Quantifying Post-Stroke Community Participation: Filling the Gap between Ability and Reality

背景/目的：每年约有15，000名退伍军人因中风住院。能力“得到 在社区中”外出走动“被认为对大多数中风患者是必不可少的或非常重要的。 幸存者社区援助和社区参与水平降低， 户外活动和重返社区的水平，以及在应对户外活动方面的感知困难 在中风后的个体中都有报道。回到社区为基础的大使馆是一个 许多中风幸存者的主要康复目标。因此，准确量化社区流动性是 这对脑卒中后康复目标的设定和治疗计划的制定非常重要。的标准 对社区流动性的测量历来集中在流动性方面，如时间， 和距离因素，因为这些因素被认为最能反映任务的各个方面。然而，这些措施， 在不熟悉的环境中评估个人，从行走的简短快照中获得移动性 性能，对功能的细微变化不敏感，也不直接评估个体的自由- 生活用品目前存在对客观地记录环境中的环境污染的测量工具的未满足的需求。 现实世界中，在诊所设置之外，可以从家庭中的真正ammonia中解析ammonia。 社区我们将招募30名卒中后非卧床社区居住退伍军人，以验证和评估 创新的可穿戴式全球定位系统（GPS）/活动监视器包的可行性， 在社区采取的步骤与在家中采取的步骤。结果将通知任何调整， 在全面研究中使用该传感器包之前，将评估个人，社会和身体因素， 为社区步行做出贡献。 受试者：30名卒中后> 6个月的个体将参与。其他研究标准包括：1）能够 遵循3步指令，2）步态速度> 0.4 m/s，3）无需物理辅助即可行走，4）无其他 神经学诊断，5）无间歇性跛行病史，6）静息或轻微运动时无心绞痛， 7)无COPD病史，8）目前未接受物理康复服务，9）有护理人员。 方法：为了测试GPS/活动监视器包的并发有效性，参与者将导航300 一种带传感器的由台阶、坡道、路缘石和人行道组成的计量组合式室内/室外步行线路 包裹贴在他们的非瘫痪脚踝，在物理治疗师的直接观察下， 计数器、秒表和现场记录，以记录所走的步数、行走的时间和距离以及参与者的位置。 为了测试这种新型传感器包的可行性，参与者将在七天内佩戴该传感器包。 自由生活社区大使馆参与者将在起床时穿上包装，并在睡前戴上。 他们将保留旅行活动日志，记录他们何时离开他们的财产，离开的时间长度和任何 走路，他们做到了。7天后，参与者将探头包装返回研究中心， 完成生活质量和使用感知（关于GPS/活动监测）问卷。 结果测量：我们的主要结果测量将是StepWatch测量的每天步数 活动监视器和可穿戴设备测量的这些步骤的位置（家庭内部与家庭外部） GPS设备。对于我们的第三个探索性目标，我们将管理中风特异性生活质量问卷。 数据分析计划：为了评估同时有效性，Kappa统计将计算数量之间的一致性 GPS/Activity记录的户外步数、户外行走的时间和距离以及参与者的位置 监测包和研究人员的直接观察。可行性将通过计算 参与者佩戴传感器包的时间百分比和 传感器包与跳闸活动日志中记录的跳闸进行比较。Pearson相关性将检验 每天在室内、室外和总步数与生活质量之间的关系。

Background/Purpose: Approximately 15,000 Veterans are hospitalized for stroke each year. The ability to “get out and about” in the community is considered to be either essential or very important to a majority of stroke survivors. Reduced levels of community ambulation and community participation, decreased satisfaction with levels of outdoor mobility and community reintegration, and perceived difficulty in coping with outdoor locomotion, have all been reported in individuals post-stroke. A return to community-based ambulation is a primary rehabilitation goal for many survivors of stroke. Accurately quantifying community mobility, therefore, is an important for post-stroke rehabilitation goal-setting and treatment planning. The criteria for the measurement of community ambulation has historically concentrated on mobility dimensions such as temporal and distance factors, as those were felt to best reflect the dimensions of the task. These measures, however, evaluate the individual in an unfamiliar environment, derive mobility from brief snapshots of walking performance, are not sensitive to subtle changes in function and do not directly assess an individual's free- living ambulation. There is a current unmet need for a measurement tool to objectively record ambulation in the real-world, outside of the clinic setting, that can parse ambulation in the home from true ambulation within the community. We will enroll 30 post-stroke ambulatory community-dwelling Veterans to validate and assess the feasibility of an innovative, wearable Global Positioning System (GPS)/Activity Monitor package to differentiate steps taken in the community versus steps taken in the home. Results will inform any adjustments to be made prior to using this sensor package in a full-scale study that will assess personal, social and physical factors that contribute to community walking. Subjects: Thirty individuals > 6-months post-stroke will participate. Additional study criteria include: 1) able to follow 3-step command, 2) gait speed > 0.4 m/s, 3) ambulatory without physical assistance, 4) no other neurological diagnosis, 5) no history of intermittent claudication, 6) no angina at rest or with minimal exertion, 7) no history of COPD, 8) not currently receiving physical rehabilitation services, 9) presence of a caregiver. Methods: To test the concurrent validity of the GPS/Activity Monitor package, participants will navigate a 300 meter combined indoor/outdoor walking circuit consisting of steps, ramps, curbs and sidewalks with the sensor package affixed to their nonparetic ankle, under direct observation of a physical therapist who will utilize a step counter, stop watch and field notes, to record steps taken, time and distance walked and participant location. To test the feasibility of this novel sensor package, participants will wear the package for seven days during free-living community ambulation. Participants will don the package when they arise and doff it at bedtime. They will keep a Trip Activity Log, to record when they leave their property, the length of time away and any walking they did. Following seven days, participants will return the sensor package to the study site and will complete Quality of Life and Perception of Use (with regard to the GPS/Activity Monitor) questionnaires. Outcome Measures: Our primary outcomes measures will be Steps per Day as measured by StepWatch Activity Monitor and location of those steps (inside the home vs. outside the home) as measured by a wearable GPS device. For our third exploratory aim, we will administer the Stroke-Specific Quality of Life questionnaire. Data Analysis Plan: To assess concurrent validity, Kappa statistics will calculate agreement between number of outdoor steps, time and distance traveled outdoors and participant location recorded by the GPS/Activity Monitor package and direct observation by research personnel. Feasibility will be assessed by calculating the percent time participants wore the sensor package and percentage of trips outside the home capture by the sensor package compared to trips recorded in the Trip Activity Log. Pearson correlation will test the relationship between daily steps taken inside, outside and total steps and Quality of Life.