Mellick David, Harrison-Felix Cynthia, Whiteneck Gale, Ketchum Jessica M, O'Neil-Pirozzi Therese M, Hammond Flora M, Marwitz Jennifer H, Dams-O'Connor Kristen, Juengst Shannon B, Rabinowitz Amanda R
Craig Hospital Research Department, Englewood, CO.
Craig Hospital Research Department, Englewood, CO.
Arch Phys Med Rehabil. 2025 Jul;106(7):1004-1013. doi: 10.1016/j.apmr.2025.03.037. Epub 2025 Mar 26.
To evaluate crosswalks between the Continuity Assessment Record and Evaluation (CARE) measure and the FIM motor subscale scores in a sample of persons with traumatic brain injury given the CARE measure's development by the Centers for Medicare and Medicaid Services in 2005 to assess motor function in all postacute rehabilitation settings and its intended continuity with previous measures.
Crosswalks were created using 3 methodologies (expert opinion, equipercentile, and Rasch). The dataset was split into training and validation datasets. Each crosswalk was evaluated using a reduction in uncertainty, the percent of each crosswalked score falling within ½ SD of the reference measure, population invariance, comparison of statistical moments, and effect size.
Record abstraction.
A total of 982 persons (N=982) who were hospitalized and received inpatient rehabilitation after traumatic brain injury and had both FIM and CARE collected at inpatient rehabilitation admission and discharge.
Not applicable.
Crosswalk between FIM and CARE.
In the training dataset, the expert opinion crosswalk met all criteria except the direction of population invariance within the race category. The equipercentile methodology satisfied all criteria. The Rasch model met all criteria except for a difference in directionality in the skewness of the distributions and 80% of scores not falling within ½ SD of the reference assessment. Results from the validation sample differed from the population invariance criteria, in which the age categories were in opposite directions and had observed differences between standardized mean differences for age that exceeded the threshold of 0.08 for both the equipercentile and Rasch crosswalks.
All 3 crosswalk methods produced acceptable criteria for use, indicating that motor/physical functional outcomes can be compared between cohorts assessed using CARE and FIM measures. Researchers can compare cohorts that have been assessed using these instruments on any of these crosswalks. However, we do not recommend using these crosswalks for longitudinal analyses.
鉴于医疗保险和医疗补助服务中心于2005年制定的连续性评估记录与评价（CARE）措施旨在评估所有急性后期康复环境中的运动功能及其与先前措施的预期连续性，本研究旨在评估创伤性脑损伤患者样本中CARE措施与FIM运动子量表评分之间的对应关系。
采用三种方法（专家意见法、等百分位法和拉施法）创建对应关系。数据集被分为训练数据集和验证数据集。使用不确定性降低、每个对应分数落在参考测量值的½标准差范围内的百分比、总体不变性、统计矩比较和效应量对每个对应关系进行评估。
记录摘要。
共有982名创伤性脑损伤后住院并接受住院康复治疗的患者（N = 982），在住院康复入院和出院时收集了FIM和CARE数据。
不适用。
FIM与CARE之间的对应关系。
在训练数据集中，专家意见对应关系除在种族类别内总体不变性的方向外，满足所有标准。等百分位法满足所有标准。拉施模型除分布偏度的方向性差异以及80%的分数未落在参考评估的½标准差范围内外，满足所有标准。验证样本的结果与总体不变性标准不同，其中年龄类别方向相反，且等百分位法和拉施对应关系的年龄标准化平均差异观察值之间的差异超过了0.08的阈值。
所有三种对应方法都产生了可接受的使用标准，表明使用CARE和FIM措施评估的队列之间可以比较运动/身体功能结局。研究人员可以在这些对应关系中的任何一种上比较使用这些工具评估的队列。然而，我们不建议将这些对应关系用于纵向分析。
