Abstract
Study Design:
A longitudinal retrospective study.
Objective:
To better understand individual-level temporal change in functional status for participants with paraplegia in the National Spinal Cord Injury Database (NSCID), as measured by Rasch Transformed Motor Functional Indepedence Measure (FIM) scores.
Setting:
Multicenter/Multistate longitudinal study across the United States.
Methods:
Non-linear random effects modeling, that is, individual growth curve analysis of retrospective data obtained from the National Institute on Disability and Rehabilitation Research (NIDRR) NSCID.
Results:
We generated non-linear individual level trajectories of recovery for Rasch Transformed Motor FIM scores that rise rapidly from inpatient rehabilitation admission to a plateau. Trajectories are based on relationships between growth parameters and patient and injury factors: race, gender, level of education at admission, age at injury, neurological level at discharge, American Spinal Injury Association Impairment Scale (AIS) at discharge, days from injury to first system inpatient rehabilitation admission, rehabilitation length of stay, marital status and etiology. On the basis of study results, an interactive tool was developed to represent individual level longitudinal outcomes as trajectories based upon an individual’s given baseline characteristics, that is, information supplied by the covariates and provides a robust description of temporal change for those with paraplegia within the NSCID.
Conclusions:
This methodology allows researchers and clinicians to generate and better understand patient-specific trajectories through the use of an automated interactive tool where a nearly countless number of longitudinal paths of recovery can be explored. Projected trajectories holds promise in facilitating planning for inpatient and outpatient services, which could positively impact long term outcomes.
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Acknowledgements
This work was funded by the National Institute on Disability and Rehabilitation Research (NIDRR) Traumatic Brain Injury Model Systems National Data and Statistical Center (Grant Number H133A110006), the National Spinal Cord Injury Statistical Center (Grant Number H133A110002) and the National Institutes of Health through the Center for Rehabilitation Research using Large Datasets (Grant Number R24-HD065702). This work was prepared at the Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood CO and at the National Spinal Cord Injury Statistical Center University of Alabama at Birmingham, Birmingham, AL, USA.
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Pretz, C., Kozlowski, A., Charlifue, S. et al. Using rasch motor FIM individual growth curves to inform clinical decisions for persons with paraplegia. Spinal Cord 52, 671–676 (2014). https://doi.org/10.1038/sc.2014.94
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DOI: https://doi.org/10.1038/sc.2014.94
