Functional Capacity Assessment in Hospitalized Bed-bound COPD Patients; Predicting Outcomes

项目概要/摘要 这项以患者为导向的研究 R21 应用程序将为验证一种新方法提供资金支持 评估患有慢性阻塞性肺疾病的住院老年人的功能能力 （慢性阻塞性肺病），这是一个具有实质性且日益重要的领域。我们提出的创新筛选方法是 客观、快速且基于潜在全身性缺乏症的肌肉性能评估。在此范围内 在该项目中，我们将进行一项为期 90 天的纵向研究，以验证对 COPD 恶化、住院治疗的预测， 和死亡率使用所提出的方法。 所提出的功能能力评估方法结合了上肢功能（UEF）测试，以 消除了卧床住院老人的步行任务。 UEF 测试涉及重复肘部 使用低成本传感器测量屈曲，仅需不到一分钟即可轻松完成（站立、坐着或床上） 分钟。使用笔记本电脑或计算机上的应用程序将在不到一分钟的时间内完成后处理和评分 手机。我们已获得 UEF 测试的专利并进行了验证，该测试可根据运动（运动学）数据评估虚弱程度， 其可行性此前已在试点门诊和住院参与者中得到证明。在此范围内 项目，实施相同的硬件和测量协议，我们将改进算法来评估 使用新的肌肉模型进行肌肉失调（缺乏症），该模型将添加到我们原始的 UEF 算法中。 所提出的方法以 COPD 患者的试点研究为基础，该研究由一组优秀的研究人员进行 亚利桑那大学衰老中心和亚利桑那呼吸科学中心的跨学科研究人员 中心，展示了 UEF 速度（和嵌入强度参数）与 6 分钟步行距离 (6MWD) 测试是慢性阻塞性肺病 (COPD) 功能能力最常用的测量方法。 R21项目的目标是：1）开发并评估上肢肌肉模型；和 2：（临床 研究）：纵向评估 UEF 在 120 名 COPD 相关患者中预测 90 天不良健康事件的有效性 住院老年人（≥ 65 岁）——预测指数的制定和 UEF 准确性的评估， 可行性、可靠性。 我们期望扩展有关与肌肉功能失调（dynapenia）相关的性质的科学知识 对于慢性阻塞性肺病，重点关注上肢功能测量（而不是步态评估）。从临床 观点，我们期望验证一种快速准确的客观工具来评估人员的功能能力 COPD 患者作为 6MWD 测试的替代方案，最终目标是提供快速且经济高效的检测 支持急性和门诊老年人风险分层的筛查工具。如果证明有效，我们预计 该工具可用于预测那些风险最高的人，以实现个性化的慢性阻塞性肺病护理并支持质量 患有慢性阻塞性肺病或多种慢性病的老年人的生活和独立性。

PROJECT SUMMARY/ABSTRACT This patient-oriented research R21 application will provide funding support for validating a novel approach for assessing functional capacity among hospitalized older adults with chronic obstructive pulmonary disease (COPD), an area of substantial and increasing significance. Our proposed innovative screening method is objective, quick, and based on muscle performance assessment of underlying systemic dynapenia. Within this project we will perform a 90-day longitudinal study to validate prediction of COPD exacerbations, hospitalizations, and mortality using the proposed method. The proposed functional capacity assessment method incorporates an upper-extremity function (UEF) test, to obviate the need for walking tasks in bed-bound hospitalized elders. The UEF test involves repetitive elbow flexion measured using low-cost sensors, which is easily performed (standing, sitting, or in bed) in less than one minute. Post-processing, and scoring will be performed in less than one minutes using an app on laptop or cellphone. We have patented and validated the UEF test for assessing frailty based on motion (kinematics) data, and its feasibility has previously been demonstrated in pilot outpatient and inpatient participants. Within this project, implementing the same hardware and measurement protocol, we will improve the algorithm to assess muscle deconditioning (dynapenia) using a new muscle model that will be added to our original UEF algorithm. The proposed approach builds upon pilot research among COPD patients, performed by an excellent group of interdisciplinary investigators at the University of Arizona Center on Aging and the Arizona Respiratory Science Center, demonstrating significant associations between UEF speed (and embedded strength parameters) with the 6-minute walk distance (6MWD) test, the most commonly used measure of functional capacity in COPD. The goal of this R21 project is to: 1) Develop and evaluate an upper-extremity muscle model; and 2: (Clinical Study): Longitudinally assess UEF validity for predicting 90-day adverse health events among 120 COPD-related hospitalized older adults (≥ 65 years) – Predictive Index development and assessment of UEF accuracy, feasibility, and reliability. We expect to extend scientific knowledge regarding the nature of muscle deconditioning (dynapenia) associated with COPD, focusing on an upper-extremity function measure (rather than gait assessment). From a clinical viewpoint, we expect to validate a quick and accurate objective tool for assessing functional capacity among COPD patients as an alternative to the 6MWD test, with the ultimate goal of providing a quick and cost-effective screening tool to support acute and outpatient elders’ risk stratification. If demonstrated effective, we expect that this tool could be used to predict those at highest risk, to enable personalized COPD care and support the quality of life and independence of older adults with COPD or multiple chronic conditions.