Making Standing Balance The Fifth Vital Sign in Clinical Settings

跌倒是老龄化人口早期发病率和死亡率的重要来源，然而， 导致跌倒风险增加的感觉、运动和运动变化往往没有及早发现和干预。生死攸关 体征通常在临床环境中用于评估心血管系统(血压、心率)， 免疫系统(体温)和呼吸系统(呼吸率)建立基准值 在开始护理时，筛查合并症或疾病的风险增加，并允许识别和 在不同时间和地点的卫生保健专业人员之间沟通基线的变化。没有相似之处 生命体征是用来评估平衡系统的，它利用神经、感觉和运动功能。 因此，迫切需要一种平衡生命体征，以便主动抓住平衡健康下降的问题 在一个人摔倒之前。理想情况下，此测试必须便宜、一致、客观、易于采用和经过验证 在确定单个患者的跌倒风险方面具有敏感度和特异性。考虑到这些设计 考虑因素和不断增长的证据基础，定量姿势控制测量(QPCM)作为 最有可能作为平衡健康的标准生命体征的候选人。我们的长期目标是 在初级保健和其他临床环境中将qPCM作为生命体征实施，以跟踪 随着时间的推移和临床地点的不同，患者的个体。第一阶段细分市场-目标1：设计一款价格低廉的 易于使用的qPCM工具，适合医生、高级实践提供商和医疗助理使用 繁忙的临床环境，使用可用性和实施科学的理论框架来告知形成者 评估和利益相关者参与。里程碑：qPCM设备的完成样机和实现 获得最终用户的高初始接受度并准备生产以进行有效性测试的工具包。第二阶段 细分-目标2：评估qPCM的初步疗效，以更好地识别 在临床环境下，相对于标准病史和体检的平衡。使用随机对照 临床随机设计，接受qPCM工具或使用护理标准，检验假设 (A)提供者会认为这会影响他们的临床决策过程，以及(B)提供者 可能建议在使用qpcm系统时对余额赤字或跌倒风险进行进一步评估或治疗。 总比没有它强。预计拟议项目的贡献将是量化姿势控制。 评估和实施工具包，以与临床环境中的工作流程保持一致。这一贡献将是 意义重大，因为每个患者都可以在每个办公室接受客观、定量的姿势控制评估 参观。我们提议的研究是创新的，因为它使用了以利益相关者为中心的方法来创建 循证评估在临床中适合成为“生命体征”的背景和必要条件 实施工具包，以促进采用和接受评估。我们还提出了创新的方法来确定 评估在实践中是否会影响临床决策。

Falls are a significant source of early morbidity and mortality in the aging population, yet the neurological, sensory, and motor changes that lead to increased fall risk often escape early identification and intervention. Vital signs are commonly used in clinical settings to assess the cardiovascular system (blood pressure, heart rate), immune system (body temperature), and the respiratory system (respiratory rate) to establish baseline values when initiating care, screen for increased risk of co-morbidities or diseases, and allow for identification and communication of changes from baseline between health care professionals across time and locations. No similar vital sign exists for assessing the balance system, which draws upon neurological, sensory and motor functions. Therefore, there is an urgent need for a balance vital sign in order to proactively catch declining balance health before an individual falls. Ideally, this test must be inexpensive, consistent, objective, easy to adopt, and proven sensitive and specific with regard to identifying an individual patient’s risk of falling. Given these design considerations and a growing evidence base, quantitative postural control measurement (qPCM) stands out as the most viable candidate to serve as a standardized vital sign for balance health. Our long term goal is the implementation of qPCM as a vital sign in primary care and other clinical settings to track balance health among individual patients over time and across clinical locations. Phase I Segment - Aim 1: Design an inexpensive, easy-to-use qPCM tool suitable for use by physicians, advanced practice providers, and medical assistants in busy clinic settings, using theoretical frameworks for usability and implementation science to inform formative evaluation and stakeholder engagement. Milestone: Completed prototype of qPCM device and implementation toolkit that achieves high initial acceptance from end users and is ready to produce for efficacy testing. Phase II Segment - Aim 2: Assess the initial efficacy of qPCM to better identify patients with a significant decline in balance relative to the standard history and physical exam in the clinical setting. Using a randomized controlled design with randomization by clinic to receive the qPCM tool or use standard of care, test the hypotheses that (a) providers will perceive that it influences their clinical decision-making process, and (b) providers are more likely to recommend further evaluation or treatment for a balance deficit or fall risk when using the qPCM system than without it. The contribution of the proposed project is expected to be quantitative postural control assessment and an implementation toolkit to align with workflow in the clinical environment. This contribution will be significant because every patient could receive objective, quantitative postural control assessment at every office visit. Our proposed research is innovative because it uses a stakeholder-centered approach to create an evidence-based assessment suitable of becoming a “vital sign” in the clinical setting and the requisite implementation toolkit to facilitate adoption and uptake of the assessment. We also propose innovative methods to determine whether the assessment influences clinical decision making in practice.