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

量化中风后社区参与：填补能力与现实之间的差距

• 批准号: 9892590
• 负责人: Dorian K Rose
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2021-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892590
• 关键词: Accelerometer; Acute; Agreement; Ankle; Area; Assessment tool; Caregivers; Caring; Chronic Obstructive Airway Disease; Clinic; Clinical; Clinical assessments; Communities; Community Participation; Complement; Continuity of Patient Care; Counseling; Data; Data Analyses; Devices; Diagnosis; Dimensions; Enrollment; Environment; Evaluation; Exertion; Feeling; Gait speed; Geography; Glean; Global Positioning System; Goals; Gold; Health; Home environment; Hour; Household; Individual; Intermittent Claudication; Intervention; Length; Life; Location; Locomotion; Measurement; Measures; Methods; Monitor; Motivation; Needs Assessment; Neurologic; Observational Study; Outcome Measure; Participant; Patients; Perception; Performance; Persons; Physical Rehabilitation; Property; Quality of life; Questionnaires; Ramp; Recording of previous events; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Scientist; Site; Stroke; Testing; Time; Translating; Travel; Unstable angina; Veterans; Walking; awake; base; biopsychosocial; community living; community reintegration; coping; design; improved; innovation; meter; multidisciplinary; novel; physical therapist; post stroke; primary outcome; rehabilitation service; rehabilitation strategy; satisfaction; sensor; social; statistics; stroke recovery; stroke rehabilitation; stroke survivor; tool; treatment planning; walking speed

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.

背景/目的：每年约有15,000名退伍军人因中风住院。“获得”的能力 对于大多数中风患者来说，在社区中外出走动被认为是必要的或非常重要的 幸存者。社区活动和社区参与程度降低，对 户外活动和重新融入社区的水平，以及在应对户外活动方面的感知困难 据报道，所有中风后的个体都有运动障碍。回归社区步行是一种 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 对于卒中后康复目标的设定和治疗计划的制定具有重要意义。评选的标准 社区迁徙的测量历来集中在移动性维度，如时间 以及距离因素，因为这些因素被认为最能反映任务的维度。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灵活性 表现，对机能的细微变化不敏感，也不直接评估个人的自由- 活生生的行走。目前对一种测量工具的需求尚未得到满足，该工具可以客观地记录 诊所设置之外的真实世界，它可以解析在家里的移动与在 社区。我们将招募30名中风后流动社区退伍军人来验证和评估 创新、可穿戴的全球定位系统(GPS)/活动监控套装的可行性，以实现差异化 在社区采取的步骤与在家中采取的步骤。结果将通知要进行的任何调整 在使用该传感器包进行全面研究之前，该研究将评估个人、社会和身体因素 为社区步行做出贡献。 研究对象：30名卒中后6个月的患者。其他研究标准包括：1)能够 遵循三步指令，2)步速&gt；0.4米/S，3)无身体辅助行走，4)无其他 神经学诊断，5)无间歇性跛行病史，6)休息或少量运动时无心绞痛， 7)无慢性阻塞性肺病病史，8)目前没有接受身体康复服务，9)有照顾者在场。 方法：为了测试GPS/Activity Monitor程序包的同时有效性，参与者将导航一个300 米结合的室内/室外步行电路，包括台阶、坡道、路缘和带有传感器的人行道 包贴在他们非瘫痪的脚踝上，在理疗师的直接观察下，理疗师将利用一个步骤 计数器、秒表和实地笔记，以记录所走的步数、步行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装的可行性，参与者将在 自由生活的社区活动。参与者将在起床时戴上包裹，并在就寝时间脱下包裹。 他们将保留一份旅行活动日志，以记录他们何时离开自己的财产，离开的时间长度以及任何 他们走着去了。七天后，参与者将传感器包裹送回研究现场，并将 填写生活质量和使用感受(关于全球定位系统/活动监测)问卷。 结果衡量：我们的主要结果衡量标准将是StepWatch衡量的每天步数 通过可穿戴设备测量的活动监视器和这些步骤(室内与室外)的位置 GPS设备。对于我们的第三个探索性目标，我们将实施中风特有的生活质量问卷。 数据分析计划：为了评估同时效度，Kappa统计将计算数字之间的一致性 由GPS/活动记录的户外步数、户外旅行的时间和距离以及参与者的位置 监控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外出旅行的百分比 将传感器包与跳闸活动日志中记录的跳闸进行比较。皮尔逊相关性将测试 日常的内外步数与生活质量的关系