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

Open AccessPublished:November 17, 2022DOI:https://doi.org/10.1016/j.jclinepi.2022.10.021
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      Abstract

      Objective

      To develop the FRIDA (Functional Risk Index for Dependence in Ambulation) score, a nomogram to predict individual risk of dependence in ambulation at discharge (DAD) from post-acute 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 8796 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 3026 patients (34.4%) were discharged with DAD. In the training set of 5162 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 a set of 3234 patients (41.3%), meta-analysis showed that the FRIDA score had good homogeneous discrimination (I2= 0.0%) (synthetic AUC 0.84, 95% CI= 0.83-0.86) combined with accurate calibration (synthetic Log O/E ratio 0.02, 95% CI -0.16-0.19). These performances remained stable at spatial validation obtained on 3626 patients from 9 facilities, with higher heterogeneity. Decision curve analyses showed that a FRIDA score-supported strategy far outperformed the usual "treat all" approach in each impairment categories.

      Conclusions

      The FRIDA score is a new clinically useful tool to predict individual risk for dependence in ambulation at rehabilitation discharge across many different disabilities.

      Graphical abstract

      Keywords

      Abbreviations:

      DAD (Dependence in Ambulation at Discharge), DCA (Decision Curve Analysis), FRIDA (Functional Risk Index to predict Dependence in Ambulation), IMCs (Indicators of Medical Complexity), IPER-2.0 (Indicators for Performance Evaluation in Rehabilitation, version 2.0), mRS (modified Rankin Scale), RICs (Rehabilitation Impairment Categories)