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Recovery of mobility function and life-space mobility after ischemic stroke (MOBITEC-Stroke)

English title Recovery of mobility function and life-space mobility after ischemic stroke (MOBITEC-Stroke)
Applicant Hinrichs Timo
Number 182681
Funding scheme Project funding (Div. I-III)
Research institution Dept. für Sport, Bewegung und Gesundheit Medizinische Fakultät Universität Basel
Institution of higher education University of Basel - BS
Main discipline Rehabilitation
Start/End 01.08.2019 - 31.07.2022
Approved amount 383'182.00
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All Disciplines (5)

Discipline
Rehabilitation
Sport Medicine
Other disciplines of Environmental Sciences
Neurology, Psychiatry
Geriatrics

Keywords (7)

stroke; rehabilitation; mobility function; life-space mobility; gait; global positioning system; accelerometry

Lay Summary (German)

Lead
Der Schlaganfall stellt die häufigste Ursache einer körperlichen Behinderung im Erwachsenenalter dar. Das Risiko eines Schlaganfalls steigt mit dem Alter. Aufgrund der demographischen Entwicklung ist daher in Zukunft mit einer Zunahme von betroffenen Menschen zu rechnen. Häufig ist nach einem Schlaganfall die Mobilität eingeschränkt. Diese umfasst sowohl die Fähigkeit sich zu bewegen, als auch die Fähigkeit, den Lebensraum optimal zu nutzen. Um rehabilitative Massnahmen zu optimieren und eine individuell optimale Lebensqualität zu erreichen, ist eine detaillierte Kenntnis des Erholungsverlaufes dieser Mobilitätskomponenten nach Schlaganfall notwendig.
Lay summary

Inhalt und Ziele des Forschungsprojekts

Hauptziel des Projektes ist es, Veränderungen der Mobilität von Patienten im ersten Jahr nach Schlaganfall zu charakterisieren. Hierbei stellt sich vor allem die Frage, welche Erholungsverläufe von welchen Patientenmerkmalen begünstigt werden. Zudem sollen motivationale Aspekte sowie Umgebungsfaktoren untersucht werden, welche die Mobilität beeinflussen können. Hierzu werden etwa 60 Patienten, die erstmalig einen Schlaganfall erlitten haben, in die Studie eingeschlossen. Ein Jahr lang werden diese sich regelmässig Analysen der funktionellen und der räumlichen Mobilität unterziehen. Hierzu kommen laborbasierte Testverfahren (z. B. Ganganalysen) und Messungen im täglichen Leben (z. B. mittels GPS) zum Einsatz. Zudem werden die Patienten mittels digitaler Karten zu motivationalen Aspekten und Umgebungsfaktoren befragt.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Die gewonnenen Erkenntnisse werden es ermöglichen, Rehabilitationsmassnahmen gezielt und zum idealen Zeitpunkt einzusetzen sowie individualisierte und motivierende Rehabilitationsziele festzulegen.

Direct link to Lay Summary Last update: 13.11.2018

Responsible applicant and co-applicants

Employees

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Associated projects

Number Title Start Funding scheme
163378 Treatment of intracerebral hemorrhage in patientes on non-vitamin K antagonist oral anticoagulants with tranexamic acid (TICH-NOAC) 01.10.2016 Project funding (Div. I-III)

Abstract

Background: Stroke is a major cause of mortality and stroke incidence increases with age. If survived, stroke is the most common cause of disability in adults. Thus, stroke frequently results in permanent limitations of mobility, and consequently the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcome, a detailed knowledge of the functional recovery process in particular regarding mobility is needed. So far, studies evaluating the recovery of mobility have mostly used self-report measures or simple functional tests. People’s life-space mobility, i.e. their mobility in interaction with the environment, has been neglected so far. To close this knowledge gap is important for patients, as restriction in mobility is the number one concern of stroke survivors.Objectives: We will make use of a battery of innovative data collection methods including wearable sensors and interactive digital maps to pursue the following objectives:1.To characterize mobility, including mobility function and life-space mobility, and changes in mobility within the first year after stroke.2.To identify and characterize subgroups with different mobility trajectories.3.To evaluate whether changes in mobility function parameters are associated with changes in life space mobility.4.To evaluate patients’ motivation for going outdoors, transportation use and assistance needed as well as environmental barriers and facilitators of outdoor mobility.Design: Cohort studySubjects: Subjects with incident first stroke treated at the Stroke Center, University Hospital Basel (target N=59). Inclusion criteria comprise presence of stroke symptoms potentially affecting gait and mobility; exclusion criteria comprise severe cognitive impairment and physical disability leading to dependency and loss of mobility (modified Rankin score >3).Methods: At 3, 6, 9 and 12 months after stroke a battery of mobility tests will be performed at the study center, including laboratory-based performance tests of balance and strength, and gait analysis (using body-worn sensors and a pressure-sensitive walkway). Life space assessment (using the Global Positioning System) will be performed in participants’ real life. Sensor-based measures of life space will be amended by semantic information on visited locations (including motivation, use of transportation, assistance needed) as well as perceived mobility barriers and facilitators by using interactive digital maps. Statistical Analysis: Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for different predefined subgroups (objective 1). Comparison of trajectories between subgroups will be assessed using likelihood ratio tests. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories (objective 2). GMMs identify multiple latent classes that have similar trajectories over time. After identifying relevant subgroups with different trajectories, multinomial logistic regression models will be used to identify predictors of group-membership. Linear mixed effect models will be used to test whether changes in mobility function parameters are associated with changes in life space mobility (objective 3). Participants’ motivation for going outdoors, transportation use, assistance needed as well as barriers and facilitators for outdoor mobility will be analysed descriptively by predefined subgroups (objective 4).Prospects: A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and correctly timed rehabilitation measures. Knowledge about patients’ motivation as well as barriers and facilitators of outdoor mobility will provide the opportunity to define individualized and highly motivating patient-oriented rehabilitation goals.
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