Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach
BackgroundStroke 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...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2021-11-01
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| Series: | JMIR Medical Informatics |
| Online Access: | https://medinform.jmir.org/2021/11/e28090 |
| _version_ | 1797735597116227584 |
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| author | Alejandro Garcia-Rudolph Eloy Opisso Jose M Tormos Vince Istvan Madai Dietmar Frey Helard Becerra John D Kelleher Montserrat Bernabeu Guitart Jaume López |
| author_facet | Alejandro Garcia-Rudolph Eloy Opisso Jose M Tormos Vince Istvan Madai Dietmar Frey Helard Becerra John D Kelleher Montserrat Bernabeu Guitart Jaume López |
| author_sort | Alejandro Garcia-Rudolph |
| collection | DOAJ |
| description |
BackgroundStroke 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.
ObjectiveThis 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.
MethodsThe 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 R2 for linear regressions.
ResultsThree 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 R2=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.
ConclusionsElo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels. |
| first_indexed | 2024-03-12T13:00:20Z |
| format | Article |
| id | doaj.art-55ae4abb9dcf4413bb05af734c7eeb22 |
| institution | Directory Open Access Journal |
| issn | 2291-9694 |
| language | English |
| last_indexed | 2024-03-12T13:00:20Z |
| publishDate | 2021-11-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Medical Informatics |
| spelling | doaj.art-55ae4abb9dcf4413bb05af734c7eeb222023-08-28T19:45:08ZengJMIR PublicationsJMIR Medical Informatics2291-96942021-11-01911e2809010.2196/28090Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating ApproachAlejandro Garcia-Rudolphhttps://orcid.org/0000-0003-0853-8334Eloy Opissohttps://orcid.org/0000-0002-6868-6737Jose M Tormoshttps://orcid.org/0000-0002-8764-2289Vince Istvan Madaihttps://orcid.org/0000-0002-8552-6954Dietmar Freyhttps://orcid.org/0000-0001-5407-2331Helard Becerrahttps://orcid.org/0000-0003-2652-3195John D Kelleherhttps://orcid.org/0000-0001-6462-3248Montserrat Bernabeu Guitarthttps://orcid.org/0000-0003-2037-3069Jaume Lópezhttps://orcid.org/0000-0002-0614-0798 BackgroundStroke 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. ObjectiveThis 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. MethodsThe 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 R2 for linear regressions. ResultsThree 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 R2=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. ConclusionsElo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels.https://medinform.jmir.org/2021/11/e28090 |
| spellingShingle | Alejandro Garcia-Rudolph Eloy Opisso Jose M Tormos Vince Istvan Madai Dietmar Frey Helard Becerra John D Kelleher Montserrat Bernabeu Guitart Jaume López Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach JMIR Medical Informatics |
| title | Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach |
| title_full | Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach |
| title_fullStr | Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach |
| title_full_unstemmed | Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach |
| title_short | Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach |
| title_sort | toward personalized web based cognitive rehabilitation for patients with ischemic stroke elo rating approach |
| url | https://medinform.jmir.org/2021/11/e28090 |
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