Driving Rehabilitation and Innovation for Evaluating Risk in Post-Intensive Care Unit Survivors (DRIVE-PICS)

推动康复和创新以评估重症监护室幸存者的风险 (DRIVE-PICS)

• 批准号: 10574692
• 负责人: Valerie Danesh
• 金额: $ 22.01万
• 依托单位: BAYLOR RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10574692
• 关键词: Acute; Address; Admission activity; Affect; Attention; Automobile Driving; Behavior assessment; Behavioral; Biological; Brain; Caring; Clinical; Cognitive; Cognitive deficits; Compensation; Complex; Critical Illness; Data; Data Collection; Delirium; Dementia; Diagnosis; Elderly; Employment; Enrollment; Funding; Future; Goals; Health Promotion; Hospitals; Image; Impaired cognition; Impairment; Intensive Care; Intensive Care Units; Licensing; Life; Longevity; Measures; Monitor; Movement; Neurocognitive; Neurologic; Older Population; Physicians; Predisposition; Protocols documentation; Quality of life; Recovery; Rehabilitation therapy; Reproducibility; Research; Risk; Risk Factors; Safety; Spinal cord injury; Strategic Planning; Stroke; Survivors; Syndrome; System; Technology; Time; United States; Universities; Vehicle crash; Visit; Work; acceptability and feasibility; automobile accident; behavior change; clinical diagnosis; cognitive change; cohort; cost; design; driving behavior; driving safety; evidence base; experience; health care service utilization; high risk; improved; innovation; insight; kinematics; normal aging; novel; older driver; post stroke; processing speed; programs; psychologic; recruit; rehabilitation strategy; response; risky driving; safety assessment; sensor; skills; success; survivorship; therapy development; virtual

There are more than 50 million older adults licensed to drive in the United States. Driving is a complex task requiring cognitive and sensorimotor skills. Survivors of critical illness experience cognitive, psychological and physical impairments, known as Post-Intensive Care Syndrome (PICS), that can last months to years following critical illness. Across the lifespan, ICU recovery has far-reaching implications for independent functioning, employment, and healthcare utilization, costing billions annually. Older adults are at risk for ICU- acquired cognitive decline discernible from clinical, biological, and imaging-related changes in the brain following delirium and critical illness. Similar to other forms of dementia, the combination of normal aging paired with cognitive deficits associated with critical illness survivorship places these older adults at high risk of automobile crashes. To address ICU-acquired cognitive decline, driving assessments to characterize risky driving behaviors are promising to guide driving rehabilitation and intervention development. Rigorous and reproducible driving safety assessment programs have demonstrated success in post-stroke and dementia contexts, established via in-vehicle and virtual modes. We hypothesize that in-vehicle driving assessment and monitoring is a feasible and acceptable approach to assess and address ICU survivor driving safety. We seek to implement novel in-vehicle cloud-data collection technology developed by our team. We propose to pair neurocognitive assessments with in-vehicle kinematic driving data to conduct essential formative work to develop data-based insights into driving behaviors of older adults with ICU-acquired cognitive declines. We aim to determine protocol feasibility and acceptability of neurocognitive assessments and in-vehicle sensor deployment (Aim 1). We will enroll a cohort of older ICU survivors (n=24) with risk factors for ICU-acquired cognitive impairment to complete neurocognitive measures and participate in driving data collection via in-vehicle sensors over a 6-month post-hospital discharge period. Next, we will evaluate the relationship between neurocognitive assessments and driving behavior and safety in older ICU survivors (Aim 2). Lastly, we will conduct stakeholder advisory panels on the priorities and data presentation needs of driving assessments for older ICU survivors (Aim 3). The stakeholder advisory panel insights will provide scientific justification and protocol feasibility to evaluate recruitment, acceptability and attrition for future full-scale implementation. As the population of older drivers grows, almost doubling in size from 2012 to 2040 there is an immediate and critical need to address this impactful issue. This work is designed in response to the NIA Strategic Plan (Goal C-1-9 Safety of Older Drivers) to contribute to a critical gap in health promotion to develop an evidence-based, in- vehicle driving assessment system to provide actionable driving safety data and rehabilitation strategies tailored to ICU survivors, their care partners and clinicians.

在美国，有超过5000万老年人被许可驾驶。驾驶是一项复杂的任务 需要认知和感觉运动技能。重症疾病的幸存者经验认知，心理 和身体障碍，被称为强化后护理综合征（图片），可以持续数月至几年 危重疾病。在整个生命周期中，ICU恢复对独立的影响很深远 每年耗资数十亿美元的功能，就业和医疗保健利用。老年人有ICU的风险 从临床，生物学和成像相关的大脑变化中可发现的认知下降 del妄和重症疾病。与其他形式的痴呆相似，正常衰老配对的组合 与危害疾病生存相关的认知缺陷将这些老年人高度高 汽车崩溃。为了解决ICU获得的认知能力下降，推动评估以表征风险 驾驶行为有望指导驾驶康复和干预发展。严格和 可重现的驾驶安全评估计划已证明在势后和痴呆症中取得了成功 通过车载和虚拟模式建立的上下文。我们假设车载驾驶评估 监测是一种可行且可接受的方法，可以评估和解决ICU幸存者驾驶安全性。 我们试图实施由我们的团队开发的新型车载云数据收集技术。我们建议 将神经认知评估与车载运动学驾驶数据配对以进行基本的形成性工作 为了开发基于数据的洞察力，以驱动具有ICU获得认知能力的老年人的驱动行为。我们 旨在确定神经认知评估和车载传感器的可行性和可接受性 部署（AIM 1）。我们将招募一组老年ICU幸存者（n = 24），具有ICU获得的风险因素 认知障碍以完成神经认知措施并通过车辆进行驱动数据收集 在院后出院6个月内的传感器。接下来，我们将评估 较老的ICU幸存者的神经认知评估以及驱动行为和安全性（AIM 2）。最后，我们会的 进行利益相关者咨询面板，以驾驶评估的优先级和数据显示需求 年长的ICU幸存者（AIM 3）。利益相关者咨询小组的见解将提供科学的理由和 评估招聘，可接受性和损耗的协议可行性，以实现未来的全面实施。作为 老年驾驶员的人口增长，从2012年到2040年的大小几乎增加了一倍 需要解决这个有影响力的问题。这项工作是根据NIA战略计划而设计的（目标C-1-9 老年驾驶员的安全）有助于促进健康促进的鸿沟，以开发基于证据的，不 车辆驾驶评估系统可提供可行的驾驶安全数据和康复策略 对于ICU幸存者，他们的护理伙伴和临床医生。