Measuring Recovery in Chronic Disability

Ipad with data showing on it next to a laptop, papers, and a stethoscope

What are we doing?

We are studying how to better describe, evaluate, and report change in function over time in persons receiving rehabilitation services. This work involves applying Rasch Measurement theory to develop more precise, reliable, and valid assessments that produces person measures sensitive to change over time. We are particularly interested in assessments of daily living (self-care, mobility), cognition, and neurobehavioral function.

Why does this matter?

There have been no successful clinical trials of interventions for persons in disordered states of consciousness after TBI. One of the major reasons cited for these poor results is the lack of precise, accurate measurement of recovery of neurobehavioral function. In the field of rehabilitation broadly, limited attention has been paid measuring change over time and determining functionally important changes in outcomes.

What are our current/recent projects?

Recovery Trajectories in Chronic Disability

The Advanced Metrics Lab has been working on a series of studies to investigate the associations among the amount and type of therapy that people receive, how long it takes them to recover, and the degree of functional independence they attain.

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  • Conditional MDCs and other change indices
    • Weaver J, Cogan A, Davidson L, Schlumpf K, Mallinson T. (2020). When is change meaningful?: A comparison of the MCID, MDC, and cMDC. Archives of Physical Medicine & Rehabilitation, 101 (11), E57. https://doi.org/10.1016/j.apmr.2020.09.169
    • Weaver J, Mallinson T, Pape T, Guernon A, Walsh E. (2017). Clinically Meaningful Change Using the Coma Near Coma Scale. Archives of Physical Medicine and Rehabilitation, 98(12): e159. https://doi.org/10.1016/j.apmr.2017.09.031
    • Mallinson T, Pape T & Guernon A. (2016). 0633 Identifying patterns of clinically meaningful recovery of NBF in persons in states of disordered consciousness due to TBI. Brain Injury, 30(5-6), 726. https://doi.org/10.3109/02699052.2016.1162060
  • Developing a measure of cognition to evaluate recovery of function
    • Weaver JA, Cogan A, Davidson L, & Mallinson T. (2021). Combining Items from Three Federally Mandated Assessments Using Rasch Measurement to Reliably Measure Cognition Across Post-Acute Care, Archives of Physical Medicine & Rehabilitation, 102(1), 106-114, Jan 1, 2021. PMID: 32750375. https://doi.org/10.1016/j.apmr.2020.07.003
  • Describing the association of therapy intensity on recovery of function
    • Cogan A, Weaver JA, Davidson L, Khromouchkine N, Mallinson T. (2021). Response to Hori et al, “Association of speech therapy time and cognitive recovery in stroke patients: A comparison of studies.” Journal of the American Medical Directors Association, 22(6): 1328-1329. DOI: https://doi.org/10.1016/j.jamda.2021.02.026
    • Cogan A, Weaver J, Ganz D, Davidson L, Cole K, & Mallinson T. (2021). Association of therapy time per day with functional outcomes and rate of recovery in older adults after elective joint replacement surgery. Archives of Physical Medicine and Rehabilitation, 881-887. https://doi.org/10.1016/j.apmr.2020.10.123 Epub 2020 Nov 17. PubMed PMID: 33217373.
    • Cogan A, Weaver J, Davidson L, Khromouchkine N, & Mallinson T. (2021). Association of therapy time and cognitive recovery in stroke patients in post-acute rehabilitation. Journal of the American Medical Directors Association, 22(2), 453-458, Feb 01, 2021.  PMID:  https://doi.org/10.1016/j.jamda.2020.06.031
    • Cogan A, Weaver J, McHarg M, Leland N, Davidson L, & Mallinson T. (2020). Association of length of stay, recovery rate, and therapy time per day with functional outcomes after hip fracture surgery. JAMA Network Open, 3(1), e1919672, Jan 24, 2020. PMID: 31977059. https://doi.org/10.1001/jamanetworkopen.2019.19672
  • Application of Rasch Measurement Theory to outcome assessments
    • Cogan A, Weaver JA, Scholten J, Bender Pape T, Mallinson T. (in press). Psychometric properties and sex differences on the Mayo-Portland Adaptability Inventory Participation subscale (M2PI) in Veterans with TBI. Archives of Physical Medicine & Rehabilitation, DOI: https://doi.org/10.1016/j.apmr.2021.06.003

Improving Assessment for Persons in States Disordered Consciousness

We are conducting a series of studies to describe the psychometric properties of the major neurobehavioral function (NBF) assessments in persons in DoC. We use Rasch Measurement Theory to investigate which behaviors are most/least challenging in response to sensory stimuli. We are also trying to understand what kind of change in NBF matters, for whom, and in what ways raters/assessors matter to the process of assessment.

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  • Reporting Guidelines for Rasch Measurement Theory Studies
    • Mallinson T, Kozlowski A, Johnston M, Weaver J, Terhorst L, Grampurohit N, Juengst S, Ehrlich-Jones L, Heinemann A, Melvin J, Sood P, & Van de Winckel A. (2020). Rasch Reporting Guideline for Rehabilitation Research (RULER): The RULER Statement. https://doi.org/10.1016/j.apmr.2022.03.013
    • Van de Winckel A, Kozlowski A, Johnston M, Weaver J, Terhorst L, Grampurohit N, Juengst S, Ehrlich-Jones L, Heinemann A, Melvin J, Sood P, & Mallinson T. (2020). Rasch Reporting Guideline for Rehabilitation Research (RULER): Explanation and Elaboration. https://doi.org/10.1016/j.apmr.2022.03.019
  • Psychometrics of the major DoC outcome assessments
    • Weaver J, Liu J, Guernon A, Pape T, & Mallinson T. (2021). Psychometric Properties of the Coma Near-Coma Scale in Adults in Disordered States of Consciousness: A Rasch Analysis, Archives of Physical Medicine and Rehabilitation, 102(4), 591-597, Apr 01, 2021. PMID: https://doi.org/10.1016/j.apmr.2020.10.119
    • Mallinson T, Weaver J, Guernon A, & Pape T. (2020). Letter to the Editor: Updating the Disorders of Consciousness Scale. Journal of Head Trauma & Rehabilitation, 35(5), 363-363, May 27, 2020. PMID: 32472831. https://doi.org/10.1097/HTR.0000000000000577
    • Weaver J, Elgin E, Jones A, Pape T, Guernon A, & Mallinson T. (2019). Disorders of Consciousness Instrument Summary. The Rehabilitation Measures Database. Retrieved from: https://www.sralab.org/rehabilitation-measures/disorders-consciousness-scale
    • Weaver J, Elgin E. Jones A, Guernon A, Cogan A, Mallinson T, Pape T, & Ehrlich-Jones L. (2019). Measurement Characteristics and Clinical Utility of the Disorders of Consciousness Scale Among Individuals With Brain Injury. Archives of Physical Medicine & Rehabilitation. DOI: https://doi.org/10.1016/j.apmr.2019.03.006
    • Liu J, Mallinson T, Pape T, & Guernon A. (2015). The Coma-Near Coma Scale: An examination of the psychometric properties using Rasch analysis. Archives of Physical Medicine and Rehabilitation, 96(10): e81. https://doi.org/10.1016/j.apmr.2015.08.273
  • Co-calibration of the major DoC outcome assessments
    • Guernon A, Walsh E, Weaver J, Bender Pape T, & Mallinson T. (2018). Aligning Two Neurobehavioral Assessment Tools for Patients with Disorders of Consciousness – Accepted Abstracts from the Federal Interagency Conference for Traumatic Brain Injury, Archives of Physical Medicine and Rehabilitation, 99(11): e154. https://doi.org/10.1016/j.apmr.2018.08.082
  • Systematic reviews of NBF outcome assessments
  • Evaluating the impact of rater severity-leniency on DoC outcomes
    • Mallinson T, Pape T, & Guernon A. (2014). Poster #226: Clinician and Observer Reported Endpoints (Clinros & Obsros): Accounting for Rater Severity/Leniency in Measures of Recovery of Consciousness, Archives of Physical Medicine and Rehabilitation, October 2014, 95(10): e74. https://doi.org/10.1016/j.apmr.2014.07.238