TY - JOUR
T1 - Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable
T2 - a systematic review
AU - Pommerich, Uwe M.
AU - Stubbs, Peter W.
AU - Eggertsen, Peter Preben
AU - Fabricius, Jesper
AU - Nielsen, Jørgen Feldbæk
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - Acquired brain injury
KW - Cerebrovascular disorder
KW - Prognosis
KW - Prognostic prediction model
KW - Rehabilitation
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85150928999&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2023.02.009
DO - 10.1016/j.jclinepi.2023.02.009
M3 - Review
C2 - 36764467
AN - SCOPUS:85150928999
SN - 0895-4356
VL - 156
SP - 53
EP - 65
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -