Translation of In-Clinic Gains to Gains in Daily Life

项目摘要/摘要 人们寻求上肢康复服务来改善日常生活中的活动表现， 世界卫生组织ICF模型定义的绩效，即某人在 无组织的、自由的生活环境。可穿戴的运动传感器现在可以直接测量鞋帮 日常生活中的肢体功能，但在研究和护理中很少测量或考虑性能。数据 从我们的第二个周期中清楚地看到，在 诊所或实验室的结构化环境通常不会转化为绩效的改善 日常生活中的活动。这些数据表明，显然有必要将绩效评估从 专业研究领域更普遍地应用于上肢研究和临床护理。一位少校 阻碍传感器更广泛地用于常规上肢功能评估的障碍是缺乏临床 验证。对于许多临床验证挑战，一个优雅的解决方案是从单变量 个体人群对患者日常生活中上肢功能多变量类别的影响 人口。 我们的中心假设是，尽管生物条件的巨大差异以及由此产生的 肢体损伤和功能能力谱，上肢在日常生活中的表现可以组织成 类别数量相对较少。定义的、经过验证的类别可以跨人群使用，以推动 前瞻上肢康复研究，个性化临床决策。我们现在建议 将初步类别从中风扩展并验证为各种情况，将人们送到上 肢体康复服务，并导致上肢残疾。可穿戴传感器将用于评估上部 在一组不同的、纵向的、观察性队列中(N=340)中风患者的肢体功能。 多发性硬化症、UL骨折、粘连性囊炎、乳腺癌)和无UL残疾(对照)，以及 回顾，儿科队列(n≥400)，以解决三个目标。目标1将确定和验证以下类别 日常生活中的上肢功能，可应用于导致上肢残疾的各种情况 成年人。AIM 2将评估对不同类别变化的响应能力。《目标3》将探讨类别如何 在成人中发现的这种情况与儿童时期的上肢表现有关。 建议周期结束时的预期结果是经过验证的上肢功能类别 对变化做出反应，并跨越患者群体。这些类别(以及用于 将立即用于干预研究，以衡量最相关的结果 对病人来说。随着未来几年硬件和软件的预期进步，未来的工作将 容易地将经过验证的类别实施到临床康复护理中。

PROJECT SUMMARY/ABSTRACT People seek out upper limb rehabilitation services to improve performance of activities in daily life, with performance defined by the World Health Organization ICF model as what someone actually does in the unstructured, free-living environment. Wearable, motion sensors now allow for direct measurement of upper limb performance in daily life, but performance is rarely measured or considered in research and care. Data from our 2nd cycle make it clear that improvements in impairments and/or functional capacity assessed in the structured environment of the clinic or laboratory most often do not translate to improvements in performance of activities in daily life. These data point to the clear need to move assessment of performance from the specialized research realm into more universal use in upper limb research studies and clinical care. A major barrier to more wide-spread use of sensors for routine upper limb performance assessment is lack of clinical validation. An elegant solution to the many clinical validation challenges is to move from single variables in individual populations to multivariate categories of upper limb performance in daily life that span patient populations. Our central hypothesis is that, despite the immense variability in biological conditions and their resulting upper limb impairments and functional capacity profiles, upper limb performance in daily life can be organized into a relatively small number of categories. Defined, validated categories could be used across populations to push upper limb rehabilitation research forward and personalize clinical decision-making. We now propose to expand and validate preliminary categories from stroke into a variety of conditions that send people to upper limb rehabilitation services and result in upper limb disability. Wearable sensors will be used to assess upper limb performance in a heterogeneous, longitudinal, observational cohort (N=340) of persons with (stroke, multiple sclerosis, UL fracture, adhesive capsulitis, breast cancer) and without UL disability (controls), and a retrospective, pediatric cohort (n ≥ 400) to address three aims. Aim 1 will identify and validate categories of upper limb performance in daily life that can be applied across conditions that cause upper limb disability in adults. Aim 2 will evaluate responsiveness to change across categories. And Aim 3 will explore how categories identified in adults map to upper limb performance in childhood. Expected outcomes at the end of the proposed cycle are validated categories of upper limb performance that are responsive to change and span patient populations. These categories (and the software algorithms to derive them) will immediately be available for intervention studies to measure outcomes that are most relevant to patients. With anticipated advances in hardware and software over the next few years, future work will implement validated categories readily into clinical rehabilitation care.