Informing the development of an outcome set and banks of items to measure mobility among individuals with acquired brain injury using natural language processing

Abstract

Background The sheer number of measures evaluating mobility and inconsistencies in terminology make it challenging to extract potential core domains and items. Automating a portion of the data synthesis would allow us to cover a much larger volume of studies and databases in a smaller fraction of the time compared to the usual process. Thus, the objective of this study was to identify a comprehensive outcome set and develop preliminary banks of items of mobility among individuals with acquired brain injury (ABI) using Natural Language Processing (NLP). Methods An umbrella review of 47 reviews evaluating the content of mobility measures among individuals with ABI was conducted. A search was performed on 5 databases between 2000 and 2020. Two independent reviewers retrieved copies of the measures and extracted mobility domains and items. A pre-trained BERT model (state-of-the-art model for NLP) provided vector representations for each sentence. Using the International Classification of Functioning, Disability, and Health Framework (ICF) ontology as a guide for clustering, a k-means algorithm was used to retrieve clusters of similar sentences from their embeddings. The resulting embedding clusters were evaluated using the Silhouette score and fine-tuned according to expert input. Results The study identified 246 mobility measures, including 474 domains and 2109 items. Encoding the clusters using the ICF ontology and expert knowledge helped in regrouping the items in a way that is more closely related to mobility terminology. Our best results identified banks of items that were used to create a 24 comprehensive outcome sets of mobility, including Upper Extremity Mobility, Emotional Function, Balance, Motor Control, Self-care, Social Life and Relationships, Cognition, Walking, Postural Transition, Recreation, and Leisure Activities, Activities of Daily Living, Physical Functioning, Communication, Work/Study, Climbing, Sensory Functions, General Health, Fatigue, Functional Independence, Pain, Alcohol and Drugs Use, Transportation, Sleeping, and Finances. Conclusion The banks of items of mobility domains represent a first step toward establishing a comprehensive outcome set and a common language of mobility to develop the ontology. It enables researchers and healthcare professionals to begin exposing the content of mobility measures as a way to assess mobility comprehensively.

Implementation of an Interprofessional Mobility Program in a Neurosurgical Intensive Care Unit

“…The act of moving from one position to another is not always recognized as a mobility event. 3 This is exacerbated by a lack of established standards around mobility in the adult patient population, particularly in neurosurgical units, where the impact of mobility protocols, guidelines, or programs has not been widely studied. 4 In addition to high acuity levels, neurosurgical patients have unique needs that may impact participation in mobility activities, including neurological deficits such as spinal instability, tissue plasminogen activator administration, bed rest restrictions associated with endovascular intervention, increased intracranial pressure, hemodynamic instability, femoral sheaths, spine traction, continuous renal replacement therapy, and advanced modes of ventilation.…”

“…The act of moving from one position to another is not always recognized as a mobility event. 3 This is exacerbated by a lack of established standards around mobility in the adult patient population, particularly in neurosurgical units, where the impact of mobility protocols, guidelines, or programs has not been widely studied. 4…”