The AMPREDICT PROsthetics Decision Support Tool: using evidence to guide personalized prosthetic prescription and rehabilitation planning

AMPREDICT 假肢决策支持工具：利用证据指导个性化假肢处方和康复规划

• 批准号: 10750706
• 负责人: Daniel C Norvell
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 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 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10750706
• 关键词: Address; Amputation; Amputees; Back; Caring; Categories; Characteristics; Chronic; Classification; Clinical; Clinical Practice Guideline; Communication; Communities; Department of Defense; Development; Education; Electronic Health Record; Ensure; Environment; Equity; Evaluation; Femur; Focus Groups; Frustration; Future; Geographic Locations; Geography; Goals; Health; Healthcare; Healthcare Systems; Inequity; Injury; Interview; Ischemia; Life; Limb Prosthesis; Limb structure; Lower Extremity; Medical; Medical Records; Medicare; Methods; Modeling; Online Systems; Outcome; Output; Patients; Persons; Physical Examination; Private Sector; Probability; Process; Prosthesis; Prosthetic rehabilitation; Provider; Quality of life; Recommendation; Rehabilitation therapy; Research; Resources; Risk; Risk Factors; Secondary to; Services; Shapes; Standardization; Structure; Surface; System; Testing; Theoretical Domains framework; Time; United States Agency for Healthcare Research and Quality; United States Department of Veterans Affairs; Variant; Veterans; Veterans Health Administration; Walking; Wheelchairs; Woman; analytical tool; care systems; clinical decision support; clinical implementation; clinical practice; comparative effectiveness; cost; empowerment; evidence base; expectation; experience; functional restoration; gender disparity; health care availability; health care disparity; implementation barriers; implementation facilitators; improved; individual patient; instrument; limb loss; men; mobility rehabilitation; patient education handout; patient expectation; patient subsets; point of care; predictive modeling; predictive tools; programs; prosthesis wearer; racial disparity; smartphone application; support tools; tool; usability; web site

Recent research has highlighted the challenges faced by the clinical rehabilitation team in providing a personalized rehabilitation experience for patients undergoing lower extremity amputation due to chronic limb threatening ischemia. These challenges include the prescription of personalized prosthetic componentry, formulating the most appropriate prosthesis rehabilitation plans based upon the patient’s functional goals and potential, and setting appropriate patient expectations by communicating clearly what level of prosthesis mobility they will likely achieve. Though not the primary impetus behind prosthesis prescription justification within the VHA, the traditional paradigm for a lower limb prosthetic prescription is largely driven by the providers best estimation of the patient’s future mobility outcome sometimes using K-levels or other analogous mobility categories. The appropriate prosthetic componentry is then matched to the predicted mobility level. This approach is wrought with challenges and clinicians do not have a lot of confidence in this process. There is no evidence to back the clinician’s ability to predict future mobility. Current clinical practice guidelines also do not offer adequate evidence or guidance to shape these decisions. The time of initial prosthesis evaluation is a key time point in the amputation rehabilitation continuum that can profoundly influence future functional and quality of life outcomes. Lower extremity amputations are a major health care concern within the VA Health Care System. The VA Amputee System of Care (ASoC) is a national clinical program within Rehabilitation and Prosthetic Services with the primary goal of enhancing the care and outcomes of Veterans with limb loss. The ASoC is concerned with the most appropriate management of persons with limb loss to maximize 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 rehabilitation clinician’s ability in setting rehabilitation mobility goals, prescribing personalized prosthesis components to meet those goals, helping patients set appropriate expectations, [and reassessing patient progress], we propose to develop the AMPREDICT PROsthetics (aka, AMPREDICT PRO) decision support tool. This tool will use the AMPREDICT PRO prediction model output to develop a calculator that will predict the probability that a patient will achieve each of the following mobility levels 12 months after their prosthesis prescription: (1) wheelchair mobility only, (2) able to walk in the house, (3) able to walk in the community short distances on even surfaces, and (4) ability to walk in the community unlimited distances on several terrains. The tool will be developed and tested by VHA rehabilitation clinicians from all geographic regions to help determine the methods of delivering the tool such as a website, smart phone application, or the electronic health record, and to provide input on ways to ensure the tool will be utilized and successfully implemented throughout the VHA medical system. In addition to assisting in personalized prosthesis prescription and rehabilitation planning [and progress assessment, the tool will generate a patient facing educational handout that will help them understand their predicted mobility level and empower them with strategies to achieve the highest level possible.] The results of this research could be incorporated within the Veterans Affairs and Department of Defense Amputation Clinical Practice Guidelines, ASoC core tools, and accomplish one of the VA Health Information Strategic Recommendations for increased decision support and analytic tools.

最近的研究强调了临床康复团队在提供一个 慢性下肢截肢患者的个性化康复体验 威胁缺血这些挑战包括个性化假体部件的处方， 根据患者的功能目标制定最合适的假肢康复计划， 潜力，并通过明确沟通假体水平来设定适当的患者期望 他们可能会获得的流动性。虽然不是假体处方合理性背后的主要动力 在VHA中，下肢假肢处方的传统范例主要是由 提供者对患者未来活动结果的最佳估计，有时使用K水平或其他类似方法 流动性类别。然后将适当的假体部件与预测的活动度水平相匹配。 这种方法面临着挑战，临床医生对这个过程没有太大的信心。那里 没有证据支持临床医生预测未来移动性的能力。目前的临床实践指南也 没有提供足够的证据或指导来形成这些决定。初次假体评价时间为 截肢康复连续体中的关键时间点，可以深刻影响未来的功能和 生活质量结果。下肢截肢是VA Health中的主要医疗保健问题 护理系统。VA截肢者护理系统（ASoC）是康复和康复领域的国家临床计划， 假肢服务的主要目标是加强护理和结果的退伍军人与肢体损失。的 ASoC关注的是对肢体丧失者进行最适当的管理，以最大限度地发挥功能， 生活质量，以及减少地区之间的保健差距和改善地理可及性 卫生保健资源。为了提高康复医生制定康复活动目标的能力， 处方个性化的假体组件，以满足这些目标，帮助患者设置适当的 期望，[和重新评估患者进展]，我们建议开发AMPREDICT假体（又名， AMPREDICT PRO）决策支持工具。此工具将使用AMPREDICT PRO预测模型输出， 开发一个计算器，可以预测患者实现以下每一项活动的概率 假肢处方后12个月的水平：（1）仅轮椅移动性，（2）能够在家中行走， (3)能够在社区中短距离地在平坦的表面上行走，以及（4）能够在社区中行走 在几个地形上的无限距离。该工具将由VHA康复临床医生开发和测试 从所有地理区域，以帮助确定提供工具的方法，如网站，智能 电话应用程序，或电子健康记录，并提供有关如何确保该工具将 在整个VHA医疗系统中使用并成功实施。除了协助 个性化的假肢处方和康复计划[和进展评估，该工具将 生成面向患者的教育讲义，帮助他们了解其预测的移动水平， 使他们有能力实现尽可能高的水平。这项研究的结果可能是 纳入退伍军人事务部和国防部截肢临床实践指南， ASoC核心工具，并完成VA健康信息战略建议之一，以增加 决策支持和分析工具。