UIC College of Nursing

Eileen Collins, PhD, RN, Funded Projects

Polestriding versus Walking for PAD Rehabilitation

Funding Source: National Institute of Nursing Research

Dates: 6/1/05 – 3/31/10

Co-Investigators: Mark Grabiner, Ben Gerber, Domenic Reda

Abstract: Peripheral arterial disease (PAD) is a debilitating condition affecting between 8 and 12 million people in the United States . Patients with PAD of the lower extremities are subject to periods of intermittent claudication pain. Gait changes such as reduced stride length, cadence and walking speed are reported in patients with PAD. Walking exercise has been prescribed as the primary mode of rehabilitative treatment in patients with PAD. An enhanced form of walking exercise, polestriding, has been found to improve rehabilitation outcomes for patients with PAD. Walking with poles also increases stride length, cadence and walking speed and decreases ground reaction forces on the joints. Changes in walking mechanics secondary to walking pole use may allow more time for perfusion of the leg muscles thus delaying the onset of and decreasing the severity of ischemic pain. Thus, we hypothesize that polestriding may be superior to walking exercise in the rehabilitation of persons with PAD. The two therapies however, have never been compared in a randomized trial in this population. Specific Aims: The primary specific aim is to compare the effects of a 24-week walking versus polestriding exercise in patients with PAD on exercise endurance, perceived physical function and walking abilities. The secondary aim is to explore biomechanical and physiologic mechanisms to explain the expected differences observed in the polestriding and walking groups. Mechanistic variables include perceived claudication pain, gait biomechanics, tissue oxygenation in the most severely affected leg and daily physical activity. Design: A randomized, controlled clinical trial will be used to compare the effects of polestriding and walking exercise. 180 patients will be enrolled in the study to randomize 126 (n=63 in each group). Baseline testing will consist of treadmill exercise, completion of functional assessment questionnaires, gait analysis, and physical activity measurement. Subjects will then be randomized to a 24-week walking or polestriding program. Subjects will exercise three times weekly for 30-60 minutes. Duration and intensity of exercise will be systematically increased. Subjects will be re-tested at 6, 12, and 24 weeks. A final testing battery will be completed at 32 weeks to assess how well subjects have maintained fitness gains. Analysis: Data will be analyzed using descriptive statistics, repeated measures ANOVA and linear regression analysis. Potential co-variates such as smoking and medication use will be monitored and analyzed.

Weaning from Prolonged Mechanical Ventilation

Funding Source: National Institute of Nursing Research

Principal Investigator: Amal Jubran

Abstract: Patients requiring mechanical ventilation (MV) for more than 21 days account for more than 37% of all ICU costs. As such, these patients are now transferred to centers that specialize in weaning from MV, so called long-term acute care (LTAC) facilities. Despite the proliferation of LTAC facilities, research on tests that can reliably identify which of these patients are likely to wean and methods for expediting weaning is lacking. In addition, little or no information is available regarding the determinants of survival, home discharge, and patient's perception of quality of life (QOL) after a prolonged course of MV. Thus, the aim of this proposal is to determine the most efficient way to wean patients who require prolonged MV (defined as > 21 days) and have been transferred to an LTAC facility and to identify which patients are likely to wean from MV. The secondary aim is to determine the factors that are responsible for short- and long-term survival, QOL, and discharge to home in patients who are transferred to a LTAC facility for prolonged MV. To address these aims, a prospective, randomized trial in patients who are transferred to a LTAC facility will be done to compare the efficacy of two weaning techniques: pressure support and spontaneous breathing trials. Health status (age, pre-morbid functional status, comorbid illness), social status, nutritional status (hand grip and respiratory muscle strength), cardiac function, anxiety level, frequency-to-tidal volume ratio, and the duration of tolerating a trial of spontaneous breathing will be measured before randomization to examine the accuracy of such measurements in predicting weaning outcome, survival and home discharge. Respiratory muscles strength and handgrip strength and their relationship to patient's perception of functional status and QOL will be measured at the LTAC facility and in the patients' place of residence at 6 and 12 months after discharge. Findings from this proposal will provide novel insights into the most reliable way for predicting which patients can wean and survive to be discharged to home, the most efficient method of weaning patients, and the impact of prolonged MV on long-term QOL and functional status. Such information will provide for the first time solid scientific evidence to health care providers, and help them formulate objective guidelines for the management of patients being weaned at a LTAC facility.