TITLE:
Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation
AUTHORS:
Frank D. Lewis, Gordon J. Horn
KEYWORDS:
Traumatic Brain Injury, TBI, Cerebrovascular Accident, CVA, Stroke, Outcome, Post-Hospital Rehabilitation, MPAI-4, Rasch Analysis, Functional Assessment
JOURNAL NAME:
Open Journal of Statistics,
Vol.8 No.4,
August
3,
2018
ABSTRACT: The purpose of this study was to demonstrate an application of Rasch
analysis to identify differences in disability profiles resulting from
traumatic brain injury (TBI) and cerebral vascular accident (CVA) and to
examine outcome differences between the two groups following post-hospital
residential rehabilitation. Participant data were collected from 32 facilities in 16 states. From 2990 neurologically
impaired individuals with consecutive admissions from 2011 through 2017, 874
met inclusion criteria: TBI (n = 687) or
CVA (n = 187), 18 years or older, minimum length of stay of one month, and maximum
chronicity of 1 year. Participants were evaluated at admission and discharge on
the Mayo Portland Adaptability Inventory-Version
4 (MPAI-4). Rasch analysis was performed to establish item reliability,
construct validity and item difficulty. A Repeated Measures Multivariate
Analysis of Covariance (RM MANCOVA) determined group differences and
improvement from admission and discharge. Rasch Analysis demonstrated satisfactory
construct validity and internal consistency (Person reliability > 0.90,
Item reliability > 0.98 for admission and discharge MPAI-4s). Both groups showed significant
improvement on the MPAI-4 (p 0.0005).
The TBI group was more impaired on the adjustment scale at both admission and
discharge (p 0.001). Rasch analysis identified two distinct impairment patterns. CVA
participants exhibited deficits characteristic of focal impairment while the
TBI group presented with deficits reflective of diffuse impairment.
Rehabilitation was shown to be beneficial in reducing disability following
neurologic injury in both groups. Importantly, Rasch Analysis accurately
produced unique disability profiles that differentiated the treatment groups.
This unique statistical technique offers a promising prescriptive hierarchical
model for guiding neurological rehabilitation treatment.