A template for physical resilience research in older adults: Methods of the PRIME‐KNEE study

Abstract

Background: Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME-KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors.Methods: PRIME-KNEE is an ongoing, prospective cohort study that will enroll 250 adults ≥60 years undergoing total knee arthroplasty. Data are collected at baseline (pre-surgery), during surgery, daily for 7 days after surgery, and at 1, 2, 4, and 6 months post-surgery. Provocative tests include a cognition-motor dualtask walking test, cerebrovascular reactivity assessed by functional near-infrared spectroscopy, peripheral blood mononuclear cell reactivity ex vivo to lipopolysaccharide toxin and influenza vaccine, and heart rate variability during surgery. Cognitive, psychological, and physical performance batteries are collected at baseline to estimate prestressor reserve. Demographics, medications, comorbidities, and stressor characteristics are abstracted from the electronic medical record and via participant interview. Blood-based biomarkers are collected at baseline and postoperative day 1. Repeated measures after surgery include items from a delirium assessment tool and pain scales administered daily by telephone for 7 days and cognitive change index (participant and informant), lower extremity activities of daily living, pain scales, and step counts assessed by Garmin actigraphy at 1, 2, 4, and 6 months after surgery. Statistical models use these measures to characterize resilience phenotypes and evaluate prestressor clinical indicators associated with poststressor resilience. Conclusion: If PRIME-KNEE validates feasible clinical tests and biomarkers that predict recovery trajectories in older surgical patients, these tools may

Resilience: Biological Basis and Clinical Significance - A Perspective Report from the International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force

“…Finally, during the Task Force meeting, the protocol of the PRIME-KNEE study ( 46 ) was presented. PRIME-KNEE is a prospective cohort study enrolling 250 patients aged 60 years and older scheduled for elective knee replacement surgery.…”

Editorial: Resilience and the Future

“…Being able to measure baseline resilience, its magnitude, the type of stress (e.g., anesthesia or chemotherapy), the recovery trajectory, and predicting adverse outcomes will enable clinicians to provide cost-effective, personalized care. PRIME-KNEE is an ongoing prospective cohort study for elective knee replacement surgery where pre-stressor static and provocative tests will be validated, and the utility of biomarkers in predicting recovery will be measured ( 39 ).…”

Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study

“…In contrast to the well-established construct of psychological resilience, defined as adaptive attitudes and behaviors in response to stressful life events [ 12 , 13 ], physical resilience is an emerging area of aging research [ 10 ]. Physical resilience characterizes one’s physical ability to overcome health stressors and is supported by the recognition that while some older adults “snap back” after an acute health event, many others do not recover physical function quickly or at all [ 11 , 14 ].…”

“…One possibility is that older adults with advanced CKD commonly experience health stressors, including illnesses or injuries that require an acute care encounter such as an emergency department (ED) visit or hospitalization, and these events result in functional impairment [ 7 – 9 ]. One’s capacity to respond before a health stressor and the trajectory of functional recovery afterwards are described by the emerging geriatric concepts of reserve and resilience, respectively [ 10 , 11 ]. However, reserve and resilience have not yet been studied among older adults with CKD.…”