Recovery Hints from Massive Study

2015-1016 EBP

Excerpt of article by Daphne Chen |

For decades, clinicians who help patients recover from traumatic brain injuries have been operating in what David Ryser, medical director of the Intermountain Medical Center Neuro Specialty Rehabilitation Unit in Murray calls a “black box.” There are hundreds of processes going on during rehabilitation, said Ryser. To suggest, “inpatient rehabilitation helps is kind of a blanket statement and not well-defined.”

Researchers have struggled for years to pinpoint what part of the extensive brain injury rehab process is doing the trick — and why it works.

Those are the questions Ryser and Susan Horn, an adjunct professor of biomedical informatics at the University of Utah and a pioneer of “practice-based evidence,” set out to answer seven years ago when they launched a massive study on traumatic brain injury rehabilitation. That study, published in August, involved more than 2,000 subjects at 10 rehabilitation centers across the U.S. and Canada (one of them headed by Ryser, at Intermountain).

Traumatic brain injury has numerous health effects — cognitive, physical and mental — that affects each individual differently. An almost infinite list of factors, like the intensity of treatment, the combination with other types of treatment, or even pre-injury factors like age or family support, can affect outcomes. There isn’t one “typical” brain injury patient. And that’s what makes rehab so hard to study.

The best way to pinpoint what works, Horn contends, is “practice-based evidence” — an emerging research methodology that has drawn controversy for not relying on the gold standard of the randomized controlled trial, which works by comparing patients who get a treatment with patients who don’t in carefully designed experiments.

Practice-based evidence requires excruciatingly detailed data on treatments as they’re happening in the real world. There are no control groups — everyone gets a treatment — and sophisticated statistical modeling is used to tease out which treatments have effects.

The resulting database — with more than 1,000 clinicians contributing written notes on 350,000 therapy sessions — has millions upon millions of data points and is likely the richest database on traumatic brain injury rehab ever assembled, Ryser said.

To read the complete article by Daphne Chen, click here.


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Thanks to Daphne Chen for writing the article; for committing its resources to the article; David Ryser and Susan Horn for conducting the study and contributing to the article; Google for helping me find the article; and all the people who, directly or indirectly, made it possible for me to include the picture and text in this post.


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