Rehabilitation outcomes after comprehensive post-acute inpatient rehabilitation following moderate to severe acquired brain injury – study protocol for an overall prognosis study based on routinely collected health record data

Abstract

Background The initial theme of the PROGRESS framework for prognosis research is termed overall prognosis research. Its aim is to describe the most likely course of health conditions in the context of current care. These average group level prognoses may be used to inform patients, health policies, trial designs or further prognosis research. Acquired brain injury, such as stroke, traumatic brain injuries or encephalopathy, is a major cause of disability and functional limitations, worldwide. Nevertheless, rehabilitation, aiming at maximizing independent functioning and meaningful participation in society post-injury, is considered both effective and cost-effective. While some observational studies, in theory, allow an inference of the overall prognosis of the level of independent functioning, the context for the provision of rehabilitation is often only sparsely described. The aim of this protocol is to provide a detailed account of the clinical context to aid the interpretation of our upcoming overall prognosis study. Methods The study will take place at a Danish post-acute inpatient rehabilitation facility providing specialised inpatient rehabilitation for individuals with moderate to severe acquired brain injury. Routinely collected electronic health record data will be extracted from the healthcare provider's database and deterministically linked on an individual level to construct the study cohort. The study period spans from March 2011 to December 2022. Four outcome measure for the level of functioning and rehabilitation needs will be described, both for the entire cohort, across rehabilitation complexity levels and stratified for relevant demographic and clinical parameters. Descriptive statistics will be used to estimate average prognoses for the level of functioning at discharge from post-acute rehabilitation. The patterns of missing data will be investigated. Discussion As the estimates will be based on routinely collected clinical data we deem the present account of particular importance. This protocol is intended provide transparency in our upcoming study, thus aiding the readers to interpret the overall prognosis estimates within the context of our current clinical practice and assess potential sources of bias independently.