Refinement of the Comprehensive Mobile Assessment of Pressure (CMAP) System for Prevention of Pressure Injuries

改进综合移动压力评估 (CMAP) 系统以预防压力损伤

• 批准号: 10598037
• 负责人: CHRISTINE M OLNEY
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598037
• 关键词: Acute; Adult; Area; Beds; Behavior; Belief; Cellular Phone; Charge; Chest; Clinical; Community Participation; Compensation; Computer software; Cues; Data; Development; Disease; Docking; Education; Educational process of instructing; Effectiveness; Ensure; Esthesia; Evaluation; Feedback; Focus Groups; Fostering; Frequencies; Funding; Goals; Health; Healthcare Systems; Home; Hospitals; Hypesthesia; Individual; Injury; Inpatients; Intervention; Interview; Learning; Life; Manual wheelchair; Maps; Measures; Methods; Monitor; Motor; Movement; Nurses; Observational Study; Outcome; Outpatients; Paralysed; Patient Education; Patients; Performance; Personal Satisfaction; Positioning Attribute; Powered wheelchair; Prevention; Prevention education; Quality of life; Questionnaires; Rehabilitation therapy; Research Design; Risk Factors; Risk Reduction; Risk Reduction Behavior; Self Efficacy; Self Management; Site; Skin; Skin Care; Spinal cord injury; Standardization; Surface; Surveys; System; Systems Development; Testing; Time; Training; Translations; United States Department of Veterans Affairs; Update; Veterans; Visit; Visual; Visualization; Weight; Wheelchairs; actigraphy; community setting; cost; decubitus ulcer; design; education planning; experience; improved; injured; injury prevention; meetings; mobile computing; pilot test; preference; pressure; prevent; real-time images; smart watch; smartphone based assessment; success; tool; usability

Objectives: The long-term goal of this project is to improve the effectiveness of pressure injury prevention education by clinicians and self-management by Veterans with spinal cord injury (SCI) through a methodical development and testing of a mobile platform based pressure mapping system called “Comprehensive Mobile Assessment of Pressure” (CMAP). The targeted risk-reduction behavior in this project is the effective use of weight shifts when sitting in a wheelchair by improving consistency, frequency, duration, and quality of movements to redistribute pressure. CMAP provides visual cues as well as individually customizable reminders that are designed to compensate for the lack of sensation that prevents the use of natural cues to redistribute pressure, by wheelchair users. An updated CMAP system will serve two important objectives: 1) assist clinicians in assessment, individualized goal-setting, and monitoring the Veteran with SCI’s progress toward pressure injury prevention behavior goals while in the hospital setting; and 2) assist clinicians with individualized setup and education of the Veteran with SCI for using the CMAP system in the home setting as a self-management strategy for pressure injury prevention. Specific Aims: The specific aims of this study include: 1a) hardware expansion to improve functionality of the CMAP system to add a docking and charging station and use of CMAP on a smartwatch based on Veteran preferences and 1b) software expansion to enhance clinical education for pressure injury prevention education, with requirements provided by clinicians; 2) determine usability of the refined CMAP system when it is integrated into patient education for Veteran’s with acute SCI during their inpatient rehabilitation stay, and 3) a determine usability and efficacy of the refined CMAP system for clinician-delivered pressure injury prevention education, followed by Veteran use of CMAP in their daily routines at home. Study Design: This four-year study will have multiple stages and will use a mixed methods approach that includes iterative focus groups and interviews with Veterans who have SCI and with clinicians who provide pressure injury prevention education to Veterans with SCI; self-efficacy and usability surveys for both Veterans and clinicians; pilot testing of CMAP during inpatient rehabilitation and testing during outpatient visits. Repeated measures will be used to evaluate changes within subject for completion of weight shifts while using CMAP, compared to periods when not using CMAP. Methods: During the first two years, improvements to CMAP hardware and software will be guided by experience- based design guided requirements learned about through iterative focus groups including Veterans with SCI/D (n=10) and clinicians (n=10). Usability will be measured at each iteration of development using the System Usability Scale (SUS) and the User Experience Questionnaire (UEQ). The focus groups will be repeated to ensure alignment between development progress and the requirements identified by the focus groups. During the inpatient pilot test, clinician (n=3) and Veteran (n=6) self-efficacy will be measured. Veterans will complete selected sub-scales from the Skin Care Belief Scale and clinicians will answer survey questions developed specifically around providing education for performing weight shifts effectively. Veteran progress toward weight shift goals will be measured through performance monitoring within the CMAP app; Actual performance will be assessed against the individualized goals set by the clinician. During the outpatient testing, Veterans (n=20) will use CMAP at home for 2 weeks after receiving education and individualized goals for weight shift performance by clinicians. While at home, trunk movements will be monitored via actigraphy to monitor weight shift frequency to compare to baseline trunk movement data, weight shift performance data within CMAP app, and finally, compared with individualized goals for performing weight shifts. Self efficacy and usability (SUS and UEQ) of the overall system in both settings will be measured.

目的：本研究的长期目标是提高预防压力性损伤的有效性 由临床医生进行教育，由脊髓损伤（SCI）退伍军人进行自我管理， 开发和测试基于移动的平台的压力标测系统，称为“综合移动的 压力评估（CMAP）。本项目中有针对性的降低风险行为是有效利用 当坐在轮椅上时，通过改善一致性，频率，持续时间和质量， 运动来重新分配压力。CMAP提供视觉提示以及可个性化定制的提醒 这些设计是为了弥补感觉的缺失，这种缺失阻止了人们使用自然线索来重新分配 轮椅使用者的压力。更新后的CMAP系统将实现两个重要目标：1）协助临床医生 在评估、个体化目标设定和监控SCI退伍军人的压力进展方面 在医院环境中的伤害预防行为目标; 2）协助临床医生进行个性化设置 和教育的退伍军人与SCI使用CMAP系统在家庭设置作为一个自我管理 预防压力伤害策略。 具体目标：本研究的具体目标包括：1a）硬件扩展，以改善 CMAP系统添加一个对接和充电站，并在基于Veteran的智能手表上使用CMAP 偏好和1b）软件扩展，以加强预防压力伤害教育的临床教育， 根据临床医生提供的要求; 2）确定集成时改进的CMAP系统的可用性 急性脊髓损伤退伍军人在住院康复期间患者教育，3）确定 改进的CMAP系统用于临床医生提供的压力损伤预防教育的可用性和有效性， 其次是退伍军人在家中的日常生活中使用CMAP。 研究设计：这项为期四年的研究将有多个阶段，并将使用混合方法，包括 反复的焦点小组和采访有SCI的退伍军人和提供压力损伤的临床医生 对SCI退伍军人进行预防教育;对退伍军人和临床医生进行自我效能和可用性调查; 在住院患者康复期间进行CMAP试点测试，并在门诊患者就诊期间进行测试。重复的措施将 用于评价使用CMAP时受试者完成体重变化的变化，与 不使用CMAP的时间。 方法：在头两年，CMAP硬件和软件的改进将以经验为指导- 通过迭代焦点小组（包括SCI/D退伍军人）了解到的基于设计指导的需求 （n=10）和临床医生（n=10）。可用性将在使用系统的每次开发迭代中进行测量 可用性量表（SUS）和用户体验问卷（UEQ）。将重复举行焦点小组会议， 确保开发进度与焦点小组确定的要求保持一致。期间 将测量住院患者先导性测试、临床医生（n=3）和退伍军人（n=6）自我效能。退伍军人将完成 从皮肤护理信念量表中选择子量表，临床医生将回答制定的调查问题 特别是围绕提供有效进行体重转移的教育。向体重迈进的老兵 轮班目标将通过CMAP应用程序中的绩效监控进行衡量;实际绩效将 根据临床医生设定的个性化目标进行评估。在门诊测试期间，退伍军人（n=20）将 在接受教育和体重转移表现的个性化目标后，在家中使用CMAP 2周 由临床医生。在家时，将通过体动仪监测躯干运动，以监测体重转移频率 与基线躯干运动数据、CMAP应用程序中的体重转移性能数据进行比较，最后， 与个人化的体重转移目标相比。自我效能和可用性（SUS和UEQ） 将测量两种设置下的整个系统。