Functional Capacity Assessment in Hospitalized Bed-bound COPD Patients; Predicting Outcomes

项目总结/摘要 这项面向患者的研究R21应用将为验证一种新的方法提供资金支持， 慢性阻塞性肺疾病住院老年患者的功能能力评估 （慢性阻塞性肺病），这是一个重要且日益重要的领域。我们提出的创新筛选方法是 客观、快速，并基于潜在全身性运动失调的肌肉性能评估。在这 我们将进行一项为期90天的纵向研究，以验证COPD急性加重、住院治疗 和死亡率。 建议的功能能力评估方法包括上肢功能（UEF）测试， 探讨卧床住院长者对步行活动的需求。UEF测试涉及重复肘部 使用低成本传感器测量屈曲，这很容易在不到一个小时内完成（站立，坐着或在床上） 一下后处理和评分将在不到一分钟的时间内使用笔记本电脑上的应用程序或 手机。我们已经为UEF测试申请了专利并进行了验证，该测试用于基于运动（运动学）数据评估虚弱程度， 并且其可行性先前已在试点门诊和住院参与者中得到证实。在这 项目，实现相同的硬件和测量协议，我们将改进算法，以评估 使用一种新的肌肉模型，将被添加到我们原来的UEF算法的肌肉去调节（dynapenia）。 所提出的方法建立在COPD患者中的试点研究基础上，由一组优秀的 亚利桑那大学老龄化中心和亚利桑那呼吸科学中心的跨学科研究人员 中心，证明UEF速度（和嵌入强度参数）与 6分钟步行距离（6 MWD）测试，这是COPD中最常用的功能能力测量方法。 这个R21项目的目标是：1）开发和评估上肢肌肉模型; 2：（临床 研究）：纵向评估UEF预测120例COPD相关患者90天不良健康事件的有效性 住院老年人（≥ 65岁）-UEF准确性的预测指数开发和评估， 可行性和可靠性。 我们希望扩大科学知识的性质，肌肉失调（dynapenia）相关 COPD患者，侧重于上肢功能测量（而不是步态评估）。从临床 从这个角度来看，我们希望验证一种快速准确的客观工具，用于评估 COPD患者作为6 MWD测试的替代方案，最终目标是提供快速且具有成本效益的 为急症及门诊长者提供风险分层的筛选工具。如果证明有效，我们预计， 该工具可用于预测高危人群，实现个性化COPD护理， 慢性阻塞性肺病或多种慢性疾病的老年人的生活和独立性。

PROJECT SUMMARY/ABSTRACT This patient-oriented research R21 application will provide funding support for validating a novel approach for assessing functional capacity among hospitalized older adults with chronic obstructive pulmonary disease (COPD), an area of substantial and increasing significance. Our proposed innovative screening method is objective, quick, and based on muscle performance assessment of underlying systemic dynapenia. Within this project we will perform a 90-day longitudinal study to validate prediction of COPD exacerbations, hospitalizations, and mortality using the proposed method. The proposed functional capacity assessment method incorporates an upper-extremity function (UEF) test, to obviate the need for walking tasks in bed-bound hospitalized elders. The UEF test involves repetitive elbow flexion measured using low-cost sensors, which is easily performed (standing, sitting, or in bed) in less than one minute. Post-processing, and scoring will be performed in less than one minutes using an app on laptop or cellphone. We have patented and validated the UEF test for assessing frailty based on motion (kinematics) data, and its feasibility has previously been demonstrated in pilot outpatient and inpatient participants. Within this project, implementing the same hardware and measurement protocol, we will improve the algorithm to assess muscle deconditioning (dynapenia) using a new muscle model that will be added to our original UEF algorithm. The proposed approach builds upon pilot research among COPD patients, performed by an excellent group of interdisciplinary investigators at the University of Arizona Center on Aging and the Arizona Respiratory Science Center, demonstrating significant associations between UEF speed (and embedded strength parameters) with the 6-minute walk distance (6MWD) test, the most commonly used measure of functional capacity in COPD. The goal of this R21 project is to: 1) Develop and evaluate an upper-extremity muscle model; and 2: (Clinical Study): Longitudinally assess UEF validity for predicting 90-day adverse health events among 120 COPD-related hospitalized older adults (≥ 65 years) – Predictive Index development and assessment of UEF accuracy, feasibility, and reliability. We expect to extend scientific knowledge regarding the nature of muscle deconditioning (dynapenia) associated with COPD, focusing on an upper-extremity function measure (rather than gait assessment). From a clinical viewpoint, we expect to validate a quick and accurate objective tool for assessing functional capacity among COPD patients as an alternative to the 6MWD test, with the ultimate goal of providing a quick and cost-effective screening tool to support acute and outpatient elders’ risk stratification. If demonstrated effective, we expect that this tool could be used to predict those at highest risk, to enable personalized COPD care and support the quality of life and independence of older adults with COPD or multiple chronic conditions.