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

项目摘要/摘要 这项以患者为中心的研究R21应用程序将为验证一种新的方法提供资金支持 住院老年慢性阻塞性肺疾病患者的功能评估 慢性阻塞性肺病(COPD)，这是一个意义重大且日益重要的领域。我们建议的创新筛查方法是 客观、快速、基于肌肉功能评估潜在的全身性经筋减退。在这个范围内 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、 和死亡率使用所提出的方法。 建议的功能能力评估方法包括上肢功能(UEF)测试，以 使卧床住院的老年人不再需要步行。UEF测试包括重复肘部 使用低成本传感器测量屈曲，不到一次即可轻松完成(站着、坐着或躺在床上) 等一下。后处理和评分将在不到一分钟的时间内使用笔记本电脑或 手机。我们已经为基于运动(运动学)数据评估脆弱性的UEF测试申请了专利并进行了验证， 它的可行性之前已经在试点门诊和住院参与者中得到了证明。在这个范围内 项目中，实现了相同的硬件和测量协议，我们将改进算法进行评估 使用一个新的肌肉模型的肌肉去条件化(呼吸暂停)，这将被添加到我们原来的UEF算法中。 建议的方法建立在对COPD患者进行试点研究的基础上，由一组优秀的 亚利桑那大学老年学和亚利桑那州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，这是COPD最常用的功能容量衡量标准。 该R21项目的目标是：1)开发和评估上肢肌肉模型；以及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)-预测指数开发和评估UEF准确性， 可行性和可靠性。 我们期望扩展有关肌肉去条件化(月经不全)的本质的科学知识。 对于慢性阻塞性肺疾病，重点是上肢功能测量(而不是步态评估)。从一家诊所 观点，我们期望验证一个快速和准确的客观工具来评估功能能力在 COPD患者作为6MWD测试的替代方法，最终目标是提供一种快速且经济有效的 支持急诊和门诊老年人风险分层的筛查工具。如果证明是有效的，我们预计 该工具可以用来预测高危人群，以实现个性化的COPD护理并支持质量 对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的影响。

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.