title: Secondary mediation and regression analyses of the PTClinResNet database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials.
abstract: BACKGROUND
  Each of the 4 randomized clinical trials (RCTs) hosted by the Physical Therapy Clinical Research Network (PTClinResNet) targeted a different disability group (low back disorder in the Muscle-Specific Strength Training Effectiveness After Lumbar Microdiskectomy [MUSSEL] trial, chronic spinal cord injury in the Strengthening and Optimal Movements for Painful Shoulders in Chronic Spinal Cord Injury [STOMPS] trial, adult stroke in the Strength Training Effectiveness Post-Stroke [STEPS] trial, and pediatric cerebral palsy in the Pediatric Endurance and Limb Strengthening [PEDALS] trial for children with spastic diplegic cerebral palsy) and tested the effectiveness of a muscle-specific or functional activity-based intervention on primary outcomes that captured pain (STOMPS, MUSSEL) or locomotor function (STEPS, PEDALS).
  
  
  OBJECTIVE
  The focus of these secondary analyses was to determine causal relationships among outcomes across levels of the International Classification of Functioning, Disability and Health (ICF) framework for the 4 RCTs.
  
  
  METHODS
  With the database from PTClinResNet, we used 2 separate secondary statistical approaches-mediation analysis for the MUSSEL and STOMPS trials and regression analysis for the STEPS and PEDALS trials-to test relationships among muscle performance, primary outcomes (pain related and locomotor related), activity and participation measures, and overall quality of life.
  
  
  RESULTS
  Predictive models were stronger for the 2 studies with pain-related primary outcomes. Change in muscle performance mediated or predicted reductions in pain for the MUSSEL and STOMPS trials and, to some extent, walking speed for the STEPS trial. Changes in primary outcome variables were significantly related to changes in activity and participation variables for all 4 trials. Improvement in activity and participation outcomes mediated or predicted increases in overall quality of life for the 3 trials with adult populations.
  
  
  CONCLUSIONS
  Variables included in the statistical models were limited to those measured in the 4 RCTs. It is possible that other variables also mediated or predicted the changes in outcomes. The relatively small sample size in the PEDALS trial limited statistical power for those analyses.
  
  
  CONCLUSIONS
  Evaluating the mediators or predictors of change between each ICF level and for 2 fundamentally different outcome variables (pain versus walking) provided insights into the complexities inherent across 4 prevalent disability groups.
authors: Pathokinesiology Laboratory, Rancho Los Amigos National Research Center, Downey, California, USA.
authors: Sara J
authors: SJ
authors: Mulroy
authors: Carolee J
authors: CJ
authors: Winstein
authors: Kornelia
authors: K
authors: Kulig
authors: George J
authors: GJ
authors: Beneck
authors: Eileen G
authors: EG
authors: Fowler
authors: Sharon K
authors: SK
authors: DeMuth
authors: Katherine J
authors: KJ
authors: Sullivan
authors: David A
authors: DA
authors: Brown
authors: Christianne J
authors: CJ
authors: Lane
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D002648:Child; D002965:Classification / Q000379:methods; D016208:Databases, Factual; D004185:Disability Evaluation; D026241:Exercise Movement Techniques; D017079:Exercise Tolerance / Q000502:physiology; D006304:Health Status; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000502:physiology; D011237:Predictive Value of Tests; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D055070:Resistance Training; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology