Trajectory Of Functional Recovery Research Articles

Integrated Whole-Life Cycle Accuracy Valvular Heart Disease Epidemiology Cohort Study (iWAVE): protocol for a prospective cohort study

IntroductionDespite the rapid advancements in cardiovascular surgery in China, the prevalence of valvular heart disease (VHD) continues to rise, particularly among the elderly population. In the resource-constrained western regions, the...

Recovery Trajectories of Patient-reported Outcomes After Surgery for Degenerative Cervical Myelopathy: A Bayesian Latent Class Modeling Approach.

Retrospective study. The aim of this study was to identify recovery trajectory clusters after surgery for degenerative cervical myelopathy (DCM), as well as to determine clinical and imaging characteristics associated with functional recovery trajectories. Accurate prediction of postsurgical neurological recovery for the individual patient with DCM is challenging due to varying patterns of functional recovery. Latent class Bayesian models can model individual patient patterns and identify groups of patients with similar phenotypes for personalized prognostication. A prospective single-center study of 70 consecutive patients with DCM undergoing elective cervical spine decompression for DCM between 2010 and 2017 was performed. Outcomes were recorded using the modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and the Short Form-36 Physical Component Score (SF-36 PCS) at 3, 6, 12, and 24 months. Recovery trajectories were constructed based on unsupervised Bayesian latent class modeling. Clinical and imaging predictors of recovery trajectories were also determined. Recovery after surgery for DCM showed 3 distinct recovery trajectory clusters for each outcome. The commonest recovery trajectory was sustained improvement for the mJOA (41.1%), stagnation for the NDI (60.3%), and stability for the SF-36 PCS (46.6%). Age, duration of symptoms, and baseline disability were the strongest predictors of each recovery trajectory. Degree of cord compression, neck pain, and intramedullary T2-hyperintensity were predictive of NDI and SF-36 PCS but not mJOA recovery trajectory. Sex was associated with the NDI recovery trajectory but not SF-36 PCS and mJOA recovery trajectories. Using prospective data and a data-driven approach, we identified 3 distinct recovery trajectory clusters and associated factors for mJOA, NDI, and SF-36 PCS in the first 24 months after surgery for DCM. Our results can enhance personalized clinical prognostication and guide patient expectations at different time points after surgery for DCM.

Recovery Trajectories in Children Requiring 3 or More Days of Invasive Ventilation.

To characterize health-related quality of life (HRQL) and functional recovery trajectories and risk factors for prolonged impairments among critically ill children receiving greater than or equal to 3 days of invasive ventilation. Prospective cohort study. Quaternary children's hospital PICU. Children without a preexisting tracheostomy who received greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 postdischarge data collection. None. We evaluated 144 children measuring HRQL using proxy-report Pediatric Quality of Life Inventory and functional status using the Functional Status Scale (FSS) reflecting preillness baseline, PICU and hospital discharge, and 1, 3, 6, and 12 months after hospital discharge. They had a median age of 5.3 years (interquartile range, 1.1-13.0 yr), 58 (40%) were female, 45 (31%) had a complex chronic condition, and 110 (76%) had normal preillness FSS scores. Respiratory failure etiologies included lung disease ( n = 49; 34%), neurologic failure ( n = 23; 16%), and septic shock ( n = 22; 15%). At 1-month postdischarge, 68 of 122 (56%) reported worsened HRQL and 35 (29%) had a new functional impairment compared with preillness baseline. This improved at 3 months to 54 (46%) and 24 (20%), respectively, and remained stable through the remaining 9 months of follow-up. We used interaction forests to evaluate relative variable importance including pairwise interactions and found that therapy consultation within 3 days of intubation was associated with better HRQL recovery in older patients and those with better preillness physical HRQL. During the postdischarge year, 76 patients (53%) had an emergency department visit or hospitalization, and 62 (43%) newly received physical, occupational, or speech therapy. Impairments in HRQL and functional status as well as health resource use were common among children with acute respiratory failure. Early therapy consultation was a modifiable characteristic associated with shorter duration of worsened HRQL in older patients.

Responsiveness of Section GG Scores in Tracking Post-Stroke Functional Recovery From Inpatient Rehabilitation Admission to 90-Day Follow-Up

ObjectiveTo evaluate the responsiveness and scale-to-sample targeting of Section GG of the Inpatient Rehabilitation Facility-Patient Assessment Instrument in measuring the trajectory of functional recovery in patients with stroke from inpatient rehabilitation admission to 90 days after discharge. DesignRetrospective cohort study. Setting150-bed inpatient rehabilitation facility. ParticipantsPatients with stroke (N=1087) discharged between December 2019 to April 2021. InterventionNot applicable. Main Outcome MeasuresAdmission and discharge self-care and mobility scores from Section GG were analyzed for the Inpatient Only group (n= 817). Admission, discharge and 90-day post-discharge Section GG scores from telephone interviews with patients or caregivers were analyzed for the Follow-Up group (n=270). Standardized response means (SRM) determined responsiveness of the tool for each group and time interval. Score means, standard deviations, and floor/ceiling effects illustrated scale-to-sample targeting of the tool. ResultsSelf-care and mobility scores improved significantly from admission to discharge (P<.001) for both groups and from discharge to 90 days (P<.001) for the Follow-Up group. Large SRM existed from admission to discharge for self-care and mobility scores in both groups. ​A small-to-moderate SRM was seen from discharge to 90 days for self-care (0.46) and a moderate SRM was observed for mobility (0.68). Overall floor effects were minor at admission for self-care (9.8%) and mobility (7.2.%). Overall ceiling effects were minor at discharge for self-care (11.2%) and mobility (4.6%)​ and significant at follow-up for both self-care (45.2%) and mobility (32.2%). ConclusionsSection GG is responsive to change and appropriately measures patients’ functional ability during inpatient rehabilitation. More study is required for telephone follow-up after discharge from inpatient rehabilitation.

Functional trajectories during innate spinal cord repair.

Adult zebrafish are capable of anatomical and functional recovery following severe spinal cord injury. Axon growth, glial bridging and adult neurogenesis are hallmarks of cellular regeneration during spinal cord repair. However, the correlation between these cellular regenerative processes and functional recovery remains to be elucidated. Whereas the majority of established functional regeneration metrics measure swim capacity, we hypothesize that gait quality is more directly related to neurological health. Here, we performed a longitudinal swim tracking study for 60 individual zebrafish spanning 8 weeks of spinal cord regeneration. Multiple swim parameters as well as axonal and glial bridging were integrated. We established rostral compensation as a new gait quality metric that highly correlates with functional recovery. Tensor component analysis of longitudinal data supports a correspondence between functional recovery trajectories and neurological outcomes. Moreover, our studies predicted and validated that a subset of functional regeneration parameters measured 1 to 2 weeks post-injury is sufficient to predict the regenerative outcomes of individual animals at 8 weeks post-injury. Our findings established new functional regeneration parameters and generated a comprehensive correlative database between various functional and cellular regeneration outputs.

Using Electronic Health Record Data to Examine Functional Recovery Trajectories in Adults With Acquired Brain Injury During Inpatient Rehabilitation

Abstract Date Presented 04/22/2023 The purpose of this presentation is to describe potential quality issues with using rehabilitation data extracted from electronic health records (EHRs) for research. Challenges, opportunities, and strategies for data cleaning and management will be discussed in the context of an ongoing study of rehabilitation outcomes among adults with acquired brain injury in inpatient rehabilitation at a large, urban, academic medical center. Primary Author and Speaker: Alison M. Cogan Contributing Authors: Pamela S. Roberts, Trudy Mallinson

Trajectory of Functional Recovery from 6 to 12 Months in Persons Hospitalized for Severe SARS-CoV-2 Illness

<h3>Research Objectives</h3> To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes and trajectories at 6 and 12 months post-hospitalization. <h3>Design</h3> Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. <h3>Setting</h3> Acute care and post-acute telephone follow-up. <h3>Participants</h3> English- and Spanish- speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient rehabilitation for acute COVID-19 related illness (N = 61). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Physical, cognitive, and psychological symptoms; self-reported employment status and assistance with ADLs. <h3>Results</h3> Median age 60.8 years; 59% male; 72.1% white; 72.1% non-Hispanic; 26.2% preferred assessment in Spanish. 83% required mechanical ventilation in acute care. Comorbidities were common. We found a high prevalence of persistent symptoms at 6- and 12- months across physical, cognitive, and emotional health outcome domains. Three post-acute phenotypes were identified at 6 months; a "minimally symptomatic" subgroup with minimal symptom endorsement across all domains relative to other subjects (22.95%, n = 14), a "predominantly physical symptoms" subgroup (47.54%, n = 29), and a "globally symptomatic" subgroup (29.51%, n = 18). A similar pattern for phenotypes emerges at 12-months, with 67.21% of subjects falling into the same phenotype at both time points. In the Predominantly Physical Symptom phenotype, 31.0% declined into the Globally Symptomatic Phenotype and 10.3% improved. In the Globally Symptomatic phenotype, 11.1% of participants transitioned to the Minimally Symptomatic phenotype and 16.7% to the Predominantly Physical Symptom phenotype. Compared to premorbid level of employment (50.8%), 24.6% of participants were employed at 12-months. Phenotype at 6-months was a significant predictor of employment at 12-months (B = 2.26, p = .05, OR = 9.6). <h3>Conclusions</h3> Persons with severe COVID-19 illness experience persistent functional limitations and reduced employment up to 12 months post-hospitalization. Distinct recovery subgroups were found suggesting the need for comprehensive assessment and tailored treatment for recovery. <h3>Author(s) Disclosures</h3> The authors declare no relevant conflicts of interest.

Assisted restoration interventions drive functional recovery of tropical wet forest tree communities

Choosing appropriate forest restoration interventions is challenging. Natural regeneration can rapidly facilitate forest recovery in many situations. However, barriers such as dispersal limitation and competition with non-native species can require assisted restoration approaches to facilitate plant community recovery. We used a study that has directly compared the outcomes of tropical wet forest restoration interventions across 11 replicate sites in southern Costa Rica. Within this framework, we examined the functional recovery trajectories of recruiting tree sapling communities across a gradient of restoration interventions including low (natural regeneration), intermediate (applied nucleation), and high (plantation) initial resource-investment, which we compared to remnant reference forest. We collated leaf and stem functional traits for tree species that comprised the bulk of recruiting saplings, then determined how community-weighted trait means and functional diversity metrics changed over a decade across treatments. Results show that assisted restoration approaches (applied nucleation, plantation) sped the development of more functionally diverse tree communities, more than tripling the functional richness (FRic) of recruiting communities when compared to natural regeneration. However, functional dispersion (i.e., the trait range of dominant species) was equivalent across interventions, and between 28 and 44% lower than remnant forest, indicating that increases in FRic under assisted restoration were driven by species recruiting in low abundances (&amp;lt;10 individuals across treatments). Recruits in assisted restoration treatments also had 10–15% tougher, less-palatable leaves, and leaves were even tougher in reference forest, which could be driven by increasing herbivory pressure along the gradient of interventions. Results show that tracking simple metrics such as species richness can mask a more mechanistic understanding of ecosystem recovery that is elucidated by taking a functional trait-driven approach toward evaluating outcomes. For example, our work identified a paucity of dense-wooded species recruiting across restoration interventions, wood density was 11–13% lower in restoration treatments than reference forests, underscoring such species as prime targets for enrichment planting. Overall, findings suggest that assisted restoration can catalyze the functional recovery of naturally recruiting tree communities in landscapes that are slow to recover naturally and highlight the importance of evaluating how different components of functional diversity shift over time to fully understand restoration outcomes.

MP15-01 LONGITUDINAL PATIENT-REPORTED OUTCOMES MEASURES DEMONSTRATE CONTINUED IMPROVEMENTS IN URINARY AND ERECTILE FUNCTION AFTER RADICAL PROSTATECTOMY THROUGH 30 MONTHS

You have accessJournal of UrologyCME1 May 2022MP15-01 LONGITUDINAL PATIENT-REPORTED OUTCOMES MEASURES DEMONSTRATE CONTINUED IMPROVEMENTS IN URINARY AND ERECTILE FUNCTION AFTER RADICAL PROSTATECTOMY THROUGH 30 MONTHS Daniel Frendl, Wesley Chou, Matthew Wszolek, Francis McGovern, Adam Feldman, Michael Blute, Jeffrey Twum-Ampofo, Marcela del Carmen, Marilyn Heng, Rachel Sisodia, and Douglas Dahl Daniel FrendlDaniel Frendl More articles by this author , Wesley ChouWesley Chou More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Francis McGovernFrancis McGovern More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Michael BluteMichael Blute More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , Marcela del CarmenMarcela del Carmen More articles by this author , Marilyn HengMarilyn Heng More articles by this author , Rachel SisodiaRachel Sisodia More articles by this author , and Douglas DahlDouglas Dahl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient-reported outcomes measures (PROMs) are critical for tracking quality of life and functional outcomes. Urinary incontinence and sexual dysfunction are common adverse effects experienced after radical prostatectomy (RP). PROMs may help inform patients about expected recovery after RP. We assess long-term patient-reported return of urinary and sexual function after RP in routine practice. METHODS: The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire was administered to all patients who underwent RP at our institution in 2016-2017. Questionnaires were administered preoperatively and up to 30 months postoperatively. Primary outcomes of interest were postoperative return of urinary and sexual function, respectively defined as either no urinary pads or use of one pad per day without overall urinary bother, and either erections sufficient for intercourse or erections sufficient for masturbation/foreplay without overall sexual bother. We used Kaplan-Meier estimators to evaluate time to return of these outcomes. RESULTS: Of 634 patients who underwent RP, we included 392 who completed ≥1 questionnaire; 184/392 (47%) had preoperative and postoperative responses. The mean age was 62.4 years (SD 6.5), with 93% of patients having a nerve-sparing surgery and 38% having pathologic extracapsular (≥T3a) disease (Table 1). At 12 months, unadjusted Kaplan-Meier estimates for cumulative likelihood of return of urinary function was 55%, improving to 98% by 30 months (Fig. 1A). For patients with good baseline sexual function who underwent nerve-sparing surgery, 24% reported return of sexual function by 12 months, improving to 71% at 30 months (Fig. 1B). CONCLUSIONS: Routine electronic solicitation of PROMs in our practice showed continued improvements in continence and sexual function up to 30 months postoperatively. These findings may help inform patients regarding typical functional recovery trajectories after RP. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e241 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Frendl More articles by this author Wesley Chou More articles by this author Matthew Wszolek More articles by this author Francis McGovern More articles by this author Adam Feldman More articles by this author Michael Blute More articles by this author Jeffrey Twum-Ampofo More articles by this author Marcela del Carmen More articles by this author Marilyn Heng More articles by this author Rachel Sisodia More articles by this author Douglas Dahl More articles by this author Expand All Advertisement PDF DownloadLoading ...

Time-Varying Risk Factors Associated With the Progress of Functional Recovery and Psychological Distress in First-Ever Stroke Patients.

BACKGROUND: Evaluation of stroke recovery outcome is crucial and a major goal of clinical practice. A recovery trajectory model serves as a prognostic tool that enables development of effective intervention and long-term management to improve poststroke recovery outcomes. This study explored time-varying risk factors associated with the progression of functional recovery and psychological distress poststroke. METHODS: Participants were patients with first-ever stroke who underwent assessment for activities of daily living, psychological distress, and social support at the onset (within 72 hours) and at 1, 3, and 6 months. A generalized estimation equation was used to account for the correlation between the repeated measurements. RESULTS: Of the 101 patients, 60.4% were men, and the mean (SD) age was 63.06 (13.12) years. Over time, the physical functions of patients after stroke significantly increased, and anxiety and depression significantly decreased. Approximately 50% of patients achieved full functional recovery after 6 months. The time-varying risk factors for National Institutes of Health Stroke Scale scores and depression levels affected the trajectory of functional recovery during follow-up. Factors associated with patient anxiety levels were National Institutes of Health Stroke Scale scores and depression levels. Factors associated with patient depression levels included education, anxiety, and social support levels. CONCLUSION: This study demonstrates the progression of time-varying risk factors for functional recovery and psychological distress in patients with first-ever stroke. We recommend that nurses work with patients and their families in the early poststroke stages to identify comprehensive goals based on individual needs and related factors at different stages and that they educate patients on what is required for them to regain independence.

Abstract 7: Quality Of Life Trajectories In The Year After Large Vessel Occlusion Stroke And Their Association With 90-day Functional Outcome

Background: While research has focused on the trajectory of functional recovery after ischemic stroke, the trajectory of quality of life (QoL) has not been fully explored, nor has its relation to functional recovery. Methods: In a post hoc analysis of the IMS-III trial, we included patients with an imaging-confirmed large vessel occlusion and QoL assessed as EQ-5D at 5 study visits up to 1 year after ischemic stroke onset. We used group-based trajectory modelling (GBTM) to identify trajectories of EQ-5D index values with US-based weights and report patient demographics in each trajectory and the modified Rankin Scale (mRS) score at 90 days. Results: We included 266 patients, who had QoL measured at a mean of 4.6, 93.0, 184.3, 274.3, and 367.6 days after stroke onset. GBTM identified four trajectories with excellent fit (Figure). These QoL trajectories can be described as [1] persistent low, [2] low to medium, [3] persistent medium, and [4] medium to high. The corresponding mRS at 90 days are shown in the Figure, demonstrating a clustering of trajectories by mRS but also a diversity of trajectories. In particular, low to medium and persistent medium trajectories are represented across all mRS scores. Patient demographics are shown by trajectory in the Table, with significant differences in sex, baseline NIHSS, infarct volume, WMH burden, and diabetes. Conclusion: We demonstrate four distinct trajectories of QoL in the year after large vessel occlusion stroke, with a diversity of functional recovery and unique demographic compositions. Early recognition of a likely future QoL trajectory could suggest patient-specific rehabilitation therapies and inform prognostication and goals of care.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome Results in 2 Recovery Patterns Based on Preoperative Pain and on Arthritis: Improvers and Non-improvers

PurposeTo analyze whether subgroups of patients could be distinguished with different functional recovery trajectories after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify differences between those subgroups using data from our prospective cohort registration.MethodsWe retrospectively reviewed the prospectively registered data of patients who had undergone hip arthroscopy for FAI syndrome in our clinic from 2015 through 2018. Latent class growth modeling and growth mixture modeling were used to identify and classify groups of patients according to the trajectory of functional recovery using the Hip Outcome Score–Activities of Daily Life (HOS-ADL). We used univariable analysis and descriptive statistics to explore whether differences in group membership could be identified.ResultsA total of 100 patients were analyzed. Growth mixture modeling identified 2 main types of recovery pattern after surgery: patients in whom the HOS-ADL improved significantly after surgery to 90, whom we called the “improvers” (with fast initial improvement within 3 months that is maintained during follow-up), and patients who did not significantly benefit from surgery (with only mild improvement in the HOS-ADL at 3 months and no further change during follow-up), whom we called the “non-improvers.” Univariable analysis and comparison of differences between subgroups showed higher preoperative visual analog scale scores for pain and more intraoperative arthrosis of the femoral head for the non-improvers.ConclusionsWe identified 2 main types of recovery pattern after arthroscopic treatment of FAI syndrome: improvers and non-improvers. Both groups recover in a different manner postoperatively. Preoperative pain and intraoperative arthrosis of the femoral head differed in the non-improvers compared with the improvers.Level of evidenceLevel III, retrospective cohort study.

Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery.

This study aimed to investigate the trajectory of functional recovery of activities of daily living (ADL) from the time of admission up to hospital discharge, and explored which preoperative and postoperative variables were independently associated with functional decline in ADL at discharge of patients after cardiovascular surgery. In this observational study, we evaluated ADL preoperatively and at discharge using the Functional Independence Measure (FIM) in patients after cardiovascular surgery. Functional decline in ADL was defined as scoring 1-5 on any one of the FIM items at discharge. Multiple logistic regression was performed to predict the functional decline in ADL at discharge. We found that 18.8% of elective cardiovascular surgery patients suffered from decreased ADL at discharge. The Mini-Mental State Examination (odds ratio (OR): 0.573, 95% confidence interval (CI): 0.420-0.783), gait speed (OR: 0.032, 95% CI: 0.003-0.304) and initiation of walking around the bed (OR: 1.277, 95% CI: 1.103-1.480) were independently associated with decreased ADL at discharge. A functional decline in ADL at discharge can be predicted using preoperative measures of cognitive function, preoperative gait speed and postoperative day of initiation of walking. These results show that preoperative cognitive screening and gait speed assessments can be used to identify patients who might require careful postoperative planning, and for whom early postoperative rehabilitation is needed to prevent serious functional ADL deficits.

Comparison between Ischemic and Hemorrhagic Strokes in Functional Outcome at Discharge from an Intensive Rehabilitation Hospital.

Comparison studies on recovery outcomes in ischemic (IS) and hemorrhagic strokes (HS) have yielded mixed results. In this retrospective observational study of consecutive IS and HS patients, we aimed at evaluating functional outcomes at discharge from an intensive rehabilitation hospital, comparing IS vs. HS, analyzing possible predictors. Modified Rankin Scale (mRS) at discharge was the main outcome. Out of the 229 patients included (mean age 72.9 ± 13.9 years, 48% males), 81 had HS (35%). Compared with IS (n = 148), HS patients were significantly younger (75 ± 12.5 vs. 68.8 ± 15.4 years, p = 0.002), required longer hospitalizations both in acute (23.9 ± 36.7 vs. 35.2 ± 29.9 days, p = 0.019) and rehabilitation hospitals (41.5 ± 31.8 vs. 77.2 ± 51.6 days, p = 0.001), and had more severe initial clinical deficit (mean number of neurological impairments: 2.0 ± 1.1 vs. 2.6 ± 1.4, p = 0.001) and mRS scores at admission (p = 0.046). At discharge, functional status change, expressed as mRS, was not significantly different between IS and HS (F = 0.01, p = 0.902), nor was the discharge destination (p = 0.428). Age and clinical severity were predictors of functional outcome in both stroke types. On admission in an intensive rehabilitation hospital, HS patients presented a worse functional and clinical status compared to IS. Despite this initial gap, the two stroke types showed an overlapped trajectory of functional recovery, with age and initial stroke severity as the main prognostic factors.

Distinct Trajectories of Recovery Within the First Year After Hip Fracture

Hip fracture patients experience heterogenous pathways of recovery. Knowing about these different groups can guide rehabilitation efforts. The sample was 339 hip fracture patients age 65+ recruited to the Baltimore Hip Studies 7th cohort [2006-2011; men(n=168) women(n=171)] assessed at baseline, 2.6, and 12 months. Group based trajectory modeling assessed participants’ cognitive and functional recovery trajectories as measured by the Modified Mini-Mental State Examination(3MS;0-100), Hooper Visual Organization Task(HVOT,0-30), Trail-Making Task(TrailsA,B:0-301s), Short Physical Performance Battery(SPPB,0-12), Lower Extremity Physical Activities of Daily Living(LPADL,0-12), and physical activity (YALE, hours/week). Participants were on average 80.91(7.88) years old with 13(3.41) years of education. Two groups were identified for Trails A [Consistent high performance (85.3%), declined performance (14.6%)] and YALE [low exercise(94.9%), small decline(5.0%)]. Three groups were identified for 3MS [consistently high(76.3%), consistently borderline(17.1%), consistently low-performing(6.4%)] and SPPB [failure(19.3%), low-performing with small improvement(55.7%), moderate improvement(24.9%)]. Four groups were identified for HVOT[low scoring(14.2%), mid-range(31.9%), borderline(32.4%), well-performing(21.3%)], Trails B [consistent high-performance(40.2%), improved(18.6%), declined(12.0%), consistent failure(29.1%)], and LPADL[low-performing(27.0%), small improvement(50.0%), dramatic improvement(17.0%), high-performing(5.7%)]. The polynomial functions of the trajectory groups were primarily quadratic with some cubic functions best representing the recovery trajectories. Many of the groups have similar trajectories but at different magnitudes. For most tests performance at baseline was able to differentiate performance at 1 year. These data show that there are very few changes in high or low performing groups, but mid-range participants can experience volatility.

Heterogeneity of Outcomes and Network Connectivity in Early-Stage Psychosis: A Longitudinal Study.

Imaging studies in psychotic disorders typically examine cross-sectional relationships between magnetic resonance imaging (MRI) signals and diagnosis or symptoms. We sought to examine changes in network connectivity identified using resting-state functional MRI (fMRI) corresponding to divergent functional recovery trajectories and relapse in early-stage psychosis (ESP). Prior studies have linked schizophrenia to hyperconnectivity in the default mode network (DMN). Given the correlations between the DMN and behavioral impairments in psychosis, we hypothesized that dynamic changes in DMN connectivity reflect the heterogeneity of outcomes in ESP. Longitudinal data were collected from 66 ESP patients and 20 healthy controls. Longitudinal cluster analysis identified subgroups of patients with similar trajectories in terms of symptom severity and functional outcomes. DMN connectivity was measured in a subset of patients (n = 36) longitudinally over 2 scans separated by a mean of 12 months. We then compared connectivity between patients and controls, and among the different outcome trajectory subgroups. Among ESP participants, 4 subgroups were empirically identified corresponding to: "Poor," "Middle," "Catch-up," and "Good" trajectory outcomes in the complete dataset (n = 36), and an independent replication (n = 30). DMN connectivity changes differed significantly between functional subgroups (F3,32 = 6.06, P-FDR corrected = .01); DMN connectivity increased over time in the "Poor" outcome cluster (β = +0.145) but decreased over time in the "Catch-up" cluster (β = -0.212). DMN connectivity is dynamic and correlates with a change in functional status over time in ESP. This approach identifies a brain-based marker that reflects important neurobiological processes required to sustain functional recovery.

Effect of Preexisting and Co-Occurring Comorbid Conditions on Recovery in the 5 Years After Rehabilitation for Traumatic Brain Injury.

To determine the relationship between comorbid health conditions and the trajectory of functional recovery 5 years following traumatic brain injury (TBI) rehabilitation. Two acute rehabilitation facilities. A total of 407 patients with primary diagnosis of TBI. Prospective, observational. Functional Independence Measure Cognitive and Motor scores. Female gender was negatively associated with the trajectory of motor recovery (P < .001). TBI severity was negatively associated with both motor and cognitive recovery and interacted with time after injury (both Ps < .0001). Hypertension was negatively associated with both motor (P < .0001) and cognitive (P = .0121) recovery, although this relationship diminished over time for motor function (P = .0447). Cardiac conditions were negatively associated with motor recovery (P = .0204), and rate of cognitive recovery was more rapid for patients with cardiac conditions (P = .0088). Depressed patients recovered cognitive function more quickly than those who were not depressed (P = .0196). Diabetes was negatively associated with motor function (P = .0088). Drug/alcohol use was positively associated with motor function (P = .0036). Injury severity remains an important predictor of long-term recovery; however, certain comorbid medical conditions are negatively associated with functional abilities over the first 5 years after injury. Patients being discharged from TBI rehabilitation with comorbid cardiac, hypertensive, diabetic, and/or depressive conditions may benefit from early and ongoing clinical surveillance.

The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries.

Describe the trajectory of functional recovery for patients with surgically treated unstable pelvic ring injuries from baseline to 5 years. Prospective cohort study. Level I Trauma Center. One hundred eight adult patients with surgically treated pelvic fractures (72% OTA/AO 61 B1-B3 and 28% OTA/AO 61 C1-C3) were enrolled into the institutions orthopaedic trauma database between 2004 and 2015. The cohort was 78% men with a mean age of 44.9 years and injury severity score of 16.9. Surgical pelvic stabilization. Function was measured at baseline and prospectively at 6 months, 1, and 5 years postoperatively using the Short Form-36 Physical Component Score (SF-36 PCS). The trajectory was mapped, and the proportion of patients achieving a minimal clinically important difference (MCID) between time points was determined. The mean SF-36 PCS improved for the entire group between 6 and 12 months (P = 0.001) and between 1 and 5 years (P = 0.02), but did not return to baseline at 5 years (P < 0.0001). The proportion of patients achieving a MCID between 6 and 12 months and 1 and 5 years was 75% and 60%, respectively. The functional level was similar between type B and C groups at baseline (P = 0.5) and 6 months (P = 0.2); however, the type B cohort reported higher scores at 1 year (P = 0.01) and 5 years (P = 0.01). Neither group regained their baseline function (P < 0.0001). Functional recovery for patients with surgically treated pelvic fractures is characterized by an initial decline in function, followed by sharp improvement between 6 and 12 months, and continued steady improvement between 1 and 5 years. Type B injuries show better early recovery than type C and reach a higher level of function at the final follow-up. Despite the proportion of patients achieving MCID, patients do not regain the preinjury level of function. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fast Starters, Slow Starters, and Late Dippers: Trajectories of Patient-Reported Outcomes After Total Hip Arthroplasty: Results from a Dutch Nationwide Database.

The purpose of this study was to explore whether subgroups of patients with different functional recovery trajectories after total hip arthroplasty can be discerned, as well as their predictors, using data from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten [LROI]). We retrospectively reviewed prospectively collected Oxford Hip Scores (OHS) up to 1 year postoperatively for patients who had undergone a primary total hip arthroplasty. Latent class growth modeling was used to classify subgroups of patients according to the trajectory of functional recovery represented by the patients' OHS. We used multivariable multinomial logistic regression analysis to explore factors associated with class membership. A total of 6,030 patients were analyzed. Latent class growth modeling identified fast starters (fast initial improvement, high 12-month scores; 87.7%), slow starters (no initial change and subsequent improvement; 4.6%), and late dippers (initial improvement and subsequent deterioration; 7.7%). Factors associated with slow starters were female sex (odds ratio [OR], 1.63 [95% confidence interval (CI), 1.14 to 2.33]) and smoking (OR, 1.95 [95% CI, 1.26 to 3.03]); an anterior approach (OR, 0.47 [95% CI, 0.29 to 0.78]) had a protective effect against a less favorable response. Factors associated with late dippers were age of >75 years (OR, 1.62 [95% CI, 1.22 to 2.15]), smoking (OR, 1.68 [95% CI, 1.17 to 2.42]), American Society of Anesthesiologists (ASA) grade of III or IV (OR, 1.41 [95% CI, 1.05 to 1.91]), obesity (OR, 1.96 [95% CI, 1.43 to 2.69]), poorer EuroQol-5 Dimensions (EQ-5D) Self-Care (OR, 1.41 [95% CI, 1.09 to 1.82] for "some problems" and OR, 2.90 [95% CI, 1.39 to 6.03] for "unable"), poorer EQ-5D Anxiety/Depression (OR, 1.31 [95% CI, 1.00 to 1.71] for "moderately" and OR, 1.86 [95% CI, 1.06 to 3.24] for "extremely"), poorer EQ-5D visual analog scale (OR, 0.91 [95% CI, 0.86 to 0.97] per 10 points), direct lateral approach (OR, 2.18 [95% CI, 1.58 to 3.02]), and hybrid fixation with a cemented acetabular implant (OR, 1.79 [95% CI, 1.00 to 3.21]). We discerned fast starters, slow starters, and late dippers after total hip arthroplasty. Female sex, older age, obesity, higher ASA grades, and worse EQ-5D scores were associated with a less favorable response to total hip arthroplasty, as well as hybrid fixation (cemented acetabular implant) and direct lateral approach. Anterior approach had a protective effect against a less favorable response. However, all subgroups experienced functional improvement following total hip arthroplasty. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Divergent Six Month Functional Recovery Trajectories and Predictors after Traumatic Brain Injury: Novel Insights from the Citicoline Brain Injury Treatment Trial Study.

Cross-sectional approaches to outcome assessment may not adequately capture heterogeneity in recovery after traumatic brain injury (TBI). Using latent class mixed models (LCMM), a data-driven analytic that identifies groups of patients with similar trajectories, we identified distinct 6 month functional recovery trajectories in a large cohort (n = 1046) of adults 18-70 years of age with complicated mild to severe TBI who participated in the Citicoline Brain Injury Treatment Trial (COBRIT). We used multinomial logistic fixed effect models and backward elimination, forward selection, and forward stepwise selection with several stopping rules to explore baseline predictors of functional recovery trajectory. Based on statistical and clinical considerations, the seven-class model was deemed superior. Visualization of these seven functional recovery trajectories revealed that each trajectory class started at one of three recovery levels at 1 month, which, for ease of reference we labeled groups A-C: Group A, good recovery (two classes; A1 and A2); Group B, moderate disability (two classes; B1 and B2); and Group C, severe disability (three classes; C1, C2, and C3). By 6 months, these three groups experienced dramatically divergent trajectories. Group A experienced stable good recovery (A1, n = 115) or dramatic decline (A2, n = 4); Group B experienced rapid complete recovery (B1, n = 71) or gradual recovery (B2, n = 742); Group C experienced dramatic rapid recovery (C1, n = 12), no recovery (C2, n = 91), or death (C3, n = 11). Trajectory class membership was not predicted by citicoline treatment (p = 0.57). The models identified demographic, pre-injury, and injury-related predictors of functional recovery trajectory, including: age, race, education, pre-injury employment, pre-injury diabetes, pre-injury psychiatric disorder, site, Glasgow Coma Scale (GCS) score, post-traumatic amnesia, TBI mechanism, major extracranial injury, hemoglobin, and acute computed tomographic (CT) findings. GCS was the most consistently selected predictor across all models. All models also selected at least one demographic or pre-injury medical predictor. LCMM successfully identified dramatically divergent, clinically meaningful 6 month recovery trajectories with utility to inform clinical trial design.