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

虽然改善身体功能 (PF) 是假肢康复的首要目标，但测量 PF 由于现有措施的局限性和挑战，使用上肢假肢的人面临着挑战。 在日常护理环境中实施标准化数据收集。在过去的十年里，我的研究团队 测试、开发和完善患者报告的结果测量（PROM）以及基于绩效的测量 上肢截肢 (ULA) 的 PF 测量。我们开发了三种有前景的针对具体情况的 PF ULA 的测量，假肢使用者上肢功能量表 (UEFS-P)，定制的 13 项 患者报告结果测量信息系统 (PROMIS) 上肢版本 测量（PROMIS-13 UE 截肢样本特定校准评分 AMP）和活动测量 上肢截肢术（AM-ULA）。我们还评估了患者简表 (SF) 的几个版本 - 报告结果测量信息系统上肢测量 (PROMIS-UE SF)。这部作品 确定了应解决的重要差距，以确保措施可靠、有效和 对患有 ULA 的女性和男性的变化做出反应。 我们证明了 UEFS-P 的已知组有效性和重测可靠性（由 单手和双手任务量表）。然而，单手任务量表的人信度较差 和显着的地板效果。此外，双手任务量表又长又繁重。这 PROMIS-13 UE AMP 使用截肢特定校准进行评分，比 PROMIS-13 具有更好的可靠性 UE SF 测量使用通用总体校准进行评分。然而，它无法检测到差异 假肢使用者和非使用者在同一截肢水平上的分数，限制了其在以下方面的用途： 通过假肢使用进行比较并评估假肢康复的效果。迄今为止，UEFS-P 和 PROMIS-13 UE AMP 已通过电话进行管理，但也有其他管理模式 在临床环境中更可取。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评估的工具 通过 ULA 满足女性和男性的需求。该提案的理由是：有效、可靠、 需要采取响应性 PF 措施来检测性别差异，准确跟踪一段时间内的功能，以及 辨别假肢特性和假肢训练的效果。该提案的总体目标是 通过改进 UEFS-P 和定制的 PROMIS-UE SF 来推进 ULA 中的 PF 测量 提供促进措施实施的工具。研究的具体目标是：1）完善 内容、评估测量属性并提高 UEFS-P 和定制 PROMIS-UE SF 的实用性； 2） 按管理模式测试改进后的 UEFS-P 和 PROMIS UE SF 措施的等效性；和 3) 开发临床翻译工具以促进研究措施的采用。 这项研究将推进 ULA 中最先进的 PF 测量，并提供转化工具 加快措施的采用，最终推动护理质量和研究设计的改进。这部作品 直接解决退伍军人管理局/国防部上肢截肢康复管理部门确定的优先事项 工作组。主要成果包括：1) 改进的 UEFS-P 单手任务量表，可靠性更高，2) 简短的 UEFS-P 双手任务量表，3) 精确的针对特定人群的 PROMIS-UE SF 测量，4) UEFS-P 和 PROMIS-13 UE AMP 并发有效性的证据，5) 模式比较 管理，以及 6) 促进 PF 措施采用的工具，将在未来的实施研究中进行测试。 1