Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.
Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Ultimo 2007, Australia.
J Clin Epidemiol. 2023 Apr;156:53-65. doi: 10.1016/j.jclinepi.2023.02.009. Epub 2023 Feb 9.
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).
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.
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.
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.
旨在识别和总结成人获得性脑损伤（ABI）患者在急性后期康复出院时用功能独立性测量（FIM®）的经过验证的多变量预后模型。
本综述是根据 Cochrane 预后方法组的建议进行的，符合系统评价和荟萃分析报告的首选项目指南。2021 年 5 月对三个数据库进行了系统搜索，并于 2022 年 4 月进行了更新。主要纳入标准为：a）成人 ABI 患者，b）经过验证的多变量预后模型，c）预后时间在急性后期康复入院后 1 周内，d）结果为急性后期康复出院时的 FIM®。
搜索结果产生了 3169 篇独特的文章。三篇文章符合纳入标准，包括 n = 6 个内部和 n = 2 个外部验证的预后模型。区分度估计为 0.76 到 0.89 之间的曲线下面积。校准被认为评估不足。所包括的模型被认为存在高偏倚风险。
目前用于 ABI 患者急性后期康复的 FIM®预后模型缺乏在开发环境之外支持临床使用的方法学严谨性。未来研究应确保对功能独立性进行适当的模型验证，并符合预后研究的统一报告标准。
