Dr Resnik's research activities bridge the methodologies of rehabilitation and health services research. Her interests include rehabilitation service delivery, outcomes measurement, prosthetics and amputation, and postdeployment reintegration. She is a member of 3 research teams; Brown's Center for Gerontology and Health Care Research, Providence VA's Research Enhancement Program and Center for Restorative and Regenerative Medicine.

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Biography

Dr. Resnik received her Ph.D. in physical therapy from Nova Southeastern University, her MS in physical therapy from Sargent College, Boston University, and her BS from Hampshire College. Dr. Resnik has a clinical background in physical therapy and is a Board Certified Orthopaedic Clinical Specialist (OCS). She completed a two year AHRQ funded postdoctoral fellowship at the Center for Gerontology and Health Care Research and was appointed Assistant Professor in the Department of Community Health in July 2004, and Associate Professor in July 2009. She is also a Research Health Scientist/physical therapist at the Providence VA Medical Center (PVAMC).

Research Description

My current research activities are in the areas of rehabilitation of combat wounded, rehabilitation outcomes measurement, and rehabilitation health services delivery. Highlights of my work are presented below.

Rehabilitation of Combat Wounded: Revolutionizing Prosthetics
My background in rehabilitation outcomes measurement, and my affiliation with the Center for Restorative and Regenerative Medicine led me to become Principal Investigator of a VA RR&D funded study on a new advanced prosthetic upper limb, called the DEKA arm. The DEKA arm was developed through the Defense Advanced Research Projects Agency's (DARPA) Revolutionizing Prosthetics Program. After an initial planning grant, I launched a preliminary study of the DEKA arm at the NY VA which will soon be followed by a multisite study involving up to 50 upper limb amputees. The purpose of these studies is to optimize the DEKA arm to ready it for commercial production and distribution. This research synthesizes my clinical rehabilitation background, experience in outcome measurement development, and skills in both qualitative and quantitative data analyses.
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Rehabilitation Outcomes Measurement
My measurement testing, development, and refinement work has been greatly informed by the WHO's International Classification of Health and Functioning (ICF). A number of my endeavors have involved mapping outcomes tools to the ICF. Recently I've developed a measure of participation for injured service members, called the Community Reintegration of Injured Service Members (CRIS). I am in the process of testing my new measure at Brooke Army Medical Center and developing the measure into a computer adaptive test called the CRIS-CAT . Use of the CRIS-CAT will provide a method for comprehensive assessment and monitoring of community reintegration outcomes within the VA and Department of Defense (DOD).

My current efforts to refine risk adjustment models for outpatient rehabilitation use a new index of functional co-morbidity to predict patient physical function outcomes. This project is particularly timely given the interest at the Centers for Medicare and Medicaid Services (CMS) in implementing alternative payment systems for outpatient rehabilitation.

My study titled, Identifying Clinically Meaningful Improvement in Lower Limb Amputees involves testing both physical performance and self-report measures of physical function and prosthetic satisfaction. The results of this study will be used to drive collection within the VA system of amputee care. One of my long term goals is to promote the collection of rehabilitation-relevant data within the VA electronic medical record, which in turn will enable expansion of my rehabilitation related health services research agenda within the VA.

Rehabilitation Service Delivery
My research has explored factors related to clinical outcomes in outpatient therapy. My early research identified expert therapists based upon their patient outcomes, and used this sample to explore the theory of expertise in physical therapy. My research on clinical outcomes has since progressed from inquiries at the therapist level to inquiries at the clinic and state regulatory levels. My study of state regulations examined the relationships between physical therapy regulatory policy, outcomes and service utilization. My study of providers of outpatient rehabilitation services explored the relationship between clinic characteristics, patient outcomes and service utilization.

Another of my major interest areas is the use of assistive technologies and home modifications. My research has explored the relationship between home modifications and use of personal assistance, the relationship between race and ethnicity and use of mobility aids, and the relationship between obesity and personal care for people with mobility impairments. My study on culture and mobility examined the relationship between environmental and personal factors and the use of mobility equipment.

Awards

Dorothy Briggs Memorial Scientific Inquiry Award. Post-Professional Doctoral Level, 2004

OPTP Award for Excellence in a Published Review of the Literature for 2001

Affiliations

American Physical Therapy Association

Funded Research

Current Grants
VA RR&D VA Study to Optimize the DEKA Arm
4/1/09- 9/30/11 $1,936,882
Principal Investigator
The primary objectives of this iterative usability and optimization study are to: 1) determine the feasibility of the deployment of the DEKA arm by clinicians in the rehabilitation community; and 2) optimize the DEKA arm system to best suit VA patient needs. Specifically we aim to: 1) Evaluate the amputee's experience of using the DEKA arm; 2) Evaluate clinicians' experience of fitting, setting up and training subjects with the DEKA arm; 3) Evaluate improvements in the arm and it's software as it is optimized by DEKA throughout the study. The study sample will consist of up to 50 upper limb amputees across all sites. Subjects will be purposefully sampled to include participants at each of four levels: transradial, transhumeral, shoulder disarticulation, and if possible forequarter level. Methodology: Each subject's involvement in the study will require between 18 and 21 visits. Assessments of subjects will be performed at baseline, within 1 week of baseline, with DEKA arm after set-up of the controls is complete, midway through the training period and at the end of the study. Study results will inform design efforts leading to the optimization of the arm design for the Gen 3 prototype.

VA RR&D A6780 VA Cooperative Study to Optimize a New Upper Limb Prosthesis: Phase II
10/1/08-9/30/09 $726,573
The objectives of this study are to 1) obtain preliminary data to inform the design of a VA multisite study and 2) share findings with DEKA so that information can be used to optimize the arm, its software, and training materials. Research Design: The study will employ a case series design using a mixed-methodology approach. The ample will consist of up to 10 upper limb amputees. Methodology: Subjects will participate in a minimum of 15 visits for medical screening, testing with current prosthetic limb, fit, fabrication and set-up of the DEKA arm, testing the arm and training. Assessments will be performed at: 1) baseline, 2) after set-up of the controls, 3) midway through training, and 4) at the conclusion of training. Analysis of data will be largely descriptive and used to identify procedural issues and help us work with DEKA to refine the training and usage manual for the DEKA arm. Findings will be used to refine processes of prosthetic fitting and set-up of system controls, and obtain estimates of time needed to complete each aspect of the study.

VA HSR&D DHI-07-144 A Computer Adaptive Test to Measure Community Reintegration
12/1/07-05/31/11 $1,122,065
Principal Investigator
The Community Re-integration of Service Members (CRIS) measure was recently developed through formative research on OIF/OEF veterans, caregivers and clinical experts, and a comprehensive review of concepts and content of existing measures. The CRIS is based upon the conceptual framework of the WHO's International Classification of Function (ICF), measures 9 domains of participation and 3 dimensions: objective and subjective aspects of participation as well as satisfaction with participation. The objectives of this proposal are to: 1) develop the CRIS into a computer adaptive test (the CRIS-CAT) that will facilitate efficient yet comprehensive collection of community re-integration data; 2) assess psychometric characteristics of the CRIS-CAT including concurrent, discriminant and predictive validity, and to 3 )use the new measure to compare and contrast community re-integration outcomes in the 3 groups of veterans whose outcomes are expected to span the spectrum.

DOD W81XWH-07-1-0689 PTSD in Limb Trauma and Recovery
10/07-09/09 $1,000,000
Investigator: Identifying Clinically Meaningful Improvement in Rehabilitation of Lower-Limb Amputees
(Aaron PI)
This study will build necessary evidence for choosing and interpreting measures to assess outcomes of care for amputees. Specifically we will: 1) compare test-retest reliability for self-report and performance-based measures, 2) Test a new scoring system for the PEQ, 3) determine if any measures should be omitted from future study due to prevalent floor or ceiling effects and 4) assess the feasibility of using a composite score of physical performance as an external criterion of change in our future study of measure responsiveness. This is a multi-site study with repeated subject measurements. Data will be collected at the VA Medical Centers in Providence and Boston. The study will include war-fighters with single lower-extremity amputations. Data analysis for Aims 1-3 will use a reliability sample consisting of 50 amputees. Data analysis for Aim 4 will sue a separate 10-20 person responsiveness ample whose functional status is expected to change.VA

HSR&D SDR 07-327 Community Reintegration for OEF/OIF Veterans: Research Collaborations
7/1/07-6/30/09 $250,000
Principal Investigator
The objectives of this study are to: 1) to develop a research agenda of mutual interest with researchers and clinicians from the Brooke Army Medical Center 2) to continue psychometric testing of the paper-and-pencil version of the Community Reintegration of Service Members (CRIS), a new veteran-centric measure of community reintegration specific to veterans, in preparation for development of a computer adaptive test, 3) to test the responsiveness of the CRIS measure in a sample of 50 patients from Brooke Army Medical Center, 4) To explore issues in adjustment to community living following deployment for female veterans.

NICHD R03 HD053780-01A1 Refining Models for Risk Adjustment in Outpatient Rehabilitation
3/07-3/31/09 $100,000
Principal Investigator
The Functional Comorbidity Index (FCI) developed to predict functional status (FS) was recently added to the Focus on Therapeutic Outcomes (FOTO) outpatient rehabilitation database. The FCI was developed using cross-sectional data, and we do not know if observed relationships will persist in longitudinal analysis. SPECIFIC AIMS:1) To examine the association between the FCI and functional status (FS) at intake and discharge, 2) examine the impact of FCI on discharge FS when added to comprehensive predictive models of FS, 3) examine the impact of FCI on the number of visits utilized, when added to comprehensive predictive models.

Department of Veterans Affairs A3772C (Aaron) RR&D Center of Excellence for Tissue Engineering (TECOE)
7/1/04-7/1/09 $6,000,000
Investigator, Clinical and Translation Core: The focus of our research program is the restoration of function after limb loss through sophisticated and advanced techniques of tissue engineering, neurotechnology, and robotics. The research plan considers the limb conceptually as a biohybrid organ consisting of biological tissue, endoprotheses (including neural devices and joint replacements) and exoprotheses. There are five research programs that focus on improving the function of amputees by advancing the concept of the biohybrid limb, translating developments in basic science to the clinic, and evaluating the efficacy of those developments: Program 1 Tissue Engineered Solutions for Traumatic Limb Loss; Program 2 Improving the Soft Tissue Seal Around and Osseointegration Device; Program 3 Broadband Microelectric Interfaces: Advance Technology, Human Performance Augmentation and Robotic Control; Program 4 Lower Extremity Protheses with Muscle-Like Actuation, Distributed Sensing, and Biomimetic Control; and Program 5 Application of Advanced Surgical Techniques and Translational Opportunities.

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