Enhanced medical rehabilitation increases therapy intensity and engagement and improves functional outcomes in postacute rehabilitation of older adults: a randomized-controlled trial.
Enhanced medical rehabilitation increases therapy intensity and engagement and improves functional outcomes in postacute rehabilitation of older adults: a randomized-controlled trial.
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DOI：
10.1016/j.jamda.2012.06.014
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发表时间：
2012-10
影响因子：
7.6
通讯作者：
Binder, Ellen F.
中科院分区：
文献类型：
--
作者：
Lenze, Eric J.;Host, Helen H.;Hildebrand, Mary W.;Morrow-Howell, Nancy;Carpenter, Brian;Freedland, Kenneth E.;Baum, Carolyn A.;Dixon, David;Dore, Peter;Wendleton, Leah;Binder, Ellen F.
对于每年数百万残疾老年人来说，在熟练护理机构（snf）接受急症后护理是一个短暂的机会窗口，使他们能够恢复足够的功能，回到家中独立生活。这一目标往往无法实现，可能是由于治疗强度不够或不够吸引人。本研究测试了强化医疗康复，这是一种干预措施，旨在提高患者在急性期后护理康复中的日常物理和职业治疗课程的参与度和强度。强化医疗康复与标准护理康复的随机对照试验。密苏里州圣路易斯一家专业护理机构的急性后护理单元。26名老年人入院接受急性后康复治疗。基于动机和行为改变模型，增强医疗康复是一套针对物理和职业治疗师（PT/OT）的行为技能，通过：(1)以患者为导向的互动方法，(2)增加康复强度，(3)频繁反馈患者的努力和进展，提高患者的参与度和强度，以改善功能结果。治疗强度：评估患者在治疗过程中的活动时间。治疗参与：康复参与量表。功能和性能结果：Barthel指数、步态速度和6分钟步行。随机分配到强化医疗康复组的参与者接受了更高强度的治疗，并且在康复过程中更投入；与随机分配到标准护理康复组的参与者相比，他们在步态速度（从0.08提高到0.38米/秒，标准护理组从0.08提高到0.22米/秒，p=0.003）和6分钟步行（从73提高到266英尺，标准护理组从40提高到94英尺，p= 0.026）方面有更大的改善趋势（+43分，标准护理组为26分，p= 0.087）。在急性后康复环境中，可以实现更高的强度和患者参与，从而为老年人带来更好的功能结果。研究结果应在更大的随机对照试验中得到证实。
For millions of disabled older adults each year, post-acute care in skilled nursing facilities (SNFs) is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly due to therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in post-acute care rehabilitation. Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. Post-acute care unit of a skilled nursing facility in St Louis, MO. 26 older adults admitted from a hospital for post-acute rehabilitation. Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists (PT/OT) that increase patient engagement and intensity, with the goal of improving functional outcome, through: (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress. Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and six-minute walk. Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 meter/sec vs. 0.08 to 0.22 in standard of care,p=0.003) and six-minute walk (from 73 to 266 feet vs. 40 to 94 feet in standard of care, p=0.026), with a trend for better improvement of Barthel Index (+43 points vs. 26 points in standard of care, p=0.087), compared to participants randomized to standard-of-care rehabilitation. Higher intensity and patient engagement in the post-acute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.
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DOI：
10.1111/j.1532-5415.2007.01413.x
发表时间：
2007-11-01
影响因子：
6.3
作者：
Hardy, Susan E.;Perera, Subashan;Studenski, Stephanie A.
通讯作者：
Studenski, Stephanie A.
影响因子：
3.9
作者：
HORVATH, AO;GREENBERG, LS
通讯作者：
GREENBERG, LS
影响因子：
4.3
作者：
Lang, Catherine E.;MacDonald, Jillian R.;Reisman, Darcy S.;Boyd, Lara;Kimberley, Teresa Jacobson;Schindler-Ivens, Sheila M.;Hornby, T. George;Ross, Sandy A.;Scheets, Patricia L.
通讯作者：
Scheets, Patricia L.
影响因子：
3
作者：
Outermans, Jacqueline C.;van Peppen, Roland P. S.;Kwakkel, Gert
通讯作者：
Kwakkel, Gert
DOI：
10.1111/j.1532-5415.2010.03157.x
发表时间：
2010-12-01
影响因子：
6.3
作者：
Liggins, Charlene;Pryor, Lisa;Bernard, Marie A.
通讯作者：
Bernard, Marie A.