A Systematic Review of Comorbidity Measurement Methods for Patients With Nontraumatic Brain Injury in Inpatient Rehabilitation Settings.
Wayne Khuu, Vincy Chan, Angela Colantonio
PMID 28682841WHAT IT FOUND
No standard way to measure comorbidities in nontraumatic brain injury inpatient rehabilitation was found.
Included studies used many different methods, and none showed which best predicts rehabilitation outcomes.
Key findings
01The 16 included studies used different comorbidity measurement methods, and none compared which method best predicted inpatient rehabilitation outcomes for patients with nontraumatic brain injury.
02The only study testing whether a comorbidity measure predicted an inpatient rehabilitation outcome found no significant association between the CCI and living setting at discharge.
03Patients with nontraumatic brain injury had an average of 3.9 comorbidities, and depressive disorders were the most common mental health condition, occurring in 34%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 16 studies were included, and many used administrative data, so the comorbidity profiles may not apply to all nontraumatic brain injury patients. The search was limited to English and to certain study types, so relevant articles may have been missed if comorbidity was only in full text or poorly indexed. Comorbidity was defined only as medical conditions, so procedures and functional ability were not investigated. No study compared which comorbidity measure best predicts inpatient rehabilitation outcomes, so the review cannot identify a validated score for practice. Administrative comorbidity coding may be poor or unknown in validity, and it may underestimate comorbidity compared with medical records. Some included studies grouped nontraumatic brain injury with other patients, so profiles may not be generalizable to specific nontraumatic brain injury subtypes. Stroke was excluded, so the review does not cover stroke rehabilitation. Studies rarely explained why their comorbidity measure was chosen for rehabilitation outcomes.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that any comorbidity score can predict outcomes after nontraumatic brain injury. The review found no standard measure and no study comparing measures, and the only predictive test found no significant association (p>0.1).