Principal Investigator: Eric E. Sabelman, PhD
Project Staff: H.F. Machiel Van der Loos, PhD; D. Wilson, RN M.; Douglas, RN; L. Goldschmidt, MD; Ruth Yap, MS; David L. Jaffe, MS; and James H. Anderson, JEM
Project Category: Spinal Cord Injury - 2001
Objective: Skin pressure and body motion algorithms developed during project E2153TC "Pressure/Motion Feedback To Protect Skin of Sensorimotor Impaired Elders" will be applied to larger populations of test subjects to determine if compliance with skin care regimens is improved and incidence of skin problems is reduced using the Wearable Accelerometric Motion Analysis System ("WAMAS") as a partial substitute for an on-scene therapist.
Research Plan: We intend to investigate the clinical utility of (1) information indicative of a patient's compliance extracted from multichannel pressure/motion data processed on-site, with a centrally-located clinician becoming involved only if the remote processor detects an unusual event, and (2) presentation of pressure/motion patterns to the clinician at the same time as video images during a teleconference with the patient. In both cases, computer-aided interpretation of the data is the key contribution of this project, so as to minimize burdens placed upon the clinician by lack of physical contact with the patient.
It is proposed to test the WAMAS as an adjunct to skin care in VA spinal cord injured and long-term care (nursing home) patients by: (1) daily monitoring in a residential setting, with computer-generated feedback to the user if time and pressure limits are exceeded or weight relief activities are incorrectly done and periodic automatic reporting of data to a remote clinician, and (2) supplementation of weekly video-based (image + speech) interviews with real-time motion display and interpretation.
We propose a 42-month project to enroll 172 mentally competent in- and out-patients with sensorimotor deficit who are at risk for or recovering from pressure sores. Testing no more than 36 subjects at a time minimizes cost for equipment and staff, but requires adding 6 months to the usual 3-year term of a Merit Review project to achieve statistical power of 0.8. Inpatients will reside at the Menlo Park and Livermore Divisions of VAPAHCS. Outpatients will be given WAMAS and teleconference equipment equivalent to inpatients.
Expected Outcome: The primary outcome measure is the time from start of participation to detection of a pressure sore (stage 2 decubiti or lower extremity wounds) by a nurse or therapist blinded to subjects' treatment group assignment. Secondary measures include: incipient sores (stage 1), number and days of hospital admission for skin breakdown, change in functional status (SF-36 health survey), quality of life (Functional Assessment for Cancer Therapy "FACT") or Braden scores over time, compliance with therapeutic pressure relief (by WAMAS-recorded data, compared to self-reported compliance), and satisfaction with treatment as reported by subjects and caregivers. Differences between groups will be evaluated by appropriate statistical methods.
Funding Source: VA RR&D Merit Review
Funding Status: In review