Cost-effectiveness and efficacy of a combined intervention to facilitate motor recovery following stroke

促进中风后运动恢复的联合干预措施的成本效益和功效

基本信息

  • 批准号:
    10219312
  • 负责人:
  • 金额:
    $ 13.33万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2018
  • 资助国家:
    美国
  • 起止时间:
    2018-08-02 至 2023-07-31
  • 项目状态:
    已结题

项目摘要

Project Summary/Abstract The goal of this project is to investigate, in parallel, the clinical efficacy and cost-effectiveness of combining aerobic exercise with repetitive task practice (RTP) to improve upper extremity motor recovery in individuals with stroke compared to time-matched RTP. Current approaches to stroke rehabilitation involve time-intensive, therapist-directed task practice that, while efficacious, are not easily translatable into the clinical setting, in part due to managed care reimbursement models that cap rehabilitation. The identification of a safe and cost- effective approach, such as aerobic exercise, to facilitate neuroplasticity post-stroke would optimize motor recovery while reducing costs associated with intensive rehabilitation. Our novel approach to stroke rehabilitation exploits the physiologic effects of intensive aerobic exercise training and combines it with an abbreviated session of motor task practice to improve motor recovery. This application of aerobic exercise training paired with RTP has been shown in our preliminary study (NIH R03HD073566) to enhance motor recovery greater than time-matched RTP without an aerobic exercise component. Results from our R03 indicated that those completing an 8-week high-rate aerobic exercise intervention paired with an abbreviated session of RTP exhibited an 8-point or 26% improvement in Fugl-Meyer scores at end of treatment despite completing 40% fewer RTP repetitions than the control group (time-matched RTP), that achieved a 17% improvement in Fugl-Meyer scores. The combined approach is expected to be more cost-effective, given that decreased one-on-one time is required, and clinical outcomes were superior in our preliminary study. Improvements in cardiovascular fitness and lower extremity motor function were also evident in the aerobic exercise group, indicating that the economic impact may extend beyond simply improving upper extremity function, and has the potential to reduce disability and diminish indirect costs associated with stroke. Positive results from our preliminary trial provide rationale for a systematic and larger scale trial to determine the clinical efficacy and cost effectiveness of aerobic exercise in facilitating motor recovery following stroke. A total of 60 individuals with chronic stroke will be randomized into one of two groups: 1) aerobic exercise and RTP or 2) time-matched RTP only. Both groups will receive an identical dose of contact time over 8 weeks (3X per week). Clinical and biomechanical outcomes measuring change in upper extremity motor function and quality of life metrics will be obtained, in addition to extensive participant demographics, and incorporated into decision analytic models to determine the incremental cost-effectiveness of each intervention. These analyses will examine cost-effectiveness in the short and long term from the healthcare provider and patient perspective, and identify specific social determinants of health that impact the cost-effectiveness of the interventions. Investigating and reporting the cost-effectiveness of each intervention represents a forward thinking approach, as emphasis in medicine and rehabilitation progress toward models emphasizing value over volume.
项目总结/摘要 本项目的目标是调查,在平行,临床疗效和成本效益相结合, 有氧运动结合重复性任务练习(RTP)对改善个体上肢运动恢复的作用 与时间匹配的RTP相比。目前的中风康复方法涉及时间密集, 治疗师指导的任务实践,虽然有效,但不容易转化为临床环境,部分 因为管理式医疗报销模式限制了康复。保险箱的鉴定和费用- 促进中风后神经可塑性有效方法,如有氧运动,将优化运动 同时减少与密集恢复有关的费用。我们治疗中风的新方法 康复利用了高强度有氧运动训练的生理效应,并将其与 缩短运动任务练习的时间,以提高运动恢复。这种有氧运动的应用 我们的初步研究(NIH R 03 HD 073566)显示,与RTP配对的训练可以增强运动能力, 恢复大于无有氧运动成分的时间匹配RTP。R 03的结果 研究表明,那些完成8周高速率有氧运动干预的人, RTP治疗结束时Fugl-Meyer评分改善8分或26%, 完成RTP重复次数比对照组(时间匹配RTP)少40%,达到17% Fugl-Meyer评分改善。综合办法预计更具成本效益,因为 需要减少一对一的时间,并且在我们的初步研究中临床结果上级。 在有氧运动中,心血管健康和下肢运动功能的改善也很明显。 运动组,表明经济影响可能不仅仅是改善上肢 功能,并有可能减少残疾和减少与中风相关的间接费用。积极 我们初步试验的结果为系统性和更大规模的试验提供了理论基础,以确定临床 有氧运动促进脑卒中后运动功能恢复的有效性和成本效益。了60余 慢性中风患者将被随机分为两组:1)有氧运动和RTP或2) 仅时间匹配RTP。两组将在8周内接受相同剂量的接触时间(每周3次)。 测量上肢运动功能和生活质量变化的临床和生物力学结局 除了广泛的参与者人口统计数据外,还将获得指标,并将其纳入决策 分析模型,以确定每项干预措施的增量成本效益。这些分析将 从医疗保健提供者和患者的角度检查短期和长期的成本效益, 并确定影响干预措施成本效益的具体健康社会决定因素。 调查和报告每项干预措施的成本效益是一种前瞻性思维方法, 随着医学和康复的重点朝着强调价值而不是数量的模式发展。

项目成果

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Susan Marie Linder其他文献

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{{ truncateString('Susan Marie Linder', 18)}}的其他基金

Cost-effectiveness and efficacy of a combined intervention to facilitate motor recovery following stroke
促进中风后运动恢复的联合干预措施的成本效益和功效
  • 批准号:
    9754841
  • 财政年份:
    2018
  • 资助金额:
    $ 13.33万
  • 项目类别:

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