At-home gait-cadence functional assessment and recovery trajectory for older adults undergoing major abdominal surgery

接受腹部重大手术的老年人的在家步态节奏功能评估和恢复轨迹

• 批准号: 10518992
• 负责人: Daniel Steven Rubin
• 金额: $ 16.4万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10518992
• 关键词: Abdomen; Abdominal Surgical Procedures; Accelerometer; Anesthesia procedures; Cellular Phone; Clinic; Clinic Visits; Clinical Trials; Computer software; Development Plans; Early Diagnosis; Elderly; Enrollment; Exercise; Family; Gait; Gait speed; Goals; Habilitation; Health; Home; Hospitals; Intervention; K-Series Research Career Programs; Knowledge; Logistics; Measures; Medicine; Moderate Activity; National Institute on Aging; Operative Surgical Procedures; Outcome; Patient-Focused Outcomes; Patients; Pattern; Performance; Perioperative; Physical activity; Postoperative Period; Public Health; Questionnaires; Recovery; Reporting; Research; Risk; Step Tests; Testing; Time; Walking; actigraphy; acute care; age related; base; experience; functional outcomes; functional status; high risk; home test; hospital readmission; improved; improved mobility; innovation; multidisciplinary; multimodality; novel; open source; patient mobility; postoperative recovery; programs; prospective; remote assessment; smartphone Application; usability; walking program; walking speed; wearable device

ABSTRACT Over 100,000 older adults undergo elective major abdominal surgeries in the US each year and many experience loss of mobility after surgery. Risk of mobility loss is greater for older adults unable to engage in moderate-intensity physical activity before surgery. Identifying at risk older adults pre-operatively is critical as functional status is modifiable before surgery through multimodal pre-habilitation. However, objective functional assessments of older adults are not routinely performed before surgery in part due to time. Gait-cadence is directly associated with activity-intensity and can be quickly and easily measured by smartphone accelerometers, making it a novel measure to remotely assess preoperative functional status. Our central hypothesis is that gait-cadence during usual and fast pace walks at-home will 1) provide an accurate and easy to use functional assessment 2) identify patients at-risk of mobility loss as compared to the currently used 6- minute walk test (6MWT) and overall daily active time and 3) determine walking recovery trajectories for older adults after surgery. The overall objective of this proposal is to validate the accuracy and usability of at-home gait-cadence assessment using patient owned smartphones before surgery and determine recovery trajectories after surgery in older adults. We will achieve this objective with the following three aims: 1) Determine the accuracy and usability of at-home gait cadence assessment. We will compare at-home gait- cadence during usual and fast pace brief walks performed remotely and independently at-home to in-clinic equivalents. Gait-cadence will be measured using open-source accelerometer analysis software which represents a significant innovation from traditional approaches that use native software from commercial wearable devices. 2) Determine the association between at-home gait-cadence, in-clinic 6MWT distance, and daily active time. We will compare at-home gait-cadence to 6MWT distance which is currently used to identify older adults at high perioperative risk. Actigraph accelerometers will be worn for 7-days prior to surgery to identify patients that engage in moderate-activity intensity. 3) Determine walking recovery trajectories for older adults after surgery. Patients will perform the usual and fast pace walk using Step Test weekly for two months after discharge and evaluate trajectories of walking recovery after surgery. The professional development plan combined with the completion of these aims is the necessary first study for further research (K awards) that identify high-risk patients for mobility loss using gait-cadence and test a walking pre-habilitation program to improve mobility after surgery for older adults.

摘要 在美国，每年有超过10万名老年人接受择期腹部大手术， 手术后失去活动能力。老年人无法参与活动的风险更大 中等强度的体力活动。术前识别有风险的老年人至关重要， 功能状态在手术前可通过多模式预处理来改变。然而，客观功能 部分由于时间的原因，老年人的评估在手术前不是常规进行的。步态节奏是 与活动强度直接相关，可以通过智能手机快速轻松地测量 加速度计，使其成为一种新的措施，远程评估术前功能状态。我们的中央 假设是，在家里通常和快节奏行走时的步态节奏将1）提供准确和容易的 使用功能评估2）与目前使用的6- 分钟步行试验（6 MWT）和总体每日活动时间; 3）确定老年人的步行恢复轨迹 成年人手术后本提案的总体目标是验证在家中 在手术前使用患者拥有的智能手机进行步态节奏评估，并确定恢复情况 老年人手术后的轨迹。我们会透过以下三个目标来达致这个目标： 确定在家步态节奏评估的准确性和可用性。我们会比较在家的步态 在家中和诊所内远程独立进行的常规和快节奏短暂步行期间的步频 等价物步态节奏将使用开源加速度计分析软件进行测量， 代表了对传统方法的重大创新，传统方法使用商业上的本地软件， 可穿戴设备2)确定在家步态节奏、门诊6 MWT距离和 每日活动时间我们将比较在家里的步态节奏，以6 MWT的距离，这是目前用来确定 围手术期高风险的老年人。手术前将佩戴Activograph加速度计7天， 确定从事中等活动强度的患者。3)确定老年人的步行恢复轨迹 成年人手术后患者将每周使用台阶测试进行常规和快节奏步行，持续两个月 出院后，评估术后步行恢复的轨迹。专业发展计划 与这些目标的完成相结合的是必要的进一步研究的第一项研究（K奖）， 使用步态节奏识别活动性丧失的高风险患者，并测试步行预障碍程序， 改善老年人手术后的活动能力。