Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis
老年骨关节炎髋关节和膝关节置换术的围手术期心理健康干预
基本信息
- 批准号:10415139
- 负责人:
- 金额:$ 22.93万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-06-01 至 2025-05-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAdultAntidepressive AgentsAnxietyAttentionBehavior TherapyBehavioralBenzodiazepinesClinical Trials DesignCommunicationCommunity PracticeDegenerative polyarthritisDeliriumDepressed moodEffectivenessEffectiveness of InterventionsElderlyElective Surgical ProceduresEmotionalEnrollmentEventEvidence based interventionFamilyGoalsGrantHealthcare SystemsHospitalsHybridsIndividualInstitutesInterventionLifeMental DepressionMental HealthMental Health ServicesMotivationMulticenter TrialsNeurocognitiveOperative Surgical ProceduresOrthopedic ProceduresOrthopedic SurgeryOrthopedicsOutcomePainParticipantPatient PreferencesPatient-Focused OutcomesPatientsPerioperativePharmaceutical PreparationsPharmacologyPhasePopulationPostoperative PeriodPredispositionPreparationProcessProtocols documentationProviderPsyche structureQuality of lifeRandomizedRandomized Clinical TrialsRandomized Controlled TrialsRecoveryRehabilitation therapyReplacement ArthroplastyReportingResearch PersonnelRiskTestingTimeWalkingadverse outcomeage groupanxiety symptomsanxiety treatmentanxiousbaseclinical practiceclinically significantcompare effectivenessdepressive symptomsdosageeffective interventioneffectiveness outcomeeffectiveness testingexperiencefallsgroup interventionhip replacement arthroplastyhospital readmissionhuman old age (65+)implementation outcomesimprovedinnovationinteractive feedbackknee replacement arthroplastymultidisciplinaryolder patientopioid usephysically handicappedprogramsprotocol developmentpsychologicreduce symptomsshared decision makingsymptomatic improvementtherapy developmenttime intervaltreatment as usualtrial design
项目摘要
Abstract/Project Summary – PROJECT 1
By 2030, 4 million older adults will undergo elective total hip or knee arthroplasty (THA/TKA), the most
common elective surgical procedures intended to mitigate pain and physical disability in this age group. Mental
health problems are highly prevalent in these patients, with 20-30% reporting substantial symptoms of anxiety
and depression both pre- and post-operatively. Depression and anxiety worsen THA/TKA outcomes by (i)
reducing participation in rehabilitation, thereby impeding recovery, (ii) heightening susceptibility to pain which
increases the risk of revision surgery and increases the likelihood of prolonged opioid use, and (iii) raising the
risk for delirium and delayed neurocognitive recovery. Despite the documented impact on individuals and our
health care system, effective interventions that treat anxiety and depression have not been applied to and
evaluated for older adults undergoing THA/TKA. In this proposal, we will optimize and test a pharmacological
and behavioral intervention bundle for older patients undergoing total joint arthroplasty for osteoarthritis, with
clinically significant depressive and anxiety symptoms. In this proposal, we will institute a perioperative mental
healthcare bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with
strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD),
targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications.
Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an
optimal perioperative mental health intervention bundle for older adults undergoing major orthopedic
procedures. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication
optimization intervention bundle for implementation in this population. Following initial protocol development,
through treatment development trials, we will iteratively optimize the intervention through interactive feedback
from patients over the age of 65 undergoing major orthopedic intervention, and other stakeholders, noting
barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled
trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms
of depression and anxiety in older patients undergoing orthopedic surgery. For this aim, 100 patients with
symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral
intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse
outcomes after surgery, including complications, falls, delirium, and pain. Thus, medication optimization,
deprescribing, and behavioral treatment of depression and anxiety in older adults undergoing total joint
arthroplasty may improve symptoms of depression and anxiety as well as other important post-operative
outcomes.
摘要/项目摘要-项目1
到2030年,400万老年人将接受选择性全髋关节或膝关节置换术(THA/TKA),其中
旨在减轻这一年龄段疼痛和身体残疾的常见择期外科手术。精神性
健康问题在这些患者中非常普遍,20%-30%的人报告说有明显的焦虑症状
以及手术前和术后的抑郁。抑郁和焦虑通过(I)使THA/TKA预后恶化
减少对康复的参与,从而阻碍康复;(2)增加对疼痛的敏感性,
增加翻修手术的风险并增加长期使用阿片类药物的可能性,以及(3)提高
有精神错乱和神经认知恢复延迟的风险。尽管记录了对个人和我们的
在卫生保健系统中,治疗焦虑和抑郁的有效干预措施尚未应用于
为接受全髋关节置换术/全膝关节置换术的老年人评估。在这项提案中,我们将优化和测试一种药理
和行为干预捆绑包,适用于接受骨关节炎全关节置换术的老年患者,
临床上有明显的抑郁和焦虑症状。在这项建议中,我们将建立围手术期的心理状态
医疗保健捆绑包包括:(1)应用经过验证的行为干预,即行为激活(BA),
基于患者偏好和需求的策略;以及(2)药物优化和停药(MOD),
有针对性地优化抗抑郁药物的剂量,停止有害或无效的药物。
目标1(适应):在协作规划方法的指导下,我们将适应、制定和实施
老年人接受大型骨科手术的最佳围手术期心理健康干预包
程序。通过利益相关者的输入,我们将开发并迭代地调整行为和药物
用于在该人群中实施的优化干预捆绑包。在最初的协议开发之后,
通过治疗开发试验,我们将通过互动反馈反复优化干预
来自正在接受主要骨科干预的65岁以上患者和其他利益相关者,注意到
项目完成的障碍和促进者。目标2(测试):使用混合型1型随机对照
试验设计,我们将比较干预捆绑和常规护理在减轻症状方面的有效性
在接受骨科手术的老年患者中抑郁和焦虑的发生率。为此,100名患者接受了
抑郁和焦虑的症状将被随机分配到药物和行为
干预捆绑或常规护理。术前抑郁和焦虑与许多不良反应有关
手术后的结果,包括并发症、跌倒、精神错乱和疼痛。因此,药物优化,
全关节手术中老年患者抑郁和焦虑的停药和行为治疗
关节成形术可以改善抑郁和焦虑的症状以及其他重要的术后症状
结果。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Eric J Lenze其他文献
Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach.
中风后认知的个体差异及其与日常生活活动和社会功能的关系:生态瞬时评估方法。
- DOI:
10.1080/10749357.2024.2307203 - 发表时间:
2024 - 期刊:
- 影响因子:2.2
- 作者:
Elizabeth G. S. Munsell;Q. Bui;Katherine J. Kaufman;Stephanie E. Tomazin;Bridget A Regan;Eric J Lenze;Jin;David Mohr;M. Fong;Christopher L. Metts;Vy Pham;A. W. Wong - 通讯作者:
A. W. Wong
Eric J Lenze的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Eric J Lenze', 18)}}的其他基金
Slow Wave Induction by Propofol to Eliminate Depression (SWIPED) Trial
异丙酚慢波诱导消除抑郁 (SWIPED) 试验
- 批准号:
10356683 - 财政年份:2022
- 资助金额:
$ 22.93万 - 项目类别:
Slow Wave Induction by Propofol to Eliminate Depression (SWIPED) Trial
异丙酚慢波诱导消除抑郁 (SWIPED) 试验
- 批准号:
10559540 - 财政年份:2022
- 资助金额:
$ 22.93万 - 项目类别:
Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis
老年骨关节炎髋关节和膝关节置换术的围手术期心理健康干预
- 批准号:
10616806 - 财政年份:2021
- 资助金额:
$ 22.93万 - 项目类别:
Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis
老年骨关节炎髋关节和膝关节置换术的围手术期心理健康干预
- 批准号:
10206500 - 财政年份:2021
- 资助金额:
$ 22.93万 - 项目类别:
相似海外基金
Co-designing a lifestyle, stop-vaping intervention for ex-smoking, adult vapers (CLOVER study)
为戒烟的成年电子烟使用者共同设计生活方式、戒烟干预措施(CLOVER 研究)
- 批准号:
MR/Z503605/1 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Research Grant
Early Life Antecedents Predicting Adult Daily Affective Reactivity to Stress
早期生活经历预测成人对压力的日常情感反应
- 批准号:
2336167 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Standard Grant
RAPID: Affective Mechanisms of Adjustment in Diverse Emerging Adult Student Communities Before, During, and Beyond the COVID-19 Pandemic
RAPID:COVID-19 大流行之前、期间和之后不同新兴成人学生社区的情感调整机制
- 批准号:
2402691 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Standard Grant
Elucidation of Adult Newt Cells Regulating the ZRS enhancer during Limb Regeneration
阐明成体蝾螈细胞在肢体再生过程中调节 ZRS 增强子
- 批准号:
24K12150 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Migrant Youth and the Sociolegal Construction of Child and Adult Categories
流动青年与儿童和成人类别的社会法律建构
- 批准号:
2341428 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Standard Grant
Understanding how platelets mediate new neuron formation in the adult brain
了解血小板如何介导成人大脑中新神经元的形成
- 批准号:
DE240100561 - 财政年份:2024
- 资助金额:
$ 22.93万 - 项目类别:
Discovery Early Career Researcher Award
Laboratory testing and development of a new adult ankle splint
新型成人踝关节夹板的实验室测试和开发
- 批准号:
10065645 - 财政年份:2023
- 资助金额:
$ 22.93万 - 项目类别:
Collaborative R&D
Usefulness of a question prompt sheet for onco-fertility in adolescent and young adult patients under 25 years old.
问题提示表对于 25 岁以下青少年和年轻成年患者的肿瘤生育力的有用性。
- 批准号:
23K09542 - 财政年份:2023
- 资助金额:
$ 22.93万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Identification of new specific molecules associated with right ventricular dysfunction in adult patients with congenital heart disease
鉴定与成年先天性心脏病患者右心室功能障碍相关的新特异性分子
- 批准号:
23K07552 - 财政年份:2023
- 资助金额:
$ 22.93万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Issue identifications and model developments in transitional care for patients with adult congenital heart disease.
成人先天性心脏病患者过渡护理的问题识别和模型开发。
- 批准号:
23K07559 - 财政年份:2023
- 资助金额:
$ 22.93万 - 项目类别:
Grant-in-Aid for Scientific Research (C)