Project Summary/Abstract
Sudden-onset injuries—such as acquired injuries or insults to the brain, spinal cord, and major
extremities—begin in an instant and typically cannot be reversed. While there is potential for varying degrees
of physical, functional, psychosocial, and/or cognitive recovery with rehabilitation, these injuries often result in
life-long and life-altering disabilities. Furthermore, many such injuries occur in individuals who are young,
active, and otherwise healthy. With the approximately 2.58 million new injuries to the brain, spine, or limb that
occur each year, and an estimated 14.45 million individuals living in the U.S. with long-term disabilities related
to these conditions, sudden-onset injuries are some of the most common causes of morbidity in the U.S. Given
the invaluable opportunity to improve outcomes for such a large number of individuals, there is a vital need to
better understand the complex patterns of symptoms experienced by these individuals in the long term to
inform high-quality clinical care. Symptom clustering science offers an ideal method to achieve this goal.
This project’s broad, long-term objective is to understand the complex patterns of symptoms displayed after
acquired injuries to the brain, spine, or limb, so that clinical care can be improved. Symptom clustering has
proven useful as a strategy for personalized medicine with complex medical conditions, such as cancer.
However, there are several significant gaps in the literature, including the need to expand these methods to
other clinical groups, define the characteristics of symptom clusters, identify instruments and metrics for
measuring symptom clusters, and apply novel analytic strategies for detecting symptom clusters.
This work will leverage over a decade of the investigators’ prior qualitative and quantitative work on several
large, multi-site studies with these clinical populations. In particular, existing data sets will be reanalyzed using
new symptom clustering techniques. Results from these new analyses will be used to identify and characterize
the most important symptom clusters for individuals with acquired disabilities. Then, a new, more diverse
sample of individuals with acquired injuries to the brain, spine, or limb will be collected and evaluated to
examine the generalizability and stability of these symptom clusters for use within and across rehabilitation
populations. Last, the findings will be used to generate guidelines and clinical tools to translate symptom
clusters into clinical practice.
This work will be accomplished through four aims. Aim 1: Identify transdiagnostic and condition-specific
symptom clusters present in individuals with traumatic injuries. Aim 2: Explore the generalizability and
reproducibility of the symptom clusters identified in Aim 1 in a diverse sample of individuals with acquired
disabilities. Aim 3: Examine longitudinally the stability and predictive utility of symptom clusters in a diverse
sample of individuals with acquired disabilities. Aim 4: Develop guidelines and clinical tools for assessing and
interpreting symptom clusters in individuals with acquired disabilities.