Natural History of Shoulder Pathology in Wheelchair Users

轮椅使用者肩部病理学的自然史

基本信息

批准号：
10612667
负责人：
MELISSA M. MORROW
金额：
$ 49.21万
依托单位：
UNIVERSITY OF TEXAS MED BR GALVESTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-22 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10612667
关键词：
Activities of Daily Living Address Adult Affect Age Age Factors Aging Attention Chronic Clinical Cohort Studies Complement Coupled Data Development Disease Disease Progression Early Intervention Exhibits Exposure to Female Functional disorder Future Goals Guidelines Health Individual Intervention Intrinsic factor Investigation Knowledge Lead Lesion Life Literature Longitudinal prospective study Magnetic Resonance Imaging Manual wheelchair Measures Movement Natural History Pain Pain-Free Pathology Patient Education Patients Persons Pharmaceutical Preparations Population Population Study Posture Recovery Risk Risk Factors Role Rotator Cuff Shoulder Shoulder Pain Spinal cord injury Structure Tendinopathy Tendon structure Time Translating Upper Extremity Wheelchairs age related arm clinical care clinical diagnosis clinical risk cohort comorbidity disability dosage evidence based guidelines follow-up high risk improved morphogens physically handicapped population based preservation prevent rehabilitation strategy rotator cuff tear sex wearable sensor technology

项目摘要

PROJECT SUMMARY/ABSTRACT This competitive renewal 1) expands on a prospective longitudinal study that defines the natural history of shoulder pathology in manual wheelchair users and an age and sex matched able-bodied referent group, 2) improves the arm use metrics measured during daily living, and 3) determines risk factors of arm use that accelerate shoulder pathology and pain progression beyond that of natural aging. Additionally, this proposal performs a large retrospective population-based cohort study to investigate the risks of comorbidities and medication to a future clinical diagnosis of shoulder pathology or pain. Abundant evidence exists that individuals with spinal cord injury who use manual wheelchairs are much more likely than age matched able- bodied individuals to have rotator cuff pathology and/or shoulder pain. This clinical problem has been receiving attention for decades, yet shoulder pain and dysfunction continues at unacceptably high rates. To maintain the health and independence of a population that relies on their upper extremities for all activities of daily living, our objective is to define the natural history of rotator cuff disease in MWC users with the long-term goal of advancing evidence-based guidelines to decelerate the disease progression. The rate of pathology progression is largely unknown for MWC users, especially early in the disease when nonsurgical interventions may be appropriate. Aim 1 addresses this need by tracking the progression of rotator cuff tendinopathy, partial tears, and pain worsening while quantifying the effect of sex, SCI lesion level, and time since SCI. Inarguably, higher rotator cuff pathology rates among manual wheelchair users is attributable to the altered shoulder function during daily living. However, clinical care would be improved if it was known which extrinsic factors of daily arm use differentiated MWC users whose pathology progression was more accelerated from those whose pathology did not progress or progressed more slowly. Aim 2 uses wearable sensor technologies to determine the association between daily arm use (arm posture, repetitive movement, and recovery) and progression of rotator cuff pathology and pain. Intrinsic factors, including comorbidities and medication use, have been associated with tendon pathology in the able-bodied literature but they are unstudied in the spinal cord injured population. Therefore, Aim 3 will evaluate the contribution of comorbidities and medication use to the onset of rotator cuff pathology and pain in a population-based cohort. By studying factors that differentiate those who have increased rates of pathology progression from those with stable or improving pathology; actionable intrinsic and extrinsic risk factors can be defined. These steps are fundamental for providing a basis for patient education and rehabilitation strategies. By focusing on the early stages of rotator cuff pathology, this study is likely to lead to rehabilitation strategies to implement prior to the development of shoulder dysfunction among individuals who rely on their shoulders for independence.

项目摘要/摘要这种竞争性更新1）扩展了一项前瞻性纵向研究，该研究定义了自然历史手动轮椅使用者的肩部病理学以及年龄和性别相匹配的健全的指称组，2）改善在日常生活中测量的手臂使用指标，3）确定手臂使用的危险因素加速肩膀病理和疼痛的进展，超出了自然衰老。此外，此提案进行大量的基于人群的研究队列研究，以调查合并症的风险和对肩部病理或疼痛的未来临床诊断的药物。有大量证据表明使用手动轮椅的脊髓损伤的人比年龄匹配的人更有可能身体有肩袖病理和/或肩部疼痛。这个临床问题一直在接受几十年来的关注，但肩部疼痛和功能障碍的持续时间持续了不可接受的高率。保持人口的健康和独立性依靠上肢来参加所有日常生活的活动目的是定义MWC使用者的肩袖疾病的自然历史，其长期目标的推进基于证据的指南，以减速疾病进展。病理率 MWC使用者的进展在很大程度上是未知的，尤其是在非手术干预措施的早期可能是合适的。 AIM 1通过跟踪肩袖肌腱病的进展来满足这种需求眼泪和疼痛恶化，同时量化了性别，科幻病变水平以及SCI以来的时间的影响。毫无疑问，手动轮椅使用者中较高的肩袖病理率归因于肩部的变化日常生活中的功能。但是，如果知道哪些外部因素的临床护理将得到改善每日手臂使用差异化的MWC用户，其病理进展的进展更加加速病理学并没有进展或进展较慢。 AIM 2使用可穿戴传感器技术来确定每日手臂使用（手臂姿势，重复运动和恢复）之间的关联与进展肩袖病理和疼痛。固有因素，包括合并症和用药，已经是与肌腱病理学相关的肌腱病理学，但在受伤的脊髓中未被研究人口。因此，AIM 3将评估合并症和药物使用对开始的贡献基于人群的队列中的肩袖病理和疼痛。通过研究与那些有区别的因素从病理稳定或改善病理的患者的病理率提高；可操作可以定义固有和外在的风险因素。这些步骤是为患者提供基础的基础教育和康复策略。通过关注肩袖病理学的早期阶段，这项研究是可能会导致康复策略在发生肩部功能障碍之前依靠肩膀独立的个人。