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Establishing Minimal Clinically Important Differences for the Cognitive and Linguistic Scale (CALS) in Pediatric
Adrian M Svingos1, Rob J Forsyth2, Ludvik Alkhoury3
1Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
This study estimated the minimal clinically important difference (MCID) for Cognitive Ability Estimates (CAE) derived from the Cognitive and Linguistic Scale (CALS). Results suggest an MCID of 4-7 CAE units for children with acquired brain injury.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Psychometrics
Background:
- The Cognitive and Linguistic Scale (CALS) is used to monitor cognitive recovery in children post-acquired brain injury.
- Cognitive Ability Estimates (CAE) derived from CALS are Rasch-propertied, suitable for research and clinical trials.
- Establishing a minimal clinically important difference (MCID) for CAE is crucial for interpreting study outcomes.
Purpose of the Study:
- To estimate the MCID for CAE derived from the CALS in pediatric patients undergoing inpatient rehabilitation.
- To provide data that aids in the design and interpretation of clinical studies utilizing CALS CAE.
Main Methods:
- Retrospective study design.
- Involved 252 pediatric patients (aged 1.9-21.6 years) admitted for inpatient rehabilitation after acquired brain injury.
- Utilized established statistical distribution-based and expert consensus-based methods to estimate MCID.
Main Results:
- The study estimated the MCID for CAE derived from the CALS.
- Results indicate a MCID of approximately 4-7 CAE units.
Conclusions:
- The estimated MCID for CALS CAE provides valuable benchmarks for clinical research.
- These findings will assist researchers in designing and interpreting studies involving cognitive recovery after acquired brain injury using the CALS.
Objective:
The Cognitive and Linguistic Scale (CALS) was developed to serially monitor cognitive recovery of children and young people after severe acquired brain injury, during inpatient rehabilitation. The CALS can be used to derive Cognitive Ability Estimates (CAE), which are Rasch-propertied (unidimensional, interval-scale) and therefore may be ideally applied for use in research including within the context of clinical trials. Here, we used established statistical distribution-based and expert consensus-based methods to estimate the minimal clinically important difference (MCID) for CAE derived from the CALS.
Design:
Retrospective study.
Setting:
Pediatric inpatient rehabilitation hospital.
Participants:
252 patients consecutively admitted for inpatient rehabilitation after acquired brain injury (46% traumatic brain injury); age at injury ranging from 1.9 to 21.6 years (median, 11.8 years).
Interventions:
Not applicable.
Main Outcome Measures:
MCID estimates.
Results:
Together, results suggest a MCID of approximately 4-7 CAE units.
Conclusions:
These data can be used to aid in the design and interpretation of clinical studies proposing to use the CALS CAE as an outcome measure.
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