Dissemination of Amputation and Prosthetic Evidenced-based Medicine (DAP-EM)

说明(由申请人提供)：这项建议的目的是：(1)通过将健康信息添加到现有的虚拟世界支持空间基础设施中，增加循证健康信息的影响和有效利用，以及(2)进行随机临床试验，比较CD-Rom和虚拟环境中提供的干预措施的个体截肢者的结果。拟议的项目加强了现有的截肢者虚拟环境支持空间(AVES)虚拟基础设施，为上下肢截肢患者(S)和为个人截肢服务的临床医生提供基于身体、情感和技术的循证健康信息。目的1开发一个上肢和一个下肢三模块的自我管理干预。第一个模块提供基于证据的陈述性信息。第二个和第三个模块提供互动体验，例如，将讨论选择假体、假肢培训、截肢生活的情感方面、以及管理共病和社会融合。目标2评价3模块自我管理干预措施的可用性；将分析来自焦点小组会议的数据，以确定与易用性、内容的适当性和有用性、视觉演示的外观和使用的可能性有关的主题领域。目的3进行一项随机临床试验，比较CD-Rom和AVESS环境下截肢者的干预结果。结果是假肢的使用、自我效能、心理社会状况、疼痛干预和身体功能。目标4评估用户对AVESS传播战略的满意度。我们将招募92名截肢者：46名上肢截肢者和46名下肢截肢者。受试者将完成前测、三模块干预和发明后的后测，并在五个月的随访中再次完成。将采用混合方法进行设计。目标1是发展。目标2和4将使用基于扎根(目标2)和解释性现象学方法(目标4)的定性方法。目标3将使用定量随机对照设计和广义线性模型进行分析。

DESCRIPTION (provided by the applicant): The purpose of this proposal is to: (1) increase the impact and effective use of evidence-based health information by adding health information to an existing virtual world support space infrastructure and (2) conduct a randomized clinical trial to compare individual-amputee outcomes of the intervention delivered on CD-Rom versus a virtual environment. The proposed project enhances the existing Amputee Virtual Environmental Support Space (AVESS) virtual infrastructure to provide physical, emotional, and technology based evidence-based health information to individuals with upper and lower limb amputation(s) and the clinicians who serve individuals with amputation. Aim 1 develops one upper limb and one lower limb 3- module self-management intervention. The first module provides declarative evidence-based information. The second and third modules provide interactive experiences that will, as examples, address choosing a prosthesis, prosthetic training, emotional aspects of living with an amputation, and managing co morbidity, and social integration. Aim 2 evaluates the usability of the 3-module self-management interventions; data from focus group sessions will be analyzed for thematic areas related to ease of use, appropriateness and usefulness of content, look of the visual presentation, and likeliness of use. Aim 3 conducts a randomized clinical trial to compare individual-amputee outcomes of intervention delivered on CD-Rom versus the AVESS environment. The outcomes are use of prosthetic devices, self-efficacy, psychosocial status, pain interference, and physical function. Aim 4 evaluates user satisfaction with the AVESS dissemination strategy. We will enroll 92 individuals with amputation: 46 upper limb amputees and 46 lower extremity amputees. Subjects will complete pretests, the 3-module intervention, and posttests after the invention and again at five months follow-up. A mixed methods design will be used. Aim 1 is development. Aims 2 and 4 will use qualitative methods based on Grounded (Aim 2) and Interpretative Phenomenological Approaches (Aim 4). Aim 3 will use a quantitative randomized control design and generalized linear models for analyses.