Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable: a systematic review.

Autor: Pommerich UM; Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark. Electronic address: uwepom@clin.au.dk., Stubbs PW; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Ultimo 2007, Australia., Eggertsen PP; Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark., Fabricius J; Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark., Nielsen JF; Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.
Jazyk: angličtina
Zdroj: Journal of clinical epidemiology [J Clin Epidemiol] 2023 Apr; Vol. 156, pp. 53-65. Date of Electronic Publication: 2023 Feb 09.
DOI: 10.1016/j.jclinepi.2023.02.009
Abstrakt: Background and Objectives: To identify and summarize validated multivariable prognostic models for the Functional Independence Measure® (FIM®) at discharge from post-acute inpatient rehabilitation in adults with acquired brain injury (ABI).
Methods: This review was conducted based on the recommendations of the Cochrane Prognosis Methods Group and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were systematically searched in May 2021 and updated in April 2022. Main inclusion criteria were: a) adult patients with ABI, b) validated multivariable prognostic model, c) time of prognostication within 1-week of admission to post-acute rehabilitation, and d) outcome was the FIM® at discharge from post-acute rehabilitation.
Results: The search yielded 3,169 unique articles. Three articles fulfilled the inclusion criteria, accounting for n = 6 internally and n = 2 externally validated prognostic models. Discrimination was estimated as an area under the curve between 0.76 and 0.89. Calibration was deemed to be assessed insufficiently. The included models were judged to be of high risk of bias.
Conclusion: Current prognostic models for the FIM® in post-acute rehabilitation for patients with ABI lack the methodological rigor to support clinical use outside the development setting. Future studies addressing functional independence should ensure appropriate model validation and conform to uniform reporting standards for prognosis research.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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