Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 12, Supplement , Pages 8-15 , December 2005

Another Look at Observational Studies in Rehabilitation Research: Going Beyond the Holy Grail of the Randomized Controlled Trial

  • Susan D. Horn, PhD

      Affiliations

    • International Severity Information Systems Inc and Institute for Clinical Outcomes Research, Salt Lake City, UT
    • Corresponding Author InformationReprint requests to Susan D. Horn, PhD, Institute for Clinical Outcomes Research, 699 E South Temple, Ste 100, Salt Lake City, UT 84102-1282
    • ,
  • Gerben DeJong, PhD

      Affiliations

    • National Rehabilitation Hospital and Department of Rehabilitation Medicine, Georgetown University, Washington, DC
    • ,
  • David K. Ryser, MD

      Affiliations

    • Division of Physical Medicine and Rehabilitation, Neuro Specialty Rehabilitation Unit, LDS Hospital, Salt Lake City, UT
    • ,
  • Peter J. Veazie, PhD

      Affiliations

    • Division of Health Services Research and Policy, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
    • ,
  • Jeffrey Teraoka, MD

      Affiliations

    • Division of Physical Medicine and Rehabilitation, Stanford University, Palo Alto, CA

References 

  1. Tunis SR , Stryer DB , Clancy CM . Practical clinical trials (increasing the value of clinical research for decision making in clinical and health policy) . JAMA . 2003;290:1624–1632
  2. Berguer R . The evidence thing . Ann Vasc Surg . 2004;18:265–270
  3. Porter ME , Teisberg EO . Redefining competition in health care . Harv Bus Rev . 2004;82:64–76 , 136
  4. In:  Horn SD editors. Clinical practice improvement methodology (implementation and evaluation) . New York: Faulkner & Gray; 1997;
  5. Pearl J . Causal inference in the health sciences (a conceptual introduction) . Health Serv Outcomes Res Method . 2002;2:189–220
  6. Pearl J . Statistics and causal inference (a review) . Test . 2003;12:281–345
  7. Rosenbaum PR . Observational studies . New York: Springer; 2002;
  8. Heckman JJ . Micro data, heterogeneity, and the evaluation of public policy (Nobel lecture) . J Political Econ . 2001;109:673–748
  9. Little RJ , Rubin DB . Causal effects in clinical and epidemiological studies via potential outcomes (concepts and analytical approaches) . Annu Rev Public Health . 2000;21:121–145
  10. Winship C , Morgan SL . The estimation of causal effects from observational data . Annu Rev Sociol . 1999;25:659–706
  11. Winship C , Mare RD . Models for sample selection bias . Annu Rev Sociol . 1992;18:327–350
  12. Newhouse JP , McClellan M . Econometrics in outcomes research (the use of instrumental variables) . Annu Rev Public Health . 1998;19:17–34
  13. Heckman J , Navarro-Lozano S . Using matching, instrumental variables, and control functions to estimate economic choice models . Rev Econ Stat . 2004;86:30–57
  14. Rosenbaum PR , Rubin DB . The bias due to incomplete matching . Biometrics . 1985;41:103–116
  15. Rosenbaum PR , Rubin DB . Difficulties with regression analyses of age-adjusted rates . Biometrics . 1984;40:437–443
  16. Averill RF , McGuire TE , Manning BE , et al.   A study of the relationship between severity of illness and hospital cost in New Jersey hospitals . Health Serv Res . 1992;27:587–606 ; discussion 607-12
  17. Clemmer TP , Spuhler VJ , Oniki TA , Horn SD . Results of a collaborative quality improvement program on outcomes and costs in a tertiary critical care unit . Crit Care Med . 1999;27:1768–1774
  18. Horn SD , Torres A , Willson D , Dean JM , Gassaway J , Smout R . Development of a pediatric age- and disease-specific severity measure . J Pediatr . 2002;141:496–503
  19. Willson DF , Horn SD , Smout R , Gassaway J , Torres A . Severity assessment in children hospitalized with bronchiolitis using the pediatric component of the Comprehensive Severity Index . Pediatr Crit Care Med . 2000;1:127–132
  20. Ryser DK , Egger MJ , Horn SD , Handrahan D , Gandhi P , Bigler ED . Measuring medical complexity during inpatient rehabilitation after traumatic brain injury . Arch Phys Med Rehabil . 2005;86:1108–1117
  21. Horn SD , Sharkey PD , Buckle JM , Backofen JE , Averill RF , Horn RA . The relationship between severity of illness and hospital length of stay and mortality . Med Care . 1991;29:305–317
  22. Gassaway JV , Horn SD , DeJong G , Smout RJ , Clark C , James R . Applying the clinical practice improvement approach to stroke rehabilitation (methods used and baseline results) . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S16–S33
  23. Benson K , Hartz AJ . A comparison of observational studies and randomized, controlled trials . N Engl J Med . 2000;342:1878–1886
  24. Concato J , Shah N , Horwitz RI . Randomized, controlled trials, observational studies, and the hierarchy of research designs . N Engl J Med . 2000;342:1887–1892
  25. Ioannidis JP , Haidich AB , Pappa M , et al.   Comparison of evidence of treatment effects in randomized and nonrandomized studies . JAMA . 2001;286:821–830
  26. Bartels SJ , Horn S , Sharkey P , Levine K . Treatment of depression in older primary care patients in health maintenance organizations . Int J Psychiatry Med . 1997;27:215–231
  27. Bartels SJ , Horn SD , Smout RJ , et al.   Agitation and depression in frail nursing home elderly with dementia (treatment characteristics and service use) . Am J Geriatr Psychiatry . 2003;11:231–238
  28. Horn SD , Sharkey PD , Tracy DM , Horn CE , James B , Goodwin F . Intended and unintended consequences of HMO cost containment strategies (results from the Managed Care Outcomes Project) . Am J Manag Care . 1996;2:253–264
  29. Horn SD , Wright HL , Couperus JJ , et al.   Association between patient-controlled analgesia pump use and post-operative surgical site infection in intestinal surgery patients . Surg Infect (Larchmt) . 2002;3:109–118
  30. Horn SD , Smout RJ . Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes . J Pediatr . 2003;143(5 Suppl):S133–S141
  31. Horn SD , Bender SA , Ferguson ML , et al.   The National Pressure Ulcer Long-Term Care Study (pressure ulcer development in long-term care residents) . J Am Geriatr Soc . 2004;52:359–367
  32. Neumayer LA , Smout RJ , Horn HG , Horn SD . Early and sufficient feeding reduces length of stay and charges in surgical patients . J Surg Res . 2001;95:73–77
  33. Willson DF , Horn SD , Hendley JO , Smout R , Gassaway J . The effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness . Pediatrics . 2001;108:851–855
  34. Willson DF , Landrigan CP , Horn SD , Smout RJ . Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia . J Pediatr . 2003;143(5 Suppl):S142–S149
  35. Horn SD , Sharkey PD , Phillips-Harris C . Formulary limitations in the elderly (results from the Managed Care Outcomes Project) . Am J Manag Care . 1998;4:1105–1113
  36. Horn SD , Sharkey PD , Kelly HW , Uden DL . Newness of drugs and use of HMO services by asthma patients . Ann Pharmacother . 2001;35:990–996
  37. Blonde L , Ginsberg GH , Horn S , et al.   Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes . Diabetes Care . 2002;25:245–246
  38. McMurray JJ , O’Meara E . Treatment of heart failure with spironolactone-trial and tribulations . N Engl J Med . 2004;351:526–528
  39. Whyte J . Traumatic brain injury rehabilitation (are there alternatives to randomized clinical trials) . Arch Phys Med Rehabil . 2002;83:1320–1322

 Supported by the National Institute on Disability & Rehabilitation Research (grant no. H133B990005) and the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032). The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(05)01183-4

doi: 10.1016/j.apmr.2005.08.116

Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 12, Supplement , Pages 8-15 , December 2005

Article Tools

* Image Usage & Resolution