Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke

Stroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends...

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Autores: Garcia-Rudolph, Alejandro|||0000-0003-0853-8334, Opisso, Eloy|||0000-0002-6868-6737, Tormos, Jose M.|||0000-0002-8764-2289, Madai, Vince|||0000-0002-8552-6954, Frey, Dietmar|||0000-0001-5407-2331, Becerra, Helard|||0000-0003-2652-3195, Kelleher, John D.|||0000-0001-6462-3248, Bernabeu Guitart, Montserrat|||0000-0003-2037-3069, López, Jaume|||0000-0002-0614-0798
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:250512
Acceso en línea:https://ddd.uab.cat/record/250512
https://dx.doi.org/urn:doi:10.2196/28090
Access Level:acceso abierto
Palabra clave:Cognitive rehabilitation
Elo rating
Predictors
Stroke rehabilitation
Web-based tasks
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network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
Elo Rating Approach
title Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
spellingShingle Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
Garcia-Rudolph, Alejandro|||0000-0003-0853-8334
Cognitive rehabilitation
Elo rating
Predictors
Stroke rehabilitation
Web-based tasks
title_short Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
title_full Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
title_fullStr Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
title_full_unstemmed Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
title_sort Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke
dc.creator.none.fl_str_mv Garcia-Rudolph, Alejandro|||0000-0003-0853-8334
Opisso, Eloy|||0000-0002-6868-6737
Tormos, Jose M.|||0000-0002-8764-2289
Madai, Vince|||0000-0002-8552-6954
Frey, Dietmar|||0000-0001-5407-2331
Becerra, Helard|||0000-0003-2652-3195
Kelleher, John D.|||0000-0001-6462-3248
Bernabeu Guitart, Montserrat|||0000-0003-2037-3069
López, Jaume|||0000-0002-0614-0798
author Garcia-Rudolph, Alejandro|||0000-0003-0853-8334
author_facet Garcia-Rudolph, Alejandro|||0000-0003-0853-8334
Opisso, Eloy|||0000-0002-6868-6737
Tormos, Jose M.|||0000-0002-8764-2289
Madai, Vince|||0000-0002-8552-6954
Frey, Dietmar|||0000-0001-5407-2331
Becerra, Helard|||0000-0003-2652-3195
Kelleher, John D.|||0000-0001-6462-3248
Bernabeu Guitart, Montserrat|||0000-0003-2037-3069
López, Jaume|||0000-0002-0614-0798
author_role author
author2 Opisso, Eloy|||0000-0002-6868-6737
Tormos, Jose M.|||0000-0002-8764-2289
Madai, Vince|||0000-0002-8552-6954
Frey, Dietmar|||0000-0001-5407-2331
Becerra, Helard|||0000-0003-2652-3195
Kelleher, John D.|||0000-0001-6462-3248
Bernabeu Guitart, Montserrat|||0000-0003-2037-3069
López, Jaume|||0000-0002-0614-0798
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Cognitive rehabilitation
Elo rating
Predictors
Stroke rehabilitation
Web-based tasks
topic Cognitive rehabilitation
Elo rating
Predictors
Stroke rehabilitation
Web-based tasks
description Stroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients' skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients' skills to optimize rehabilitation outcomes. This study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R 2 for linear regressions. Three Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P <.001). The proportions of patients from the mid-Elo level that performed tasks at difficulty levels 1, 2, and 3 were 32.1% (3997/12,449), 31.% (3997/12,449), and 36.9% (4595/12,449), respectively (P <.001), showing the highest match between skills (represented by Elo level) and task difficulties, considering the set of 38,177 task executions. Elo ratings were significant predictors in three of the four models and quasi-significant in the fourth. When predicting RAVLT075 and DIGITS at discharge, we obtained R 2 =0.54 and 0.43, respectively; meanwhile, we obtained AUC=0.73 (95% CI 0.64-0.82) and AUC=0.81 (95% CI 0.72-0.89) in RAVLT075 and DIGITS improvement predictions, respectively. Elo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels.
publishDate 2021
dc.date.none.fl_str_mv 2
2021-01-01
2021
2021-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/250512
https://dx.doi.org/urn:doi:10.2196/28090
url https://ddd.uab.cat/record/250512
https://dx.doi.org/urn:doi:10.2196/28090
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv European Commission https://doi.org/10.13039/501100000780 777107
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic StrokeElo Rating ApproachGarcia-Rudolph, Alejandro|||0000-0003-0853-8334Opisso, Eloy|||0000-0002-6868-6737Tormos, Jose M.|||0000-0002-8764-2289Madai, Vince|||0000-0002-8552-6954Frey, Dietmar|||0000-0001-5407-2331Becerra, Helard|||0000-0003-2652-3195Kelleher, John D.|||0000-0001-6462-3248Bernabeu Guitart, Montserrat|||0000-0003-2037-3069López, Jaume|||0000-0002-0614-0798Cognitive rehabilitationElo ratingPredictorsStroke rehabilitationWeb-based tasksStroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients' skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients' skills to optimize rehabilitation outcomes. This study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R 2 for linear regressions. Three Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P <.001). The proportions of patients from the mid-Elo level that performed tasks at difficulty levels 1, 2, and 3 were 32.1% (3997/12,449), 31.% (3997/12,449), and 36.9% (4595/12,449), respectively (P <.001), showing the highest match between skills (represented by Elo level) and task difficulties, considering the set of 38,177 task executions. Elo ratings were significant predictors in three of the four models and quasi-significant in the fourth. When predicting RAVLT075 and DIGITS at discharge, we obtained R 2 =0.54 and 0.43, respectively; meanwhile, we obtained AUC=0.73 (95% CI 0.64-0.82) and AUC=0.81 (95% CI 0.72-0.89) in RAVLT075 and DIGITS improvement predictions, respectively. Elo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels.Universitat Autònoma de Barcelona 22021-01-0120212021-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/250512https://dx.doi.org/urn:doi:10.2196/28090reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengEuropean Commission https://doi.org/10.13039/501100000780 777107open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2505122026-06-06T12:50:31Z
score 15.301629

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