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Natural History of Shoulder Pathology in Wheelchair Users

轮椅使用者肩部病理学的自然史

基本信息

批准号：
10612667
负责人：
MELISSA M. MORROW
金额：
$ 49.21万
依托单位：
UNIVERSITY OF TEXAS MED BR GALVESTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-22 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10612667
关键词：
Activities of Daily Living Address Adult Affect Age Age Factors Aging Attention Chronic Clinical Cohort Studies Complement Coupled Data Development Disease Disease Progression Early Intervention Exhibits Exposure to Female Functional disorder Future Goals Guidelines Health Individual Intervention Intrinsic factor Investigation Knowledge Lead Lesion Life Literature Longitudinal prospective study Magnetic Resonance Imaging Manual wheelchair Measures Movement Natural History Pain Pain-Free Pathology Patient Education Patients Persons Pharmaceutical Preparations Population Population Study Posture Recovery Risk Risk Factors Role Rotator Cuff Shoulder Shoulder Pain Spinal cord injury Structure Tendinopathy Tendon structure Time Translating Upper Extremity Wheelchairs age related arm clinical care clinical diagnosis clinical risk cohort comorbidity disability dosage evidence based guidelines follow-up high risk improved morphogens physically handicapped population based preservation prevent rehabilitation strategy rotator cuff tear sex wearable sensor technology

项目摘要

PROJECT SUMMARY/ABSTRACT This competitive renewal 1) expands on a prospective longitudinal study that defines the natural history of shoulder pathology in manual wheelchair users and an age and sex matched able-bodied referent group, 2) improves the arm use metrics measured during daily living, and 3) determines risk factors of arm use that accelerate shoulder pathology and pain progression beyond that of natural aging. Additionally, this proposal performs a large retrospective population-based cohort study to investigate the risks of comorbidities and medication to a future clinical diagnosis of shoulder pathology or pain. Abundant evidence exists that individuals with spinal cord injury who use manual wheelchairs are much more likely than age matched able- bodied individuals to have rotator cuff pathology and/or shoulder pain. This clinical problem has been receiving attention for decades, yet shoulder pain and dysfunction continues at unacceptably high rates. To maintain the health and independence of a population that relies on their upper extremities for all activities of daily living, our objective is to define the natural history of rotator cuff disease in MWC users with the long-term goal of advancing evidence-based guidelines to decelerate the disease progression. The rate of pathology progression is largely unknown for MWC users, especially early in the disease when nonsurgical interventions may be appropriate. Aim 1 addresses this need by tracking the progression of rotator cuff tendinopathy, partial tears, and pain worsening while quantifying the effect of sex, SCI lesion level, and time since SCI. Inarguably, higher rotator cuff pathology rates among manual wheelchair users is attributable to the altered shoulder function during daily living. However, clinical care would be improved if it was known which extrinsic factors of daily arm use differentiated MWC users whose pathology progression was more accelerated from those whose pathology did not progress or progressed more slowly. Aim 2 uses wearable sensor technologies to determine the association between daily arm use (arm posture, repetitive movement, and recovery) and progression of rotator cuff pathology and pain. Intrinsic factors, including comorbidities and medication use, have been associated with tendon pathology in the able-bodied literature but they are unstudied in the spinal cord injured population. Therefore, Aim 3 will evaluate the contribution of comorbidities and medication use to the onset of rotator cuff pathology and pain in a population-based cohort. By studying factors that differentiate those who have increased rates of pathology progression from those with stable or improving pathology; actionable intrinsic and extrinsic risk factors can be defined. These steps are fundamental for providing a basis for patient education and rehabilitation strategies. By focusing on the early stages of rotator cuff pathology, this study is likely to lead to rehabilitation strategies to implement prior to the development of shoulder dysfunction among individuals who rely on their shoulders for independence.

项目概要/摘要这种竞争性更新 1) 扩展了一项前瞻性纵向研究，该研究定义了自然历史手动轮椅使用者和年龄和性别匹配的健全参考组的肩部病理学，2) 改善日常生活中测量的手臂使用指标，并且 3) 确定手臂使用的风险因素加速肩部病理和疼痛进展，超越自然衰老。另外，本提案进行了一项基于人群的大型回顾性队列研究，以调查合并症的风险和药物用于未来肩部病理或疼痛的临床诊断。有大量证据表明患有脊髓损伤的人使用手动轮椅的可能性比年龄匹配的能力者高得多患有肩袖病变和/或肩部疼痛的身体个体。这个临床问题已经受到几十年来，人们一直关注肩部疼痛和功能障碍，但肩部疼痛和功能障碍的发生率仍然高得令人无法接受。为了维持依靠上肢进行所有日常生活活动的人口的健康和独立性，我们的目标是确定 MWC 用户肩袖疾病的自然史，长期目标是推进基于证据的指南以减缓疾病进展。病理发生率对于 MWC 用户来说，进展很大程度上是未知的，尤其是在疾病早期，当非手术干预时可能是合适的。目标 1 通过跟踪肩袖肌腱病的进展来满足这一需求，部分在量化性别、SCI 病变水平和自 SCI 以来的时间的影响时，眼泪和疼痛恶化。毫无疑问，手动轮椅使用者中较高的肩袖病理发生率归因于肩部改变日常生活中的功能。然而，如果知道哪些外在因素会导致临床护理的改善，那么临床护理将会得到改善。每天使用手臂使 MWC 用户与那些经常使用手臂的用户区分开来，他们的病理进展更快。病理没有进展或进展缓慢。目标 2 使用可穿戴传感器技术来确定日常手臂使用（手臂姿势、重复运动和恢复）与病情进展之间的关联肩袖病理和疼痛。内在因素，包括合并症和药物使用，已被健全文献中与肌腱病理学相关，但尚未在脊髓损伤中进行研究人口。因此，目标 3 将评估合并症和药物使用对疾病发作的影响基于人群的肩袖病理学和疼痛。通过研究区分那些人的因素与病理稳定或改善的患者相比，病理进展率增加；可执行的可以定义内在和外在风险因素。这些步骤对于为患者提供基础至关重要教育和康复策略。通过关注肩袖病理学的早期阶段，本研究可能导致在肩部功能障碍发生之前实施康复策略依靠自己的肩膀获得独立的人。