Rehabilitation Factors in Pre-Arthritic Hip Disease

描述（由申请人提供）：这个指导以患者为导向的研究职业发展奖的目标是让申请人发展所需的临床研究技能，追求独立的，富有成效的职业生涯在康复研究。申请人是一名有执照的物理治疗师，拥有临床博士学位，完成了临床研究的博士后培训。该奖项将通过将申请人在肌肉骨骼疾病方面的现有专业知识与下肢运动的运动学评估和以患者为导向的研究的先进方法相结合，提高申请人调查关节炎前髋关节疾病（PAHD）机制的能力。长期目标是为PAHD患者制定有效的康复策略，以预防或延迟手术或药物干预的需要。拟议研究的具体目的是检验异常运动模式有助于PAHD发作和持续的总体假设。拟定的研究将1）确定PAHD患者和非PAHD患者之间的肌肉骨骼差异，2）确定下肢运动模式、肌肉力量、骨骼异常和功能能力自我报告指标之间的相关性，3）获得运动模式训练对PAHD患者测量的损伤和功能能力有效性的初步数据（探索性治疗试验）。患有PAHD的人和没有PAHD的人将参与完成功能能力的自我报告测量，髋关节肌肉力量测试，特定功能运动的3D运动评估（运动学）和磁共振成像（MRI）以评估骨骼结构。将比较基线数据，以确定PAHD患者和非PAHD患者之间是否存在差异。为了确定自我报告功能能力的最佳预测变量，将使用逐步多变量线性回归建模，其中自我报告测量值作为因变量，运动模式异常、肌力和骨骼异常作为自变量。将为希望参加康复计划的PAHD受试者提供运动模式训练，包括纠正日常活动中异常运动模式的教育，以及加强被认为有助于异常运动模式的弱肌。将比较治疗前和治疗后的指标，以确定损伤（异常运动模式、肌肉力量）的改善是否与受试者自我报告的功能改善相关。本研究的结果将为未来PAHD康复和损伤预防的机制研究提供数据。此外，探索性治疗试验的数据将导致更大规模的临床试验，以评估运动模式训练的有效性。 公共卫生相关性：关节炎前髋关节疾病（PAHD）是年轻人髋关节功能障碍和活动受限的主要原因，如果没有适当的治疗，可能会进展为髋关节骨关节炎（OA）。需要有效治疗PAHD以改善年轻成人的功能并预防或延迟髋关节OA的发作，但与PAHD治疗相关的证据有限。这项研究将提高对PAHD因素的理解，并将是第一项评估针对PAHD患者特定损伤的康复策略有效性的研究。

DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award is to allow the applicant to develop the clinical research skills needed to pursue an independent, productive career in rehabilitation research. The applicant is a licensed physical therapist with a clinical doctorate completing her postdoctoral training in clinical investigation. This award will enhance the applicant's ability to investigate mechanisms underlying pre-arthritic hip disease (PAHD) by combining the applicant's existing expertise in musculoskeletal disorders with additional training in the kinematic assessment of lower extremity movement and advanced methods in patient-oriented research. The long-term objective is to develop effective rehabilitation strategies for people with PAHD that will prevent or delay the need for surgical or pharmacological intervention. The specific aims of the proposed studies are designed to test the overall hypothesis that abnormal movement patterns contribute to the onset and persistence of PAHD. The proposed studies will 1) determine musculoskeletal differences between people with PAHD and people without PAHD, 2) determine the association among lower extremity movement patterns, muscle strength, bony abnormalities and self-report measures of functional ability, and 3) obtain preliminary data on the effectiveness of movement pattern training on measured impairments and functional ability in people with PAHD (exploratory treatment trial). People with PAHD and people without PAHD will participate in completing self-report measures of functional ability, tests of hip muscle strength, 3d movement assessment (kinematic) of specific functional movements and magnetic resonance imaging (MRI) to assess bony structure. Baseline data will be compared to determine if differences exist between people with PAHD and people without PAHD. To determine the best predictive variables of self- report functional ability, stepwise multivariable linear regression modeling will be used with the self-report measures as dependent variables and movement pattern abnormality, muscle strength and bony abnormalities as independent variables. Subjects with PAHD who wish to participate in a rehabilitation program will be provided motor pattern training including education to correct abnormal movement patterns during daily activities and strengthening of weak muscles thought to contribute to the abnormal movement patterns. Pretreatment and posttreatment measures will be compared to determine if improvements in impairments (abnormal movement pattern, muscle strength) correlate with an improvement in subjects' self-report of function. Results of this study will provide data to inform future mechanism-based studies of PAHD rehabilitation and injury prevention. In addition, data from the exploratory treatment trial will lead to a larger clinical trial to assess the effectiveness of movement pattern training. PUBLIC HEALTH RELEVANCE: Pre-arthritic hip disease (PAHD) is a major cause of hip dysfunction and activity limitation in young adults that, without proper management, may progress to hip osteoarthritis (OA). Effective treatment of PAHD is needed to improve function in the young adult and prevent or delay the onset of hip OA, however evidence related to treatment of PAHD is limited. This research will improve the understanding of factors that contribute to PAHD and will be the first study to assess the effectiveness of a rehabilitation strategy targeted at specific impairments in people with PAHD.