Supplement to Novel precision medicine approach to advance rehabilitation of surgically repaired tendons of the hand

新型精准医学方法的补充，以促进手部手术修复肌腱的康复

• 批准号: 10442923
• 负责人: Sandy Chie Takata
• 金额: $ 1.29万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10442923
• 关键词: Acute; Adhesions; Anatomy; Area; Biological Markers; Biomechanics; Career Mobility; Cicatrix; Clinical; Consensus; Data; Data Analyses; Data Analytics; Data Collection; Development; Edema; Fellowship; Fingers; Flexor; Foundations; Frequencies; Future; Goals; Hand; Hand Injuries; Image; Image Analysis; Imaging Techniques; Individual; Knowledge; Measurement; Measures; Methods; Monitor; Morphology; Motion; Musculoskeletal; Operative Surgical Procedures; Outcome; Pain-Free; Participant; Patient-Focused Outcomes; Patients; Pattern; Physiological; Positioning Attribute; Process; Protocols documentation; Recovery; Recovery of Function; Rehabilitation therapy; Reliability of Results; Research; Research Methodology; Scientist; Shoulder; Skin; Standardization; Techniques; Tendon Injuries; Tendon structure; Tensile Strength; Thinness; Time; Training; Translational Research; Ultrasonography; Variant; adverse outcome; arm; candidate marker; care outcomes; career; catalyst; clinical practice; cost; cost estimate; disability; functional outcomes; hand rehabilitation; healing; imaging biomarker; imaging modality; improved outcome; kinematics; longitudinal analysis; model development; novel; personalized approach; personalized care; precision medicine; public health relevance; real-time images; rehabilitation research; repaired; skills; tendon rupture

Project Summary There is no consensus nor strong evidence that identifies the best rehabilitative protocol to optimize outcomes for patients with surgical repair of a lacerated flexor tendon of the hand. Successful functional recovery requires tendon coaptation, unimpeded tendon gliding, and adequate tensile strength of the repaired tendon. Due to limited evidence and variation in practice, adverse healing outcomes (e.g., tendon ruptures, scar adhesions) occur in a significant number of patients; some patients require a secondary surgery which is costly, less effective, and oftentimes preventable. The training and research conducted through this fellowship will support proficiency in three primary areas related to enhancing the recovery process: 1) musculoskeletal sonography, 2) morphological process of tendon healing, and 3) research methods and data analytic techniques. This fellowship will examine morphologic biomarkers of tendon coaptation using sonographic imaging. Sonographic imaging is a relatively inexpensive, widely available, non-invasive, and pain-free imaging modality that provides real-time images of anatomical structures under the skin. Sonography has been used to evaluate healthy and injured tendons, and sonographic measures have been shown to correlate with functional outcomes. However, an approach for utilizing these biomarkers to inform clinical practice has yet to be fully developed or deployed. As such, this project aims to establish a foundation for the application of sonographic imaging to aid and advance the rehabilitation of flexor tendons. As a first step, a standardized, reliable, and valid sonographic imaging protocol to evaluate tendon healing will be developed. Both static and dynamic imaging techniques will be explored to identify various candidate biomarkers, including macro-morphologic measures of tendon gapping and adhesions, as well as micro-morphologic measures using spatial frequency analysis. The timing for initiation and frequency of data collection to adequately capture changes in the healing tendon will be explored to determine how imaging biomarkers can be used to monitor recovery patterns and characterize the process of tendon healing. Establishing a reliable image analysis protocol and identifying the most salient biomarkers will be a critical step to understanding factors that promote tendon healing with safe and efficient recovery. Successfully accomplishing these aims will be instrumental in advancing practice by supporting the development of a precision medicine approach to tendon rehabilitation.

项目摘要 没有共识和强有力的证据来确定最佳的康复方案以优化结果 对于手术修复手术肌腱肌腱的患者。成功的功能恢复 需要肌腱装束，未避开的肌腱滑动以及修复后的肌腱的足够拉伸强度。 由于证据有限和实践变化，不良愈合结果（例如肌腱破裂，疤痕 粘连）发生在大量患者中；一些患者需要进行继发手术 昂贵，效率较小，并且通常可以预防。通过这项奖学金进行的培训和研究 将支持与增强恢复过程有关的三个主要领域的熟练程度：1）肌肉骨骼 超声检查，2）肌腱愈合的形态学过程，以及3）研究方法和数据分析 技术。该奖学金将使用超声检查检查肌腱共同的形态生物标志物 成像。超声成像是一种相对便宜的，广泛的，无创和无痛的成像 在皮肤下提供解剖结构的实时图像的模态。超声检查已习惯 评估健康和受伤的肌腱，超声检查措施已显示与功能相关 结果。但是，一种利用这些生物标志物来告知临床实践的方法尚未完全 开发或部署。因此，该项目旨在为超声检查的应用建立基础 成像以帮助和推进屈肌的康复。第一步，标准化，可靠和 将开发有效评估肌腱愈合的有效超声成像协议。静态和动态 将探索成像技术以识别各种候选生物标志物，包括宏观形态学 使用空间频率的肌腱间隙和粘连以及微型学测量的度量 分析。数据收集的启动和频率的时间安排，以充分捕获愈合的变化 将探索肌腱，以确定如何使用成像生物标志物来监视恢复模式和 表征肌腱愈合的过程。建立可靠的图像分析协议并确定 大多数显着的生物标志物将是理解因安全性促进肌腱愈合的因素的关键步骤 和有效的恢复。成功实现这些目标将有助于通过 支持开发肌腱康复的精密医学方法。