Advancing measurement of physical function in upper limb amputation

推进上肢截肢身体功能的测量

• 批准号: 10749083
• 负责人: LINDA J. RESNIK
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749083
• 关键词: Address; Adoption; Amputation; Automobile Driving; Calibration; Characteristics; Clinical; Custom; Data; Data Collection; Development; Feedback; Floor; Focus Groups; Generations; Goals; Information Systems; Instruction; Interview; Interviewer; Limb Prosthesis; Measurement; Measures; Online Systems; Outcome; Outcome Measure; Paper; Patient Outcomes Assessments; Patients; Persons; Physical Function; Population; Property; Prosthesis; Prosthetic rehabilitation; Quality of Care; Rehabilitation therapy; Reporting; Research; Research Design; Research Methodology; Research Personnel; Sampling; Telephone; Testing; Time; Training; United States Department of Veterans Affairs; Upper Extremity; Veterans; Woman; Work; arm; care systems; clinical care; clinical translation; cognitive interview; data standards; disability; future implementation; implementation facilitation; implementation measures; implementation study; improved; limb amputation; men; performance based measurement; pilot test; preference; prosthesis wearer; prototype; randomized, clinical trials; rehabilitation research; research and development; routine care; sex; sex disparity; tool; working group

Although improving physical function (PF) is a primary goal of prosthetic rehabilitation, measurement of PF in persons using upper limb prostheses is challenging due to limitations of existing measures and challenges in implementing standardized data collection in routine care settings. In the past decade, my research team has tested, developed, and refined patient-reported outcome measures (PROMs) as well as performance-based measures of PF for upper limb amputation (ULA). We developed three promising condition-specific PF measures for ULA, the Upper Extremity Functional Scale for Prosthesis Users (UEFS-P), a custom 13-item version of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Measure (PROMIS-13 UE Amputation sample-specific calibrated scoring AMP) and the Activities Measure for Upper Limb Amputation (AM-ULA). We also evaluated several versions of short forms (SF) of the Patient- Reported Outcomes Measurement Information System upper extremity measure (PROMIS-UE SF). This work has identified important gaps that should be addressed to ensure that measures are reliable, valid, and responsive to change in women and men with ULA. We demonstrated known group validity and test-retest reliability of the UEFS-P (which consists of a One-handed and a Two-handed Task scale). However, the One-handed Task scale had poor person reliability and a substantial floor effect. In addition, the Two-handed Task scale was long and burdensome. The PROMIS-13 UE AMP was scored using amputation-specific calibration and had better reliability than PROMIS- UE SF measures scored using generic population calibrations. However, it could not detect differences in scores between prosthesis users and non-users at the same amputation level, limiting its usefulness for comparisons by prosthesis use and for evaluating effects of prosthetic rehabilitation. To date, the UEFS-P and PROMIS-13 UE AMP have been administered by telephone, though other modes of administration are preferable in clinical settings. Data to support equivalence and feasibility of other administration modes is needed. The long-term goal of this research is to provide clinicians and researchers with tools to evaluate and address the needs of women and men with ULA. The rationale for this proposal is that valid, reliable, and responsive PF measures are needed to detect disparities by sex, accurately track function over time, and discern effects of prosthesis characteristics and prosthesis training. The overall aim of this proposal is to advance the measurement of PF in ULA by refining the UEFS-P and the custom PROMIS-UE SF as well to provide tools to facilitate implementation of the measures. The specific aims of the study are to: 1) refine content, evaluate measurement properties, and improve utility of the UEFS-P and custom PROMIS-UE SF; 2) test the equivalence of the refined UEFS-P and PROMIS UE SF measures by mode of administration; and 3) develop clinical translation tools to facilitate adoption of study measures. This study will advance state-of-the-art measurement of PF in ULA and provide translational tools to expedite measure adoption, ultimately driving improvements in care quality and research design. This work directly addresses a priority identified by the VA/DoD Management of Upper Limb Amputation Rehabilitation Work Group. Key outcomes include: 1) a refined UEFS-P One-Handed Task scale with improved reliability, 2) a short form UEFS-P Two-Handed task scale, 3) a refined population-specific PROMIS-UE SF measure, 4) evidence of concurrent validity of the UEFS-P and PROMIS-13 UE AMP, 5) comparison of mode of administration, and 6) tools to facilitate PF measure adoption to be tested in a future implementation study. 1

虽然改善身体功能（PF）是假肢康复的主要目标，但PF的测量 由于现有措施的局限性和 在常规护理环境中实施标准化数据收集。在过去的十年里，我的研究团队 经过测试、开发和完善的患者报告结局指标（PROM）以及基于性能的 测量上肢截肢术的PF。我们开发了三种有前途的条件特异性PF 假体使用者上肢功能量表（UEFS-P），一个自定义的13项 患者报告结局测量信息系统（PROMIS）版本上限 测量（PROMIS-13 UE截肢样本特定校准评分AMP）和活动测量 上肢截肢术（AM-截肢）。我们还评估了患者的几个版本的简短形式（SF）- 报告结局测量信息系统（PROMIS-UE SF）。这项工作 已经确定了应该解决的重要差距，以确保措施可靠，有效， 对女性和男性的变化做出反应。 我们证明了UEFS-P的已知组效度和重测信度（由一个 单手和双手任务量表）。单手作业量表的信度较差 和显著的地板效果。此外，双手任务量表又长又繁琐。的 使用截肢特异性校准对PROMIS-13 UE AMP进行评分，其可靠性优于PROMIS-13 UE AMP。 使用通用群体校准评分的UE SF测量。然而，它无法检测出 在相同截肢水平下，假体使用者和非使用者之间的评分，限制了其对 通过假体使用进行比较，并评估假体康复的效果。迄今为止，UEFS-P和 PROMIS-13 UE AMP已通过电话给药，但也有其他给药方式。 在临床环境中更可取。支持其他给药模式的等效性和可行性的数据是 needed. 这项研究的长期目标是为临床医生和研究人员提供评估和 满足患有自闭症的妇女和男子的需要。这一建议的理由是，有效、可靠和 需要采取反应性PF措施来检测性别差异，准确跟踪功能随时间的变化， 辨别假体特征和假体训练的效果。本建议的总体目标是 通过改进UEFS-P和自定义PROMIS-UE SF， 提供工具，以促进措施的执行。本研究的具体目标是：1）细化 内容，评估测量属性，并提高UEFS-P和自定义PROMIS-UE SF的实用性; 2） 按给药方式检验改良UEFS-P和PROMIS UE SF指标的等效性;以及3） 开发临床翻译工具，以促进采用研究措施。 这项研究将推进最先进的测量PF在脑卒中，并提供翻译工具， 加快措施的采用，最终推动护理质量和研究设计的改进。这项工作 直接解决VA/DoD上肢截肢康复管理确定的优先事项 工作组。主要成果包括：1）改进的UEFS-P单手任务量表，具有更高的可靠性，2） 简短的UEFS-P双手任务量表，3）细化的人群特异性PROMIS-UE SF测量，4） UEFS-P和PROMIS-13 UE AMP的同时有效性的证据，5） 行政，和6）工具，以促进PF措施的采用将在未来的实施研究进行测试。 1