Outdoor Environmental Facilitators and Barriers of Stroke Survivors’ Mobility and Functional Status

项目摘要 在美国，中风是导致严重长期残疾的主要原因， 20岁以上的美国人。急性中风治疗的医学进步和人口老龄化 导致我们人群中有更多的中风幸存者，许多中风幸存者直接返回 回家随着越来越多的中风幸存者生活在他们的当地社区，关键是要确定 当地环境的特征最能支持中风幸存者的功能状态，特别是 支持流动性。流动性通过各种机制影响健康，包括社会参与， 社区参与和获得卫生保健资源。使用混合方法研究设计， 拟议的项目将确定户外环境的哪些特征对移动性最重要， 中风后前18个月的功能状态。该研究项目将包括一个二级数据 通过结合三个丰富的数据源和使用移动的惯性的原始数据收集来分析现有数据 测量单位和定性方法。具体而言，该研究项目将实现以下目标： 1)研究参加者住宅大厦的环境特征对 卒中严重程度与卒中后18个月功能状态轨迹之间的关系，2）确定 调节中风严重程度和移动适应之间关系的环境特征（即， 较慢的步态速度），以及3）识别 中风幸存者报告的功能状态和活动性的最显著的环境特征， 定性访谈。混合方法允许检查哪些环境特征 与中风损害相互作用，导致不同的功能状态（目的1）， 与环境特征相互作用以影响移动性（目标2），以及为什么环境特征影响移动性 从中风幸存者自身的角度来看，功能状态（目标3）。这项研究将确定 通过确定如何最大限度地提高中风幸存者的活动能力和独立性， 室外建筑环境的可达性。这项研究的结果将为规划和政策提供信息 关于建筑环境的哪些组成部分对幸存者的流动性和功能最重要， 独立最终，积极的环境变化可以改善中风幸存者的功能 独立性和减少中风幸存者对照顾者的依赖，过早地搬迁到疗养院 设施，以及继发性疾病（如抑郁症，认知能力下降）的发展。

PROJECT SUMMARY Stroke is a leading cause of serious long-term disability within the United States, and it affects an estimated 6.6 million Americans over age 20. Medical advances in treatment of acute stroke and an aging population have resulted in a greater number of stroke survivors in our population, and many stroke survivors return directly home. With a greater number of stroke survivors living in their local community, it is critical to determine which features of the local environment best support stroke survivors' functional status, especially features that support mobility. Mobility impacts health through various mechanisms, including social engagement, community involvement, and access to health care resources. Using a mixed methods study design, the proposed project will determine which features of the outdoor environment are most important for mobility and functional status in the first 18 months post-stroke. This research project will consist of a secondary data analysis of existing data by combining three, rich data sources and primary data collection using mobile inertial measurement units and qualitative methods. Specifically, this research project will address the following aims: 1) Examine the moderating effect of environmental features found on participants' residential blocks on the relationship between stroke severity and 18-month trajectory of functional status post stroke, 2) Identify environmental features that moderate the relationship between stroke severity and mobility adaption (i.e. slower gait speed) in real-time using wearable sensors (i.e. mobile inertial measurement units), and 3) Identify the most salient environmental features for functional status and mobility as reported by stroke survivors using qualitative interviews. The mixed methods approach allows the examination of which environmental features interact with stroke impairment to result in differential functional status (Aim 1), how stroke impairment interacts with environmental features to affect mobility (Aim 2), and why environmental features affect mobility and functional status from the perspective of stroke survivors themselves (Aim 3). This research will identify potential ways to increase stroke survivors' mobility and independence by determining how to maximize the accessibility of the outdoor built environment. The findings of this research will inform planning and policy regarding which components of the built environment are most important for survivors' mobility and functional independence. Ultimately, positive environmental changes can improve stroke survivors' functional independence and decrease stroke survivors' reliance on caregivers, premature relocation to nursing home facilities, and development of secondary conditions (e.g. depression, cognitive decline).