Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable: a systematic review

Background and Objectives: To identify and summarize validated multivariable prognostic models for the Functional Independence Measure (R) (FIM (R)) at discharge from post-acute inpatient rehabilitation in adults with acquired brain injury (ABI). Methods: 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 (R) at discharge from post-acute rehabilitation. Results: 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. Conclusion: Current prognostic models for the FIM (R) 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. (C) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study aimed to identify and summarize validated multivariable prognostic models for assessing functional independence in patients with acquired brain injury (ABI) at discharge from post-acute rehabilitation. Three articles met the inclusion criteria, with a total of six internally validated and two externally validated prognostic models. However, these models were found to have limitations in terms of reliability and accuracy, indicating that they are not yet suitable for clinical use.