrics for MPAI-4 variables for this sample, (2) statistical comparison of outcomes for intensive programs with supportive programs, (3) cluster analysis to identify distinct MPAI-4 profiles which signify pattern of disability, (4) a variety of converging methods to establish the minimal clinicaly important difference (MCID) for the MPAI- 4, and (5) linear and logistic regression analyses of demographic, injury-related, program- related and MPAI-4 severity and pattern data to determine which types of patients benefit most from which types of programs. The large sample will allow for cross-validation of appropriate analyses. The impact of accomplishing research goals using an externally valid, generalizable research methodology is to provide practical, evidence-based, and currently unavailable information that translates into a standardized evaluation to guide the practice of PHBIR.