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

描述（由申请人提供）：本提案的目的是：(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来增加循证健康信息的影响和有效使用；(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结果。拟议的项目增强了现有的截肢者虚拟环境支持空间（AVESS）虚拟基础设施，为上肢和下肢截肢者以及为截肢者服务的临床医生提供基于物理、情感和技术的循证健康信息。目的1开发一上肢一下肢3模块自我管理干预。第一个模块提供说明性循证信息。第二个和第三个模块提供交互式体验，例如，解决选择假肢，假肢训练，截肢生活的情感方面，以及管理并发症和社会融合。目标2评估3模块自我管理干预措施的可用性；将对焦点小组会议的数据进行分析，以确定与易用性、内容的适当性和有用性、视觉呈现的外观和使用的可能性有关的主题领域。目的3进行了一项随机临床试验，比较CD-Rom和AVESS环境下的个体截肢者干预结果。结果是假体装置的使用、自我效能、社会心理状态、疼痛干扰和身体功能。目标4评估用户对AVESS传播策略的满意度。我们将招募92名截肢患者：46名上肢截肢者和46名下肢截肢者。受试者将在发明后完成前测、3模块干预和后测，并在随访5个月时再次进行后测。将采用混合方法设计。目标一是发展。目标2和目标4将使用基于接地（目标2）和解释现象学方法（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.