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Translation of in-clinic Gains to Gains in Daily Life After Stroke

将临床获益转化为中风后日常生活的获益

基本信息

批准号：
9901564
负责人：
Catherine Lang
金额：
$ 41.09万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-02-01 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9901564
关键词：
Accelerometer Activities of Daily Living Address Affect Age Attitude Award Belief Clinic Data Environment Equilibrium Frequencies Goals Habits Hand Health behavior Individual Injury Intervention Investigation Ischemic Stroke Knowledge Laboratories Learning Life Longitudinal cohort Lower Extremity Maps Measures Movement Outcome Outcome Measure Outpatients Parkinson Disease Patient Self-Report Performance Persons Published Comment Rehabilitation therapy Research Design Self Efficacy Services Stroke Structure Surveys Time Translating Translations Upper Extremity Work cohort comparison intervention design improved improved mobility improved outcome motor rehabilitation neurological rehabilitation outpatient programs performance tests post stroke prospective rehabilitation research rehabilitation service service delivery stroke outcome stroke recovery stroke rehabilitation stroke survivor wearable sensor technology

项目摘要

PROJECT SUMMARY/ABSTRACT Stroke rehabilitation research has produced a number of efficacious and emerging interventions for improving mobility, balance, and upper limb function. Trial outcomes are measured at the functional capacity level, where capacity is defined as what a person is capable of doing in the structured environment of the clinic or laboratory. It has long been assumed that improvements in capacity result in improvements in real-world performance, where performance is defined as what a person actually does in daily life, outside of the clinic or laboratory. Our data from the previous award cycle show a striking difference after intervention between capacity and performance measured with wearable sensors, i.e. accelerometers. Group averages indicated some improvement in capacity and in self-reported performance, but no improvement in actual performance. At the individual level, no one showed improvements in performance, even those individuals who made substantial changes in capacity. Given that a key purpose of providing rehabilitation services post stroke is to improve performance in daily life, we have uncovered a major problem that merits investigation. This project will examine the discrepancy between capacity and performance, with the long-term goal of using the knowledge gained to develop new or modify current rehabilitation interventions that will improve performance in daily life. We will study two prospective longitudinal cohorts to address three aims. Aim 1 will seek to understand the scope of the problem within the field of neurorehabilitation. We will study a cohort of people receiving outpatient services to determine whether the discrepancy between capacity and performance is unique to upper limb interventions and/or stroke rehabilitation. Aim 2 is designed to learn when, how much, and in whom, upper limb capacity gains translate to performance gains. We will study another cohort of persons with first time stroke to map the natural trajectory of performance and its relationships to capacity and other factors over the time course of stroke recovery (within 2 weeks out to 6 months). Aim 3 takes the viewpoint that upper limb performance is a health behavior, or habit, which may be amenable to change. We will capitalize on the same cohort as Aim 2 and explore the time course of stroke survivor attitudes and barriers to performance. Data from these cohorts will transform current practice with knowledge of when and with whom motor rehabilitation interventions can improve performance in daily life. Rehabilitation research will be advanced by knowledge about capacity vs. performance, and when and how capacity improvements can translate to performance improvements. Our data will inform future research design and serve as a basis for developing and testing of performance-level interventions to improve stroke outcomes in the real world, not just in the clinic or laboratory.

项目总结/文摘