Effectiveness and Patient Selection in Post-Hospital Brain Injury Rehabilitation

描述(由申请人提供)：这项研究建议对一个大型数据库(3000多个独特的病例)进行回顾性分析，该数据库来自全美11个康复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。在数据库中，计划被归类为强化(旨在改善功能)或支持性(旨在保持功能收益)，并可在住宅(参与者住在设施中)或非住宅环境中提供。拟议研究的LNG长期目标是通过对现实世界方案方法和结果的分析，改善PHBIR实践的证据基础。目的是(1)确认强化的PHBIR计划比支持性计划产生更好的结果，以及(2)确定从各种计划类型中受益最多的患者的特征。中心假设是强化计划更有效，并且可以确定从特定计划类型中受益最大的个人的特征。这项研究的基本原理是，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，将通过提供标准化的评估方法来指导PHBIR建议，从而改善PHBIR的实践。令人感兴趣的主要结果变量将是梅奥-波特兰适应性问卷(MPAI-4)，这是一种广泛使用的测量工具，具有健全的、完善的心理测量学特性。数据分析将包括：(1)项目反应理论分析，以制定本样本的MPAI-4变量的参数等价性度量；(2)强化计划和支持性计划的结果的统计比较；(3)聚类分析，以确定表示残疾模式的不同的MPAI-4简档；(4)各种汇聚方法，以建立MPAI-4的最小临床重要差异(MCID)；以及(5)人口统计学、损伤相关、计划相关和MPAI-4严重性和模式数据的线性和Logistic回归分析，以确定哪些类型的患者从哪些类型的计划中受益最大。大样本将允许对适当的分析进行交叉验证。使用外部有效、可推广的研究方法实现研究目标的影响是提供实用的、以证据为基础的、目前无法获得的信息，这些信息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.