Neuromuscular Electrical Stimulation in Individuals with Rheumatoid Arthritis

描述（由申请人提供）：Sara Piva，PT，PhD。是匹兹堡大学物理治疗系的助理教授。她是一名学术物理治疗师，拥有肌肉骨骼PT理学硕士学位和博士学位。康复科学她的目标是成为一名独立的研究者，完全有资格设计和实施关于康复有效性的临床和转化研究，以改善关节炎患者的肌肉功能并最大限度地提高功能结果。在此KO1奖，她将追求板凳训练在形态和代谢肌肉适应评估响应神经肌肉电刺激（NMES）在类风湿性关节炎（RA）患者。候选人将获得通过计算机断层扫描（CT）成像评估骨骼肌组成的技能，并对四头肌样本进行组织和生化分析，以评估肌纤维类型，脂肪含量和氧化能力（线粒体含量和酶活性）。这项培训将使候选人在临床和基础科学方面进行独特的交叉培训，以采取综合方法来研究肌肉康复。通过她的导师Delitto博士，Goodpaster博士，Wasko博士和Fitzgerald博士的帮助，并通过实践培训，课程，指导阅读，参加研讨会，与顾问合作以及实施本KO1中提出的研究，候选人将获得作为独立调查员的职业生涯所需的技能，并填补重要的研究空白。该研究计划的主要目的是确定NMES对RA患者的功能结局和肌肉肥大的影响。次要目的是确定NMES影响肌肉肥大和身体功能的机制。基线测试后，60名RA患者将被随机分配到一个为期16周的NMES计划或高强度意志锻炼计划。这两个项目都将基于当前最佳临床证据进行应用。干预后将对受试者进行重新评估。将比较干预前后基于性能和自我报告的下肢功能、肌肉体积、肌肉力量、I型和II型肌纤维的比例和面积、脂肪含量和肌肉氧化能力的差异。身体功能、肌肉体积和肌肉力量的变化将与I型和II型肌纤维的比例和面积、脂肪含量和肌肉氧化能力的标志物相关。匹兹堡大学国际公认的研究环境将为Piva博士的职业发展做出巨大贡献。

DESCRIPTION (provided by applicant): Sara Piva, PT, PhD. is Assistant Professor in the Department of Physical Therapy at the University of Pittsburgh. She is an academic Physical Therapist with a Master of Science degree in Musculoskeletal PT and a Ph.D. in Rehabilitation Sciences. Her goal is to become an independent investigator fully qualified in design and implementation of clinical and translational investigations on the effectiveness of rehabilitation to improve muscle function and maximize functional outcome in patients with arthritis. During this KO1 award, she will pursue bench training in the assessment of morphological and metabolic muscle adaptations in response to neuromuscular electrical stimulation (NMES) in patients with rheumatoid arthritis (RA). The candidate will gain skills in assessing skeletal muscle composition with computerized tomography (CT) imaging, and performing histo- and biochemical analyses of quadriceps muscle samples to assess muscle fiber type, fat content, and oxidative capacity (mitochondria content and enzyme activity). This training will make the candidate uniquely cross-trained in clinical and basic science to undertake a comprehensive approach to study muscle rehabilitation. Through the help of her mentors, Dr. Delitto, Dr. Goodpaster, Dr. Wasko, and Dr. Fitzgerald, and through a combination of practical training, coursework, directed readings, participation in symposia, collaboration with consultants, and the implementation of the research proposed in this KO1, the candidate will gain the necessary skills for a career as an independent investigator and fill an important research gap. The primary aim of the research plan is to determine the effect of NMES on functional outcome and muscle hypertrophy in individuals with RA. The secondary aim is to determine the mechanism by which NMES affects muscle hypertrophy and physical function. After baseline testing, 60 individuals with RA will be randomly assigned to a 16-week NMES program or highly intense volitional exercise program. Both programs will be applied based on the best current clinical evidence. Subjects will be re-assessed after intervention. Groups will be compared for differences in performance-based and self-reported lower extremity function, muscle volume, muscle strength, proportion and area of type I and II muscle fibers, fat content, and muscle oxidative capacity from pre- to post-intervention. Changes in physical function, muscle volume, and muscle strength will be correlated with proportion and area of type I and II muscle fibers, fat content, and markers of muscle oxidative capacity. The internationally recognized research environment of the University of Pittsburgh will highly contribute to the development of Dr. Piva's career.