A multicenter prospective study validated a nomogram to predict individual risk of dependence in ambulation after rehabilitation

Bruno Bernardini; Luigi Baratto; Costanza Pizzi; Annibale Biggeri; Giovanna Cerina; Viviana Colantonio; Carla Corsini; Sara Ghirmai; Marco Pagani; Stefania Fracchia; Marisa Gardella; Dolores Catelan; Maria Luisa Malosio; Elisa Malagamba

doi:10.1016/j.jclinepi.2022.10.021

A multicenter prospective study validated a nomogram to predict individual risk of dependence in ambulation after rehabilitation

J Clin Epidemiol. 2023 Feb:154:97-107. doi: 10.1016/j.jclinepi.2022.10.021. Epub 2022 Nov 17.

Authors

Affiliations

¹ IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy. Electronic address: bruno.bernardini@humanitas.it.
² Department of Rehabilitation, La Colletta Hospital, Arenzano, Italy.
³ Department of Medical Sciences, University of Turin, Turin, Italy.
⁴ Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence (FI), Florence, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua (PD), Padua, Italy.
⁵ IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy.
⁶ Geriatric Internal Medicine Unit, Garbagnate Hospital, Garbagnate Milanese, Milan, Italy.
⁷ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua (PD), Padua, Italy.
⁸ Institute of Neuroscience, National Research Council (CNR), Milan, Italy; Laboratory of Pharmacology and Pathology of the Nervous System, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁹ Department of Health Services of Liguria Region, Genoa, Italy.

PMID: 36403886
DOI: 10.1016/j.jclinepi.2022.10.021

Abstract

Objectives: To develop the Functional Risk Index for Dependence in Ambulation (FRIDA) score, a nomogram to predict individual risk of dependence in ambulation at discharge from postacute rehabilitation and validate its performance temporally and spatially.

Study design and setting: We analyzed the database of a multicenter prospective observational quality cohort study conducted from January 2012 to March 2016, including data from 8,796 consecutive inpatients who underwent rehabilitation after stroke, hip fracture, lower limb joint replacement, debility, and other neurologic, orthopedic, or miscellaneous conditions.

Results: A total of 3,026 patients (34.4%) were discharged dependent in ambulation. In the training set of 5,162 patients (58.7%), Lasso-regression selected advanced age, premorbid disability, and eight indicators of medical and functional adverse syndromes at baseline to establish the FRIDA score. At the temporal validation obtained on an external set of 3,234 patients (41.3%), meta-analyses showed that the FRIDA score had good and homogeneous discrimination (summary area under the curve 0.841, 95% confidence interval = 0.826-0.855, I² = 0.00%) combined with accurate calibration (summary Log O/E ratio 0.017, 95% confidence interval -0.155 to 0.190). These performances remained stable at spatial validation obtained on 3,626 patients, with substantial heterogeneity of estimates across nine facilities. Decision curve analyses showed that a FRIDA score-supported strategy far outperformed the usual "treat all" approach in each impairment categories.

Conclusion: The FRIDA score is a new clinically useful tool to predict an individual risk for dependence in ambulation at rehabilitation discharge in many different disabilities, and may also reflect well the case-mix composition of the rehabilitation facilities.

Keywords: Adverse clinical syndromes; Care pathways; Decision curve analysis; Lasso regression; Postacute rehabilitation; Prognostic nomogram.

Publication types

Observational Study
Multicenter Study

MeSH terms

Cohort Studies
Hip Fractures*
Humans
Nomograms*
Prospective Studies
Walking