Abstract
The Comparative Effectiveness of Inpatient Rehabilitation Interventions for Traumatic
Brain Injury (TBI-CER) project used causal inference methods as an alternative to
randomized controlled trials to evaluate rehabilitation practices. The TBI practice-based
evidence dataset afforded the opportunity to compare the outcomes of different rehabilitation
approaches while controlling for a large set of potential confounders using propensity
score methods (PSMs). PSMs rely on 4 assumptions: positivity, exchangeability, consistency,
and correct specification of the propensity score model. When these assumptions are
met, PSMs provide a transparent means for evaluating potential causal relations between
interventions and outcomes using observational data. In combination, the series of
studies resulting from the TBI-CER project suggested that the content and approach
used in treatment have a stronger effect on outcomes than the amount of time spent
in treatment. Further, engagement of the patient and family in treatment is key to
optimizing outcomes up to 9 months postdischarge from rehabilitation.
Keywords
List of abbreviations:
LOE (level of effort), PSM (propensity score method), RCT (randomized controlled trial), TBI (traumatic brain injury), TBI-CER (Comparative Effectiveness of Inpatient Rehabilitation Interventions for Traumatic Brain Injury)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the Patient-Centered Outcomes Research Institute (PCORI) (award no. CER-1403-13476). The statements presented in this work are solely the responsibility of the author(s) and do not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee. Funding for the databases used in this study came from the National Institutes of Health, National Center for Medical Rehabilitation Research (grant no. 1R01HD050439-01), the National Institute on Disability, Independent Living, and Rehabilitation Research (grant H133A080023), and the Ontario Neurotrauma Foundation (grant no. 2007-ABI-ISIS-525).
Disclosures: none.
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© 2019 by the American Congress of Rehabilitation Medicine
