Refinement of the Comprehensive Mobile Assessment of Pressure (CMAP) System for Prevention of Pressure Injuries

目的：本项目的长期目标是提高压伤预防的有效性。 临床医生的教育和退伍军人对脊髓损伤患者的自我管理 基于移动平台的“综合移动”压力测绘系统的开发与测试 压力评估“(CMAP)。该项目中的有针对性的降低风险行为是有效使用 当坐在轮椅上时，通过提高一致性、频率、持续时间和质量来转移体重 重新分配压力的运动。Cmap提供可视提示以及可单独定制的提醒 它们被设计用来弥补阻止使用自然线索重新分配的感觉的缺乏 轮椅使用者施加的压力。更新的CMAP系统将服务于两个重要目标：1)帮助临床医生 在评估、个性化目标设定和监控SCI退伍军人的压力进展方面 在医院环境中的伤害预防行为目标；以及2)帮助临床医生进行个性化设置 以及对患有脊髓损伤的退伍军人在家庭环境中使用CMAP系统进行自我管理的教育 预防压力性损伤的策略。 具体目标：本研究的具体目标包括：1)硬件扩展，以提高 Cmap系统将增加一个对接和充电站，并在基于退伍军人的智能手表上使用CMAP 首选项和1b)软件扩展，以加强压伤预防教育的临床教育， 2)确定改进后的CMAP系统在集成时的可用性 在住院康复期间对急性脊髓损伤退伍军人进行患者教育，3)确定 改良CMAP系统在临床压伤预防教育中的可用性和有效性， 其次是在家里的日常生活中使用CMAP的老手。 研究设计：这项为期四年的研究将分为多个阶段，并将使用混合方法，包括 反复的焦点小组和对患有脊髓损伤的退伍军人和提供压力伤的临床医生的采访 对患有脊髓损伤的退伍军人进行预防教育；退伍军人和临床医生的自我效能感和可用性调查； 住院康复期间的CMAP试验和门诊期间的试验。反复采取措施将 用于评估在使用CMAP时完成重心转移的受试者内的变化 不使用CMAP时的句号。 方法：在头两年，CMAP硬件和软件的改进将以经验为指导- 通过迭代焦点小组(包括患有SCI/D的退伍军人)了解的基于设计的指导需求 10例和临床医生各10例。可用性将在使用系统的每一次开发迭代中进行衡量 可用性量表(SUS)和用户体验问卷(UEQ)。焦点小组将重复进行，以 确保发展进展与重点小组确定的要求保持一致。在.期间 将测量住院飞行员试验、临床医生(n=3)和退伍军人(n=6)的自我效能。退伍军人将完成 从皮肤护理信念量表和临床医生中挑选出的子量表将回答制定的调查问题 具体地说，就是提供有效进行举重转移的教育。老将在体重方面的进步 班次目标将通过CMAP应用程序中的绩效监控进行衡量；实际绩效将为 对照临床医生设定的个性化目标进行评估。在门诊测试期间，退伍军人(n=20)将 在接受教育和个性化的举重成绩目标后，在家中使用CMAP 2周 由临床医生提供。在家时，躯干的运动将通过动作记录仪进行监测，以监测体重转移的频率 为了与基线躯干移动数据、CMAP APP内的重心转移性能数据进行比较，最后， 与进行负重转移的个性化目标相比。自我效能感和可用性(SUS和UEQ) 将测量这两种设置下的整个系统。

Objectives: The long-term goal of this project is to improve the effectiveness of pressure injury prevention education by clinicians and self-management by Veterans with spinal cord injury (SCI) through a methodical development and testing of a mobile platform based pressure mapping system called “Comprehensive Mobile Assessment of Pressure” (CMAP). The targeted risk-reduction behavior in this project is the effective use of weight shifts when sitting in a wheelchair by improving consistency, frequency, duration, and quality of movements to redistribute pressure. CMAP provides visual cues as well as individually customizable reminders that are designed to compensate for the lack of sensation that prevents the use of natural cues to redistribute pressure, by wheelchair users. An updated CMAP system will serve two important objectives: 1) assist clinicians in assessment, individualized goal-setting, and monitoring the Veteran with SCI’s progress toward pressure injury prevention behavior goals while in the hospital setting; and 2) assist clinicians with individualized setup and education of the Veteran with SCI for using the CMAP system in the home setting as a self-management strategy for pressure injury prevention. Specific Aims: The specific aims of this study include: 1a) hardware expansion to improve functionality of the CMAP system to add a docking and charging station and use of CMAP on a smartwatch based on Veteran preferences and 1b) software expansion to enhance clinical education for pressure injury prevention education, with requirements provided by clinicians; 2) determine usability of the refined CMAP system when it is integrated into patient education for Veteran’s with acute SCI during their inpatient rehabilitation stay, and 3) a determine usability and efficacy of the refined CMAP system for clinician-delivered pressure injury prevention education, followed by Veteran use of CMAP in their daily routines at home. Study Design: This four-year study will have multiple stages and will use a mixed methods approach that includes iterative focus groups and interviews with Veterans who have SCI and with clinicians who provide pressure injury prevention education to Veterans with SCI; self-efficacy and usability surveys for both Veterans and clinicians; pilot testing of CMAP during inpatient rehabilitation and testing during outpatient visits. Repeated measures will be used to evaluate changes within subject for completion of weight shifts while using CMAP, compared to periods when not using CMAP. Methods: During the first two years, improvements to CMAP hardware and software will be guided by experience- based design guided requirements learned about through iterative focus groups including Veterans with SCI/D (n=10) and clinicians (n=10). Usability will be measured at each iteration of development using the System Usability Scale (SUS) and the User Experience Questionnaire (UEQ). The focus groups will be repeated to ensure alignment between development progress and the requirements identified by the focus groups. During the inpatient pilot test, clinician (n=3) and Veteran (n=6) self-efficacy will be measured. Veterans will complete selected sub-scales from the Skin Care Belief Scale and clinicians will answer survey questions developed specifically around providing education for performing weight shifts effectively. Veteran progress toward weight shift goals will be measured through performance monitoring within the CMAP app; Actual performance will be assessed against the individualized goals set by the clinician. During the outpatient testing, Veterans (n=20) will use CMAP at home for 2 weeks after receiving education and individualized goals for weight shift performance by clinicians. While at home, trunk movements will be monitored via actigraphy to monitor weight shift frequency to compare to baseline trunk movement data, weight shift performance data within CMAP app, and finally, compared with individualized goals for performing weight shifts. Self efficacy and usability (SUS and UEQ) of the overall system in both settings will be measured.