Using rasch motor FIM individual growth curves to inform clinical decisions for persons with paraplegia

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Study examined individual-level temporal changes in functional status for participants with paraplegia in the National Spinal Cord Injury Database (NSCID), as measured by Rasch-transformed Functional Independence Measure (FIM) motor scores. Non-linear random effects modeling, that is, individual growth curve analysis of retrospective data obtained from the NSCID. The authors generated non-linear individual level trajectories of recovery for Rasch-transformed FIM motor scores that rise rapidly from inpatient rehabilitation admission to a plateau. The trajectories are based on relationships between growth parameters and patient and injury factors: race, gender, level of education at admission, age at injury, neurological level at discharge, American Spinal Injury Association Impairment Scale at discharge, days from injury to first system inpatient rehabilitation admission, rehabilitation length of stay, marital status and etiology. Based on the study results, an interactive tool was developed to represent individual-level longitudinal outcomes as trajectories based upon an individual’s given baseline characteristics, that is, information supplied by the covariates and provides a robust description of temporal change for those with paraplegia within the NSCID. This methodology allows researchers and clinicians to generate and better understand patient-specific trajectories through the use of an automated interactive tool where a nearly countless number of longitudinal paths of recovery can be explored. The projected trajectories holds promise in facilitating planning for inpatient and outpatient services, which could positively impact long term outcomes.

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