Outdoor Environmental Facilitators and Barriers of Stroke Survivors’ Mobility and Functional Status

项目总结 在美国，中风是导致长期严重残疾的主要原因，据估计，美国有6.6人罹患中风 百万20岁以上的美国人。治疗急性中风和人口老龄化的医学进步 导致了我们人口中更多的中风幸存者，许多中风幸存者直接返回 回家。随着大量中风幸存者生活在当地社区，确定哪些中风幸存者是至关重要的 当地环境的特征最能支持中风幸存者的功能状态，特别是 支持移动性。流动性通过各种机制影响健康，包括社会参与， 社区参与和获得卫生保健资源。使用混合方法的研究设计， 拟议的项目将确定户外环境的哪些特征对移动性和 卒中后前18个月的功能状态。这项研究项目将由一个次要数据组成 结合三个丰富的数据源和利用移动惯性进行的一次数据采集来分析现有数据 计量单位和定性方法。具体地说，本研究项目将解决以下目标： 1)研究参加者住宅区内的环境特色对 卒中严重程度与卒中后18个月功能状态轨迹的关系 调节中风严重程度和活动适应之间关系的环境特征(即 步态速度较慢)，使用可穿戴传感器(即移动惯性测量单元)进行实时识别 中风幸存者报告的功能状态和活动能力最显著的环境特征 定性访谈。混合方法方法允许检查哪些环境特征 与卒中损害相互作用导致不同的功能状态(目标1)，卒中损害如何 与环境特征相互作用以影响移动性(目标2)，以及为什么环境特征影响移动性 以及从中风幸存者本身的角度来看的功能状况(目标3)。这项研究将确定 通过确定如何最大限度地提高中风幸存者的灵活性和独立性的潜在方法 室外建筑环境的可达性。这项研究的结果将为规划和政策提供参考 关于建筑环境的哪些组成部分对幸存者的机动性和功能性最重要 独立。最终，积极的环境变化可以改善中风幸存者的功能 独立和减少中风幸存者对照顾者的依赖，过早搬迁到养老院 设施，以及继发性疾病的发展(例如，抑郁、认知衰退)。

PROJECT SUMMARY Stroke is a leading cause of serious long-term disability within the United States, and it affects an estimated 6.6 million Americans over age 20. Medical advances in treatment of acute stroke and an aging population have resulted in a greater number of stroke survivors in our population, and many stroke survivors return directly home. With a greater number of stroke survivors living in their local community, it is critical to determine which features of the local environment best support stroke survivors' functional status, especially features that support mobility. Mobility impacts health through various mechanisms, including social engagement, community involvement, and access to health care resources. Using a mixed methods study design, the proposed project will determine which features of the outdoor environment are most important for mobility and functional status in the first 18 months post-stroke. This research project will consist of a secondary data analysis of existing data by combining three, rich data sources and primary data collection using mobile inertial measurement units and qualitative methods. Specifically, this research project will address the following aims: 1) Examine the moderating effect of environmental features found on participants' residential blocks on the relationship between stroke severity and 18-month trajectory of functional status post stroke, 2) Identify environmental features that moderate the relationship between stroke severity and mobility adaption (i.e. slower gait speed) in real-time using wearable sensors (i.e. mobile inertial measurement units), and 3) Identify the most salient environmental features for functional status and mobility as reported by stroke survivors using qualitative interviews. The mixed methods approach allows the examination of which environmental features interact with stroke impairment to result in differential functional status (Aim 1), how stroke impairment interacts with environmental features to affect mobility (Aim 2), and why environmental features affect mobility and functional status from the perspective of stroke survivors themselves (Aim 3). This research will identify potential ways to increase stroke survivors' mobility and independence by determining how to maximize the accessibility of the outdoor built environment. The findings of this research will inform planning and policy regarding which components of the built environment are most important for survivors' mobility and functional independence. Ultimately, positive environmental changes can improve stroke survivors' functional independence and decrease stroke survivors' reliance on caregivers, premature relocation to nursing home facilities, and development of secondary conditions (e.g. depression, cognitive decline).