PRAISE (Pressure Relief Assessment Information System): A Paradigm-shifting Mobile Health Platform for Pressure Relief Adherence in Manual Wheelchair Users

About This Grant

TITLE: PRAISE (Pressure Relief Assessment Information System): A Paradigm-shifting Mobile Health Platform for Pressure Relief Adherence in Manual Wheelchair Users PROJECT SUMMARY: The proposed project aims to create a pressure relief assessment information system (PRAISE) to enhance the adherence of manual wheelchair users to Clinical Practice Guidelines (CPGs) designed to prevent pressure ulcers. The motivation of this research stems from two core challenges. First, pressure ulcers pose a serious threat to manual wheelchair users with spinal cord injuries, frequently leading to painful complications, infections, and even premature death. To reduce pressure ulcer risks, CPGs recommend that wheelchair users perform pressure relief activities (i.e., vertical pushups, lateral, and forward leans) every 15 to 30 minutes. However, research reveals that wheelchair users may not adhere to CPGs in everyday life. Second, no universally adopted tools currently exist to monitor CPG adherence, nor is the understanding of factors leading to non-adherence. As a result, the prevalence of pressure ulcers among wheelchair users with spinal cord injuries remains high. Built upon the International Classification of Functioning, Disability and Health (ICF) model, PRAISE will shift from the conventional singular focus on adherence to a holistic approach, which will cohesively integrate a user's health, personal, and environmental factors through its multidimensional design. First, PRAISE will enable users to create profiles, including demographics, wheelchair usage patterns, and medical records related to pressure ulcers. Second, this foundational data will be augmented by a spectrum of sensor data (i.e., accelerometer, heart rate, GPS, and battery life) from a smartwatch, critical for ecological momentary assessments (EMAs). Third, our novel distributed algorithm can accurately detect pressure relief activities without relying on frequent, costly internet connections. It achieves this through lightweight processing on mobile devices to capture patterns intrinsic to pressure relief activities, hence transmitting only relevant data segments to the server for fine-grained recognition. Fourth, grounded in the ICF framework, PRAISE will dynamically integrate user-specific health, personal, and environmental factors to deliver context-aware feedback and personalized guidance. Through reinforcement learning, PRAISE will continuously evolve its guidance by learning from user responses and behavior, ensuring that interventions remain effective and tailored to individual needs over time. In collaboration with a diverse advisory team, PRAISE's development will prioritize robust security, user- friendliness, advanced analytics, and customizable assessment modules. Once the advisory team completes the initial validation, a feasibility and acceptability assessment will be conducted by involving 15 manual wheelchair users for two weeks. To gain a deeper understanding of user experiences, we will employ multifaceted approaches to gather and analyze user feedback. As PRAISE strives to make pressure ulcer prevention more accessible and personalized for wheelchair users, it will help reduce health disparities, particularly for those who may not have easy access to traditional healthcare resources. Therefore, PRAISE will revolutionize care for the manual wheelchair users to achieve patient-centric, evidence-based interventions.