Driving Rehabilitation and Innovation for Evaluating Risk in Post-Intensive Care Unit Survivors (DRIVE-PICS)

推动康复和创新以评估重症监护室幸存者的风险 (DRIVE-PICS)

基本信息

批准号：
10574692
负责人：
Valerie Danesh
金额：
$ 22.01万
依托单位：
BAYLOR RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10574692
关键词：
Acute Address Admission activity Affect Attention Automobile Driving Behavior assessment Behavioral Biological Brain Caring Clinical Cognitive Cognitive deficits Compensation Complex Critical Illness Data Data Collection Delirium Dementia Diagnosis Elderly Employment Enrollment Funding Future Goals Health Promotion Hospitals Image Impaired cognition Impairment Intensive Care Intensive Care Units Licensing Life Longevity Measures Monitor Movement Neurocognitive Neurologic Older Population Physicians Predisposition Protocols documentation Quality of life Recovery Rehabilitation therapy Reproducibility Research Risk Risk Factors Safety Spinal cord injury Strategic Planning Stroke Survivors Syndrome System Technology Time United States Universities Vehicle crash Visit Work acceptability and feasibility automobile accident behavior change clinical diagnosis cognitive change cohort cost design driving behavior driving safety evidence base experience health care service utilization high risk improved innovation insight kinematics normal aging novel older driver post stroke processing speed programs psychologic recruit rehabilitation strategy response risky driving safety assessment sensor skills success survivorship therapy development virtual

项目摘要

There are more than 50 million older adults licensed to drive in the United States. Driving is a complex task requiring cognitive and sensorimotor skills. Survivors of critical illness experience cognitive, psychological and physical impairments, known as Post-Intensive Care Syndrome (PICS), that can last months to years following critical illness. Across the lifespan, ICU recovery has far-reaching implications for independent functioning, employment, and healthcare utilization, costing billions annually. Older adults are at risk for ICU- acquired cognitive decline discernible from clinical, biological, and imaging-related changes in the brain following delirium and critical illness. Similar to other forms of dementia, the combination of normal aging paired with cognitive deficits associated with critical illness survivorship places these older adults at high risk of automobile crashes. To address ICU-acquired cognitive decline, driving assessments to characterize risky driving behaviors are promising to guide driving rehabilitation and intervention development. Rigorous and reproducible driving safety assessment programs have demonstrated success in post-stroke and dementia contexts, established via in-vehicle and virtual modes. We hypothesize that in-vehicle driving assessment and monitoring is a feasible and acceptable approach to assess and address ICU survivor driving safety. We seek to implement novel in-vehicle cloud-data collection technology developed by our team. We propose to pair neurocognitive assessments with in-vehicle kinematic driving data to conduct essential formative work to develop data-based insights into driving behaviors of older adults with ICU-acquired cognitive declines. We aim to determine protocol feasibility and acceptability of neurocognitive assessments and in-vehicle sensor deployment (Aim 1). We will enroll a cohort of older ICU survivors (n=24) with risk factors for ICU-acquired cognitive impairment to complete neurocognitive measures and participate in driving data collection via in-vehicle sensors over a 6-month post-hospital discharge period. Next, we will evaluate the relationship between neurocognitive assessments and driving behavior and safety in older ICU survivors (Aim 2). Lastly, we will conduct stakeholder advisory panels on the priorities and data presentation needs of driving assessments for older ICU survivors (Aim 3). The stakeholder advisory panel insights will provide scientific justification and protocol feasibility to evaluate recruitment, acceptability and attrition for future full-scale implementation. As the population of older drivers grows, almost doubling in size from 2012 to 2040 there is an immediate and critical need to address this impactful issue. This work is designed in response to the NIA Strategic Plan (Goal C-1-9 Safety of Older Drivers) to contribute to a critical gap in health promotion to develop an evidence-based, in- vehicle driving assessment system to provide actionable driving safety data and rehabilitation strategies tailored to ICU survivors, their care partners and clinicians.

美国有超过 5000 万老年人拥有驾驶执照。驾驶是一项复杂的任务需要认知和感觉运动技能。危重疾病幸存者经历认知、心理以及身体损伤，称为重症监护后综合症 (PICS)，可能持续数月至数年患重病后。在整个生命周期中，ICU 康复对独立患者具有深远的影响功能、就业和医疗保健利用，每年花费数十亿美元。老年人有进入 ICU 的风险获得性认知能力下降可通过大脑的临床、生物和成像相关变化来辨别谵妄和危重疾病之后。与其他形式的痴呆症类似，正常衰老的组合配对与危重病生存相关的认知缺陷使这些老年人面临高风险汽车碰撞事故。为了解决 ICU 获得性认知能力下降的问题，推动评估来描述风险特征驾驶行为有望指导驾驶康复和干预措施的发展。严谨和可重复的驾驶安全评估计划已在中风后和痴呆症方面取得成功通过车载和虚拟模式建立的上下文。我们假设车载驾驶评估监测是评估和解决 ICU 幸存者驾驶安全问题的可行且可接受的方法。我们寻求实施我们团队开发的新颖的车载云数据收集技术。我们建议将神经认知评估与车内运动驾驶数据相结合，以进行必要的形成工作开发基于数据的见解，了解 ICU 获得性认知能力下降的老年人的驾驶行为。我们旨在确定神经认知评估和车载传感器协议的可行性和可接受性部署（目标 1）。我们将招募一组老年 ICU 幸存者 (n=24)，这些幸存者具有 ICU 获得性危险因素认知障碍完成神经认知测量并通过车内参与驾驶数据收集出院后 6 个月期间的传感器。接下来，我们将评估之间的关系老年 ICU 幸存者的神经认知评估以及驾驶行为和安全（目标 2）。最后，我们将就驱动评估的优先事项和数据呈现需求召开利益相关者咨询小组 ICU 老年幸存者（目标 3）。利益相关者咨询小组的见解将提供科学依据和评估未来全面实施的招募、可接受性和人员流失的协议可行性。作为老年司机的数量不断增加，从 2012 年到 2040 年几乎翻了一番，这是一个迫在眉睫的关键问题需要解决这个有影响的问题。这项工作是为了响应 NIA 战略计划（目标 C-1-9 老年驾驶员的安全），以弥补健康促进方面的关键差距，以制定基于证据的、内部的车辆驾驶评估系统提供可操作的驾驶安全数据和量身定制的康复策略 ICU 幸存者、他们的护理伙伴和临床医生。