Suchergebnisse

OBJECTIVES: Patient reported outcomes (PROs) serve as a means of measuring improvement and quality of care. Legacy PROs rely on a list of questions that have had to demonstrate accuracy, responsiveness, and validity in testing for intended measurements. While certain legacy PROs such as the International Knee Documentation Committee (IKDC) survey have demonstrated these properties well, a lengthy PRO creates a time burden on patients, making patient adherence and completion a challenge. In recent years, PROs such as the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys have been developed which leverage computer adaptive testing that produce equivalent accuracy, responsiveness, and validity of legacy PROs, but use only 4-12 questions per survey. This results in significant reduction in time to complete. As these new PROs are now being adopted, the ability to compare outcomes to prior studies that relied on legacy PROs is necessary. While prior studies have examined correlation between legacy PROs and PROMIS computer adaptive tests, no studies to date have developed effective prediction models utilizing PROMIS surveys to create an IKDC index score. The objective of this study was to develop a predictive model utilizing PROMIS PF and PI to effectively recreate IKDC survey scores. METHODS: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient reported outcomes and intraoperative variables. As part of inclusion in MOTION, research patients who underwent knee surgery were asked to complete the IKDC as well as the PROMIS PF and PROMIS PI at varying time points. This cohort of patients that completed both IKDC and PROMIS scores were included in the present analysis. Nonlinear multivariable predictive models using both Gaussian and beta distributions were created to establish an IKDC index score, which was then validated using leave-one-out techniques and minimal ...

Objective: The purpose was to determine if Soldier rucksack load, marching distance, and average heart rate (HR) during shooting affect the probability of hitting the target. Background: Infantry Soldiers routinely carry heavy rucksack loads and are expected to engage enemy targets should a threat arise. Method: Twelve male Soldiers performed two 11.8 km marches in forested terrain at 4.3 km/hour on separate days (randomized, counterbalanced design). The Rifleman load consisted of protective armor (26.1 kg); the Rucksack load included the Rifleman load plus a weighted rucksack (48.5 kg). Soldiers performed a live-fire shooting task (48 targets) prior to the march, in the middle of the march, and at the end of the march. HR was collected during the shooting task. Data were assessed with multilevel logistic regression controlling for the multiple observations on each subject and shooting target distance. Predicted probabilities for hitting the target were calculated. Results: There was a three-way interaction effect between rucksack load, average HR, and march ( p = .02). Graphical assessment of predicted probabilities indicated that regardless of load, marching increases shooting performance. Increases in shooting HR after marching result in lower probability of hitting the target, and rucksack load has inconsistent effects on marksmanship. Conclusion: Early evidence suggests that rucksack load and marching may not uniformly decrease marksmanship but that an inverted-U phenomenon may govern changes in marksmanship. Application: The effects of load and marching on marksmanship are not linear; the abilities of Soldiers should be continuously monitored to understand their capabilities in a given scenario.

Objective The purpose of this investigation was to elucidate the role of button-response complexity to targets in a response inhibition task. Background Response inhibition is the ability to correctly inhibit an overt response to a target. The U.S. military is actively pursuing development of armed, combat robots as a force multiplier, which may present challenges to operators of combat robots in the form of response inhibition errors. Method A total of 15 participants completed two 51-min versions of a modified sustained attention to response task (SART). Participants were outfitted with an electrocardiogram to index heart-rate variability and completed the NASA–Task Load Index (NASA-TLX) to index workload. Results The results demonstrated that the complex SART reduced errors of commission (4%) and slowed response times (874 ms) to correct Go targets relative to the simple SART (14%, 739 ms). The NASA-TLX did not show differences between the modified SARTs; however, heart-rate variability did demonstrate that Soldiers had an increased autonomic stress response to the complex SART. Conclusion Increasing the behavioral response requirement during a response inhibition task can decrease errors of commission; however, it comes at the cost of slower response times to target stimuli. Heart-rate variability may provide better insight into objective workload relative to subjective measures. Application The use of complex behavioral responses may provide a viable option to reduce potential "friendly fire" or collateral damage by Soldiers remotely engaging a target-rich environment.