Timothy Belliveau1, Alan M Jette2, Subramani Seetharama3, Jeffrey Axt4, David Rosenblum5, Daniel Larose6, Bethlyn Houlihan2, Mary Slavin2, Chantal Larose7. 1. Psychology Department, Hospital for Special Care, New Britain, CT. Electronic address: tbelliveau@hfsc.org. 2. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. 3. Physical Medicine and Rehabilitation Department, Hartford Hospital, Hartford, CT. 4. Information Technology Department, Hospital for Special Care, New Britain, CT. 5. Physical Medicine and Rehabilitation Department, Gaylord Hospital, Wallingford, CT. 6. Department of Mathematical Sciences, Central Connecticut State University, New Britain, CT. 7. School of Business, State University of New York at New Paltz, New Paltz, NY.
Abstract
OBJECTIVE: To develop mathematical models for predicting level of independence with specific functional outcomes 1 year after discharge from inpatient rehabilitation for spinal cord injury. DESIGN: Statistical analyses using artificial neural networks and logistic regression. SETTING: Retrospective analysis of data from the national, multicenter Spinal Cord Injury Model Systems (SCIMS) Database. PARTICIPANTS: Subjects (N=3142; mean age, 41.5y) with traumatic spinal cord injury who contributed data for the National SCIMS Database longitudinal outcomes studies. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported ambulation ability and FIM-derived indices of level of assistance required for self-care activities (ie, bed-chair transfers, bladder and bowel management, eating, toileting). RESULTS: Models for predicting ambulation status were highly accurate (>85% case classification accuracy; areas under the receiver operating characteristic curve between .86 and .90). Models for predicting nonambulation outcomes were moderately accurate (76%-86% case classification accuracy; areas under the receiver operating characteristic curve between .70 and .82). The performance of models generated by artificial neural networks closely paralleled the performance of models analyzed using logistic regression constrained by the same independent variables. CONCLUSIONS: After further prospective validation, such predictive models may allow clinicians to use data available at the time of admission to inpatient spinal cord injury rehabilitation to accurately predict longer-term ambulation status, and whether individual patients are likely to perform various self-care activities with or without assistance from another person.
OBJECTIVE: To develop mathematical models for predicting level of independence with specific functional outcomes 1 year after discharge from inpatient rehabilitation for spinal cord injury. DESIGN: Statistical analyses using artificial neural networks and logistic regression. SETTING: Retrospective analysis of data from the national, multicenter Spinal Cord Injury Model Systems (SCIMS) Database. PARTICIPANTS: Subjects (N=3142; mean age, 41.5y) with traumatic spinal cord injury who contributed data for the National SCIMS Database longitudinal outcomes studies. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported ambulation ability and FIM-derived indices of level of assistance required for self-care activities (ie, bed-chair transfers, bladder and bowel management, eating, toileting). RESULTS: Models for predicting ambulation status were highly accurate (>85% case classification accuracy; areas under the receiver operating characteristic curve between .86 and .90). Models for predicting nonambulation outcomes were moderately accurate (76%-86% case classification accuracy; areas under the receiver operating characteristic curve between .70 and .82). The performance of models generated by artificial neural networks closely paralleled the performance of models analyzed using logistic regression constrained by the same independent variables. CONCLUSIONS: After further prospective validation, such predictive models may allow clinicians to use data available at the time of admission to inpatient spinal cord injury rehabilitation to accurately predict longer-term ambulation status, and whether individual patients are likely to perform various self-care activities with or without assistance from another person.
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