Determining Clinically Relevant Changes in Community Walking Metrics to Be Tracked by the VA as Part of Routine Care in Lower Limb Amputee Veterans
Abstract
The objective of this study is to define clinically meaningful change in the walking function of lower limb prosthetic users in order to more easily assess whether a patient is improving or declining in function over time. Research has indicated that patients with similar actual walking function may perceive their walking function very differently making self-report in some patients unreliable. A new Department of Veterans Affairs (VA) initiative supports the use of activity monitors to collect specific community walking metrics to address this issue. However, little is known about the natural fluctuations in these walking metrics from week to week when walking function is stable versus clinically relevant changes in walking function. Therefore, it will be important to define meaningful change in walking function when interpreting the impact of prosthetic components, rehabilitation, and other treatments on real-world walking. The specific aims are (1) to determine small meaningful change in the community metrics and (2) to determine substantial meaningful change in the community metrics. The patients recruited for this study will include both Veterans and civilians. The results will be directly applicable to all adults with a lower limb amputation, especially those wanting to improve their walking function. Results of this study will allow objective and accurate interpretation of the patient s walking function for quick intervention, if needed, or validation that the patient is functioning as expected. The expected patient-related outcome of being able to interpret clinically meaning change will be achieved by the end of this 2-year study. The results will be posted on the Modus Health website for immediate use by clinicians and patients. The results will also be submitted to the Journal of Rehabilitation Research and Development for publication. This study will have the largest impact on Veterans in the short-term since the VA will be covering the cost of the activity monitors and encouraging its use. However, it is likely that tracking real-world walking function will be expanded to Service members and civilians in the future as the value of this information becomes more apparent. The results of this study will be beneficial to all adult patients with a lower limb prosthesis that are tracking the community metrics being evaluated in this study: (1) functional level assessment, (2) peak performance index, (3) daily steps, (4) walking distance, (5) cadence, and (6) cadence variability. The results from this study will also support other research studies comparing the effectiveness of different prosthetic components and treatments since statistical improvements must also be clinically relevant to improve the life of the patient. With the ability to interpret clinically relevant change, we will accelerate our understanding of what rehabilitation strategies, prosthetic components, and other interventions are best suited to the patient for improved quality of life and walking function.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510522
Entities
People
- Teri Chou
Organizations
- United States Army