Supplement to Novel precision medicine approach to advance rehabilitation of surgically repaired tendons of the hand

新型精准医学方法的补充，以促进手部手术修复肌腱的康复

• 批准号: 10442923
• 负责人: Sandy Chie Takata
• 金额: $ 1.29万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10442923
• 关键词: Acute; Adhesions; Anatomy; Area; Biological Markers; Biomechanics; Career Mobility; Cicatrix; Clinical; Consensus; Data; Data Analyses; Data Analytics; Data Collection; Development; Edema; Fellowship; Fingers; Flexor; Foundations; Frequencies; Future; Goals; Hand; Hand Injuries; Image; Image Analysis; Imaging Techniques; Individual; Knowledge; Measurement; Measures; Methods; Monitor; Morphology; Motion; Musculoskeletal; Operative Surgical Procedures; Outcome; Pain-Free; Participant; Patient-Focused Outcomes; Patients; Pattern; Physiological; Positioning Attribute; Process; Protocols documentation; Recovery; Recovery of Function; Rehabilitation therapy; Reliability of Results; Research; Research Methodology; Scientist; Shoulder; Skin; Standardization; Techniques; Tendon Injuries; Tendon structure; Tensile Strength; Thinness; Time; Training; Translational Research; Ultrasonography; Variant; adverse outcome; arm; candidate marker; care outcomes; career; catalyst; clinical practice; cost; cost estimate; disability; functional outcomes; hand rehabilitation; healing; imaging biomarker; imaging modality; improved outcome; kinematics; longitudinal analysis; model development; novel; personalized approach; personalized care; precision medicine; public health relevance; real-time images; rehabilitation research; repaired; skills; tendon rupture

Project Summary There is no consensus nor strong evidence that identifies the best rehabilitative protocol to optimize outcomes for patients with surgical repair of a lacerated flexor tendon of the hand. Successful functional recovery requires tendon coaptation, unimpeded tendon gliding, and adequate tensile strength of the repaired tendon. Due to limited evidence and variation in practice, adverse healing outcomes (e.g., tendon ruptures, scar adhesions) occur in a significant number of patients; some patients require a secondary surgery which is costly, less effective, and oftentimes preventable. The training and research conducted through this fellowship will support proficiency in three primary areas related to enhancing the recovery process: 1) musculoskeletal sonography, 2) morphological process of tendon healing, and 3) research methods and data analytic techniques. This fellowship will examine morphologic biomarkers of tendon coaptation using sonographic imaging. Sonographic imaging is a relatively inexpensive, widely available, non-invasive, and pain-free imaging modality that provides real-time images of anatomical structures under the skin. Sonography has been used to evaluate healthy and injured tendons, and sonographic measures have been shown to correlate with functional outcomes. However, an approach for utilizing these biomarkers to inform clinical practice has yet to be fully developed or deployed. As such, this project aims to establish a foundation for the application of sonographic imaging to aid and advance the rehabilitation of flexor tendons. As a first step, a standardized, reliable, and valid sonographic imaging protocol to evaluate tendon healing will be developed. Both static and dynamic imaging techniques will be explored to identify various candidate biomarkers, including macro-morphologic measures of tendon gapping and adhesions, as well as micro-morphologic measures using spatial frequency analysis. The timing for initiation and frequency of data collection to adequately capture changes in the healing tendon will be explored to determine how imaging biomarkers can be used to monitor recovery patterns and characterize the process of tendon healing. Establishing a reliable image analysis protocol and identifying the most salient biomarkers will be a critical step to understanding factors that promote tendon healing with safe and efficient recovery. Successfully accomplishing these aims will be instrumental in advancing practice by supporting the development of a precision medicine approach to tendon rehabilitation.

项目概要 没有共识也没有强有力的证据来确定最佳康复方案以优化结果 适用于手部屈肌腱撕裂的手术修复患者。成功的功能恢复 需要肌腱接合、无阻碍的肌腱滑动以及修复后的肌腱有足够的抗拉强度。 由于证据有限且实践存在差异，不良的愈合结果（例如肌腱断裂、疤痕） 粘连）发生在相当多的患者身上；有些患者需要进行二次手术 成本高昂、效果较差，而且通常是可以预防的。通过该奖学金进行的培训和研究 将支持与加强恢复过程相关的三个主要领域的熟练程度：1）肌肉骨骼 超声检查，2）肌腱愈合的形态过程，3）研究方法和数据分析 技术。该奖学金将使用超声检查检查肌腱接合的形态生物标志物 成像。超声成像是一种相对便宜、广泛使用、非侵入性且无痛的成像 提供皮下解剖结构实时图像的模式。超声检查已被用于 评估健康和受伤的肌腱，超声检查测量已被证明与功能相关 结果。然而，利用这些生物标志物为临床实践提供信息的方法尚未完全成熟。 开发或部署。因此，该项目旨在为超声检查的应用奠定基础 成像以帮助和促进屈肌腱的康复。作为第一步，建立一个标准化的、可靠的、 将制定有效的超声成像协议来评估肌腱愈合情况。静态和动态均可 将探索成像技术来识别各种候选生物标志物，包括宏观形态学 肌腱间隙和粘连的测量，以及使用空间频率的微观形态测量 分析。数据收集的启动时间和频率，以充分捕捉愈合过程中的变化 将探索肌腱以确定如何使用成像生物标志物来监测恢复模式和 描述肌腱愈合过程的特征。建立可靠的图像分析协议并识别 最显着的生物标志物将是了解安全促进肌腱愈合的因素的关键一步 和高效的恢复。成功实现这些目标将有助于推进实践 支持开发肌腱康复的精准医学方法。