Outdoor Environmental Facilitators and Barriers of Stroke Survivors’ Mobility and Functional Status

户外环境对中风幸存者的促进因素和障碍——行动能力和功能状态

• 批准号: 9758544
• 负责人: Erica Twardzik
• 金额: $ 3.68万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9758544
• 关键词: Activities of Daily Living; Address; Adult; Affect; Age; American; Ancillary Study; Area; Caregivers; Caring; Communities; Data; Data Analyses; Data Collection; Data Sources; Development; Development Plans; Elderly; Environment; Future; Gait speed; Health; Home environment; Impaired cognition; Impairment; Individual; Interview; Loneliness; Measurement; Medical; Mental Depression; Methods; Nursing Homes; Participant; Pathway interactions; Policies; Population; Qualitative Methods; Reasons for Geographic And Racial Differences in Stroke; Reporting; Research; Research Design; Research Project Grants; Residual state; Resources; Sampling; Sampling Studies; Severities; Shapes; Site; Stroke; Surface; Survivors; Time; United States; Urban Developments; Visual impairment; Walking; Width; acute stroke; aging population; built environment; cohort; community involvement; disability; environmental change; follow-up; functional disability; functional independence; functional status; health care availability; improved; post stroke; premature; social engagement; stroke risk; stroke survivor; time use; wearable device

PROJECT SUMMARY Stroke is a leading cause of serious long-term disability within the United States, and it affects an estimated 6.6 million Americans over age 20. Medical advances in treatment of acute stroke and an aging population have resulted in a greater number of stroke survivors in our population, and many stroke survivors return directly home. With a greater number of stroke survivors living in their local community, it is critical to determine which features of the local environment best support stroke survivors' functional status, especially features that support mobility. Mobility impacts health through various mechanisms, including social engagement, community involvement, and access to health care resources. Using a mixed methods study design, the proposed project will determine which features of the outdoor environment are most important for mobility and functional status in the first 18 months post-stroke. This research project will consist of a secondary data analysis of existing data by combining three, rich data sources and primary data collection using mobile inertial measurement units and qualitative methods. Specifically, this research project will address the following aims: 1) Examine the moderating effect of environmental features found on participants' residential blocks on the relationship between stroke severity and 18-month trajectory of functional status post stroke, 2) Identify environmental features that moderate the relationship between stroke severity and mobility adaption (i.e. slower gait speed) in real-time using wearable sensors (i.e. mobile inertial measurement units), and 3) Identify the most salient environmental features for functional status and mobility as reported by stroke survivors using qualitative interviews. The mixed methods approach allows the examination of which environmental features interact with stroke impairment to result in differential functional status (Aim 1), how stroke impairment interacts with environmental features to affect mobility (Aim 2), and why environmental features affect mobility and functional status from the perspective of stroke survivors themselves (Aim 3). This research will identify potential ways to increase stroke survivors' mobility and independence by determining how to maximize the accessibility of the outdoor built environment. The findings of this research will inform planning and policy regarding which components of the built environment are most important for survivors' mobility and functional independence. Ultimately, positive environmental changes can improve stroke survivors' functional independence and decrease stroke survivors' reliance on caregivers, premature relocation to nursing home facilities, and development of secondary conditions (e.g. depression, cognitive decline).

项目概要 中风是美国严重长期残疾的主要原因，估计影响 6.6 百万 20 岁以上的美国人。治疗急性中风的医学进步和人口老龄化已经 导致我们人口中的中风幸存者数量增加，许多中风幸存者直接返回 家。由于越来越多的中风幸存者生活在当地社区，因此确定哪些中风幸存者至关重要 当地环境的特征最能支持中风幸存者的功能状态，特别是以下特征： 支持移动性。流动性通过各种机制影响健康，包括社会参与、 社区参与和获得医疗保健资源。采用混合方法研究设计， 拟议的项目将确定室外环境的哪些特征对于流动性和 中风后前 18 个月的功能状态。该研究项目将包含二手数据 三结合分析现有数据，数据源丰富，利用移动惯性采集原始数据 测量单位和定性方法。具体来说，该研究项目将实现以下目标： 1) 检查参与者居住街区的环境特征对 中风严重程度与中风后 18 个月功能状态轨迹之间的关系，2) 识别 调节中风严重程度和行动适应之间关系的环境特征（即 使用可穿戴传感器（即移动惯性测量单元）实时识别（较慢的步态速度），以及 3) 识别 中风幸存者报告的功能状态和活动能力最显着的环境特征 定性访谈。混合方法方法允许检查哪些环境特征 与中风损伤相互作用导致不同的功能状态（目标 1），中风损伤如何 与环境特征相互作用影响移动性（目标 2），以及为什么环境特征影响移动性 中风幸存者自身的角度和功能状态（目标 3）。这项研究将确定 通过确定如何最大限度地提高中风幸存者的活动能力和独立性的潜在方法 室外建筑环境的可达性。这项研究的结果将为规划和政策提供信息 关于建筑环境的哪些组成部分对于幸存者的流动性和功能最重要 独立。最终，积极的环境变化可以改善中风幸存者的功能 独立并减少中风幸存者对护理人员的依赖，过早搬到疗养院 设施和次要病症的发展（例如抑郁、认知能力下降）。