ABSTRACT

Purpose

To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose.

Methods

An observational study of children receiving residential neurorehabilitation after severe ABI.

Results

Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists’ expectations of recovery.

Conclusion

Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.

中文翻译：

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儿童和青少年重度后天性脑损伤后功能康复治疗效果的论证

摘要

目的

检查小儿获得性脑损伤 (ABI) 后功能结果与康复剂量测量之间的关系。

方法

一项对严重 ABI 后接受住院神经康复的儿童的观察性研究。

结果

基本总康复剂量与总体结果呈矛盾的反比关系。这是由于初始损伤严重程度和住院时间的混杂，以及给定总康复剂量的治疗内容的变化。内容感知康复剂量测量显示，接受的康复治疗的比例与结果的可能相关方面之间存在强大的正相关关系：具体而言，在粗大运动功能的恢复率与针对积极练习和运动学习的康复努力的比例之间。这种关系在调整治疗师对康复的期望时是稳健的。

结论

康复剂量的内容感知测量与结果的相关方面密切相关。这些发现是朝着小儿神经康复比较有效性研究目标迈出的一步。