Predicting patient-reported outcomes in patients with pre-arthritic hip disorders

项目摘要/摘要 艾比·L博士，医学博士，具有生物医学工程背景的运动医学物理学家， 研究目标是开发和实现一种全面的、基于证据的管理算法 关节炎前期髋关节疾病(PAHD)患者。她的教育、临床和研究经验独一无二 为她从事这项工作做好准备，这项职业发展奖将促进 她需要流行病学培训，重点是风险预测建模、生物信息学、临床 试验、传播和实施研究。所有研究和培训活动都将在 华盛顿大学医学院，一所拥有强大的医疗服务研究计划和 多学科髋关节研究小组。帕金森病是一种骨质和软组织的髋关节形态，易患上 青少年和年轻人会出现髋关节疼痛、慢性损伤和早期骨关节炎(OA)。恰如其分 治疗可以预防这些后遗症，但目前的证据，特别是关于非手术治疗的证据 选择是有限的。为了满足这一需求，本项目的目的是确定对非 手术治疗PAHD的选择，并将这些预测因子合成为临床预测工具，以告知 使用患者初步评估期间可获得的数据来评估非手术的一年结果。目标1是一个 将量化PAHD患者一年临床结果和 他们的基线临床特征、患者报告的结果测量信息系统(PROIS) 分数和髋关节特定的“遗留”患者报告的结果测量(PROM)分数。分析还将 确定PROMIS和传统PROM措施的最低组合，以减轻调查负担，同时 与管理所有当前收集的遗产和 PROMIS措施。目标2将是一项前瞻性研究，以确定PAHD患者依从性和 8周治疗活动调整后的症状反应。活性修饰是一种保守的 针对患者如何进行常规和剧烈活动以减轻臀部疼痛的治疗。它 已经被证明在随机试验环境中是有效的，但它还没有被医生们在 诊所环境。最后，目标3将是一项前瞻性研究，旨在开发一种临床预测工具，以确定 PAHD患者慢性损害或进展至手术的风险在一年的随访中并确定 潜在的可修改的预测值。患者的人口统计、生物心理社会概况、活动和活动 模式和解剖学将被认为是预测因素。完成中列出的目标和指导培训 这一职业发展奖将为郑医生创造、验证和实施以患者为中心的 基于证据的治疗模式，产生更快的疼痛缓解，改善功能恢复，并减少 为患有PAHD和其他肌肉骨骼疾病的患者提供长期社会保健资源。

PROJECT SUMMARY / ABSTRACT Dr. Abby L Cheng, MD, is a sports medicine physiatrist with a background in biomedical engineering whose research goal is to develop and implement a comprehensive, evidence-based management algorithm for patients with pre-arthritic hip disorders (PAHD). Her educational, clinical, and research experiences uniquely prepare her to pursue this work, and this career development award will facilitate the complementary epidemiological training she requires, with an emphasis on risk prediction modeling, bioinformatics, clinical trials, and dissemination and implementation research. All research and training activities will occur at the Washington University School of Medicine, an institution with a strong health services research program and a multidisciplinary hip research group. PAHD are bony and soft tissue hip morphologies that predispose adolescents and young adults to developing hip pain, chronic impairment, and early osteoarthritis (OA). Proper management may prevent these sequelae, but current evidence, especially regarding non-operative treatment options, is limited. To address this need, the purpose of this project is to identify predictors of response to non- operative PAHD treatment options and to synthesize these predictors into a clinical prediction tool that informs non-operative one-year outcomes using data available during patients’ initial evaluation. Aim 1 is a retrospective analysis that will quantify associations between PAHD patients’ one-year clinical outcomes and their baseline clinical characteristics, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and hip-specific “legacy” patient-reported outcome measure (PROM) scores. The analysis will also determine a minimum combination of PROMIS and legacy PROM measures that reduces survey burden while maintaining similar predictive utility when compared to administration of all currently collected legacy and PROMIS measures. Aim 2 will be a prospective study to identify predictors of PAHD patient adherence and symptom response to eight weeks of therapeutic activity modification. Activity modification is a conservative treatment that addresses how patients perform routine and strenuous activities in order to reduce hip pain. It has proven to be efficacious in a randomized trial setting, but it is not yet widely discussed by physicians in the clinic setting. Finally, Aim 3 will be a prospective study to develop a clinical prediction tool that determines PAHD patients’ risk of chronic impairment or progression to surgery at one year follow-up and identifies potentially modifiable predictors. Patients’ demographics, biopsychosocial profile, movement and activity patterns, and anatomy will be considered as predictors. Completing the aims and mentored training outlined in this career development award will prepare Dr. Cheng to create, validate, and implement patient-centered, evidence based treatment models which yield quicker pain relief, improved restoration of function, and reduced long-term societal healthcare resources for patients with PAHD and other musculoskeletal conditions.