AMPREDICT PRO- Predicting Prosthetic Mobility and Matching Prosthetic Characteristics to Patient Functional Goals

最近的研究强调了临床康复团队在确定是否存在 血管障碍截肢患者是假肢候选人，制定最合适的康复计划 根据他们的功能目标，并制定一个假肢处方，最适合他们的可能 流动性的结果。目前的处方范例涉及对患者未来活动能力的估计 使用K级的结果。然后将适当的假体部件与预测的K水平相匹配。 这种方法面临挑战，临床医生对该系统没有太大信心。有 没有证据支持临床医生使用K水平预测未来功能的能力。当前临床实践 准则也没有提供足够的证据或指导来形成这些决定。初始时间 假肢评估是截肢者护理连续过程中的一个关键时间点， 结果。下肢截肢是VA医疗保健系统中的一个主要医疗保健问题。 VA截肢者护理系统（ASoC），这是康复护理中的一个专业临床项目 服务，其主要目标是加强截肢者护理和改善患者 结果。该计划关注的是截肢者的最适当的管理，以最大限度地 功能和生活质量，以及减少地区之间的保健差距， 从地理上获取医疗资源。为了改善康复活动目标的建立， 提供最佳的假肢装置，以实现这些目标，我们必须解决的关键之一， 截肢者康复服务提供者的需求。我们建议开发一个预测模型（AMPREDICT- 假体），将根据关键预测因素（包括人口统计学、合并症、 健康行为，认知，心理健康，获得护理，截肢，残肢因素，康复环境， 在假肢处方时可获得的假肢组件复杂度。它将增强假肢 处方，并协助康复团队制定现实的目标，以及管理病人的期望。 最终，它应该减少护理的区域差异，并加强所有VHA设施的决策， 执行此程序。虽然不是拟议研究的主要目标，但成功开发 所提出的预测模型可能对这一群体具有额外的下游益处， 错误，假肢组件装配，其现有的美元成本和病人的旅行费用， 反复的医疗检查。如果成功，它可以实施到VA/DoD临床实践指南中， 在整个VA截肢护理系统中实施。

Recent research has highlighted the challenges faced by the clinical rehabilitation team in determining if a dysvascular amputee patient is a prosthetic candidate, formulating the most appropriate rehabilitation plan based upon their functional goals, and developing a prosthetic prescription that best matches their probable mobility outcome. The current prescription paradigm involves the estimation of the patient's future mobility outcomes using K-levels. The appropriate prosthetic componentry is then matched to the predicted K-level. This approach is wrought with challenges and clinicians do not have a lot of confidence in the system. There is no evidence to back the clinician's ability to use K-levels to predict future function. Current clinical practice guidelines also do not offer adequate evidence or guidance to shape these decisions. The time of initial prosthetic evaluation is a key time point in the amputee care continuum that can profoundly influence later outcome. Lower extremity amputations are a major health care concern within the VA Health Care System. The VA Amputee System of Care (ASoC), which is a specialized clinical program within Rehabilitation Care Services, has been implemented with the primary goal of enhancing amputee care and improving patient outcomes. This program is concerned with the most appropriate management of amputees to maximizing function and quality of life, as well as reducing health care disparities between regions and improving geographical access to health care resources. To improve the establishment of rehabilitation mobility goals, the provision of the optimum prosthetic device to meet those goals, we must address one of the key perceived needs of amputee rehabilitation providers. We propose to develop a prediction model (AMPREDICT- PROsthetics) that will predict mobility outcome based upon key predictors including demographic, comorbidity, health behavior, cognitive, mental health, access to care, reamputation, stump factors, rehab environment, and prosthetic component sophistication available at the time of prosthetic prescription. It will enhance prosthetic prescription and assist the rehabilitation team in setting realistic goals, as well as manage patient expectations. Ultimately, it should reduce regional variation in care and enhance decision making to all VHA facilities that perform this procedure. Although not a primary aim of the proposed research, the successful development of the proposed prediction model may have additional downstream benefits for this population, reducing trial and error, prosthetic component fitting, with its incumbent dollar costs and patient costs in terms of travel and repeated health care visits. If successful, it could be implemented into VA/DoD Clinical Practice Guidelines and implemented throughout the VA Amputation System of Care.