The Department of Veterans Affairs (VA), Research Service and the Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital.
Rehabil Psychol. 2013 Aug;58(3):253-62. doi: 10.1037/a0032610.
PURPOSE/OBJECTIVE: Severe brain injury (BI) is a catastrophic event often evolving into a complex chronic and severely disabling condition making activity participation possible only with sustained caregiving. One aspect of building sustainable caregiving is early provision of information about expected outcomes germane to patients and their caregivers. An analysis was conducted to determine whether 2 levels of independence with expressing needs and ideas 1-year after severe BI could be predicted using variables available early after injury.
The authors examined a subsample (n = 79) of participants of an outcome study who received repeated neurobehavioral evaluations with the Disorders of Consciousness Scale (DOCS) and who were assessed 1 year after injury with the Functional Independence Measures (FIM). Explanatory variables included DOCS measures, patient characteristics, coexisting conditions, and interventions. The outcome is measured with the FIM Expression item. Optimal data analysis was used to construct multivariate classification tree models.
The 2nd (p = .004) DOCS visual measure and seizure (p = .004) entered the final model providing 79% accuracy in classifying more or less independence with expressing needs and ideas at 1 year. The model will correctly identify 78% of future severe BI survivors who will have more independence and 82% of persons who will have less independence.
For persons incurring severe BI, it is possible to predict, early after injury, more and less independence with expressing needs and ideas 1-year after injury. This evidence is 1 contribution to a larger body of evidence needed to enable early caregiver education about recovery expectations in terms of patient functioning relative to caregiving needs, which in turn will help build sustainable caregiving for this population.
目的/目标：严重脑损伤（BI）是一种灾难性事件，通常会演变成一种复杂的慢性和严重的残疾状况，只有持续的护理才能使患者进行活动。建立可持续护理的一个方面是尽早提供与患者及其护理人员相关的预期结果信息。进行了一项分析，以确定是否可以使用受伤后早期可用的变量来预测严重 BI 后 1 年患者表达需求和想法的 2 个独立水平。
作者检查了一项结果研究的子样本（n = 79），该研究的参与者接受了重复的神经行为评估，使用意识障碍量表（DOCS），并在受伤后 1 年使用功能独立性量表（FIM）进行评估。解释变量包括 DOCS 测量、患者特征、共存疾病和干预措施。结果用 FIM 表达项目进行衡量。使用最佳数据分析构建了多变量分类树模型。
第 2 个（p =.004）DOCS 视觉测量和癫痫（p =.004）进入最终模型，在 1 年内分类表达需求和想法的更多或更少独立性的准确率为 79%。该模型将正确识别 78%未来具有更多独立性的严重 BI 幸存者和 82%的未来具有更少独立性的患者。
对于遭受严重 BI 的人来说，有可能在受伤后早期预测 1 年后表达需求和想法的更多和更少独立性。这一证据是为了支持早期护理人员关于患者相对于护理需求的功能恢复期望的教育而提供的更大证据体的一部分，这反过来将有助于为这一人群建立可持续的护理。
