Advancing measurement of physical function in upper limb amputation

推进上肢截肢身体功能的测量

• 批准号: 10749083
• 负责人: LINDA J. RESNIK
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749083
• 关键词: Address; Adoption; Amputation; Automobile Driving; Calibration; Characteristics; Clinical; Custom; Data; Data Collection; Development; Feedback; Floor; Focus Groups; Generations; Goals; Information Systems; Instruction; Interview; Interviewer; Limb Prosthesis; Measurement; Measures; Online Systems; Outcome; Outcome Measure; Paper; Patient Outcomes Assessments; Patients; Persons; Physical Function; Population; Property; Prosthesis; Prosthetic rehabilitation; Quality of Care; Rehabilitation therapy; Reporting; Research; Research Design; Research Methodology; Research Personnel; Sampling; Telephone; Testing; Time; Training; United States Department of Veterans Affairs; Upper Extremity; Veterans; Woman; Work; arm; care systems; clinical care; clinical translation; cognitive interview; data standards; disability; future implementation; implementation facilitation; implementation measures; implementation study; improved; limb amputation; men; performance based measurement; pilot test; preference; prosthesis wearer; prototype; randomized, clinical trials; rehabilitation research; research and development; routine care; sex; sex disparity; tool; working group

Although improving physical function (PF) is a primary goal of prosthetic rehabilitation, measurement of PF in persons using upper limb prostheses is challenging due to limitations of existing measures and challenges in implementing standardized data collection in routine care settings. In the past decade, my research team has tested, developed, and refined patient-reported outcome measures (PROMs) as well as performance-based measures of PF for upper limb amputation (ULA). We developed three promising condition-specific PF measures for ULA, the Upper Extremity Functional Scale for Prosthesis Users (UEFS-P), a custom 13-item version of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Measure (PROMIS-13 UE Amputation sample-specific calibrated scoring AMP) and the Activities Measure for Upper Limb Amputation (AM-ULA). We also evaluated several versions of short forms (SF) of the Patient- Reported Outcomes Measurement Information System upper extremity measure (PROMIS-UE SF). This work has identified important gaps that should be addressed to ensure that measures are reliable, valid, and responsive to change in women and men with ULA. We demonstrated known group validity and test-retest reliability of the UEFS-P (which consists of a One-handed and a Two-handed Task scale). However, the One-handed Task scale had poor person reliability and a substantial floor effect. In addition, the Two-handed Task scale was long and burdensome. The PROMIS-13 UE AMP was scored using amputation-specific calibration and had better reliability than PROMIS- UE SF measures scored using generic population calibrations. However, it could not detect differences in scores between prosthesis users and non-users at the same amputation level, limiting its usefulness for comparisons by prosthesis use and for evaluating effects of prosthetic rehabilitation. To date, the UEFS-P and PROMIS-13 UE AMP have been administered by telephone, though other modes of administration are preferable in clinical settings. Data to support equivalence and feasibility of other administration modes is needed. The long-term goal of this research is to provide clinicians and researchers with tools to evaluate and address the needs of women and men with ULA. The rationale for this proposal is that valid, reliable, and responsive PF measures are needed to detect disparities by sex, accurately track function over time, and discern effects of prosthesis characteristics and prosthesis training. The overall aim of this proposal is to advance the measurement of PF in ULA by refining the UEFS-P and the custom PROMIS-UE SF as well to provide tools to facilitate implementation of the measures. The specific aims of the study are to: 1) refine content, evaluate measurement properties, and improve utility of the UEFS-P and custom PROMIS-UE SF; 2) test the equivalence of the refined UEFS-P and PROMIS UE SF measures by mode of administration; and 3) develop clinical translation tools to facilitate adoption of study measures. This study will advance state-of-the-art measurement of PF in ULA and provide translational tools to expedite measure adoption, ultimately driving improvements in care quality and research design. This work directly addresses a priority identified by the VA/DoD Management of Upper Limb Amputation Rehabilitation Work Group. Key outcomes include: 1) a refined UEFS-P One-Handed Task scale with improved reliability, 2) a short form UEFS-P Two-Handed task scale, 3) a refined population-specific PROMIS-UE SF measure, 4) evidence of concurrent validity of the UEFS-P and PROMIS-13 UE AMP, 5) comparison of mode of administration, and 6) tools to facilitate PF measure adoption to be tested in a future implementation study. 1

尽管改善身体功能（PF）是假肢康复的主要目标，但测量PF 在使用上肢假肢的人中，由于现有措施和挑战的局限性 在常规护理设置中实施标准化的数据收集。在过去的十年中，我的研究团队有 经过测试，开发和精致的患者报告的结果指标（PROM）以及基于绩效的结果 上肢截肢（ULA）的PF度量。我们开发了三个有希望的特定条件的PF ULA的措施，假体用户的上肢功能量表（UEFS-P），一个自定义的13个项目 患者报告的结果测量信息系统（PROMIS）上肢的版本 度量（Promis-13 UE截肢样品特定于校准的评分AMP）和活动量度 上肢截肢（AM-ula）。我们还评估了患者的几种简短形式（SF）的版本 报告的结果测量信息系统上肢措施（Promis-UE SF）。这项工作 已经确定了应解决的重要差距，以确保措施可靠，有效，并且 对与ULA的男女变革的反应。 我们证明了uefs-P的已知群体有效性和重测的可靠性（其中包括 单手和双手任务量表）。但是，单手任务量表具有贫穷的人的可靠性 并产生实质性的效果。此外，双手任务量表很长，而且负担重。这 Promis-13 UE AMP是使用特定于截肢的校准对AMP进行评分的，并且比Promis-的可靠性更好 UE SF使用通用人群校准得分。但是，它无法检测到 假体用户与非用户之间的分数在同一截肢级别，从而限制了其对 假体使用和评估假体康复的影响的比较。迄今为止，UEFS-P和 Promis-13 UE AMP是通过电话管理的，尽管其他管理模式是 在临床环境中最好。支持其他管理模式的等效性和可行性的数据是 需要。 这项研究的长期目标是为临床医生和研究人员提供评估和 满足乌拉男女的需求。该提案的理由是有效，可靠和 需要采取响应式PF措施来检测性别差异，随着时间的推移准确跟踪功能，并且 辨别假体特征和假体培训的影响。该提议的总体目的是 通过完善UEFS-P和定制的Promis-ue SF来提高ULA中PF的测量 提供工具来促进措施的实施。研究的具体目的是：1） 内容，评估测量属性并改善UEFS-P和自定义Promis-ue SF的效用； 2） 通过给药方式测试精制的UEFS-P和Promis UE SF措施的等效性； 3） 开发临床翻译工具以促进采用研究措施。 这项研究将推进ULA中PF的最新测量，并为 加快衡量采用率，最终推动了护理质量和研究设计的改进。这项工作 直接解决了上肢截肢康复的VA/DOD管理确定的优先级 工作组。关键结果包括：1）精致的UEFS-P单手任务量表具有提高的可靠性，2） 一个简短的UEFS-P双手任务量表，3）一种精致的人口特定的Promis-ue SF措施，4） UEFS-P和PROMIS-13 UE AMP的同时有效性的证据，5） 管理和6）在将来的实施研究中促进PF测量采用的工具。 1