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: 10415139
• 负责人: Eric J Lenze
• 金额: $ 22.93万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 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: https://reporter.nih.gov/project-details/10415139
• 关键词: Address; Adult; Antidepressive Agents; Anxiety; Attention; Behavior Therapy; Behavioral; Benzodiazepines; Clinical Trials Design; Communication; Community Practice; Degenerative polyarthritis; Delirium; Depressed mood; Effectiveness; Effectiveness of Interventions; Elderly; Elective Surgical Procedures; Emotional; Enrollment; Event; Evidence based intervention; Family; Goals; Grant; Healthcare Systems; Hospitals; Hybrids; Individual; Institutes; Intervention; Life; Mental Depression; Mental Health; Mental Health Services; Motivation; Multicenter Trials; Neurocognitive; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Orthopedics; Outcome; Pain; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perioperative; Pharmaceutical Preparations; Pharmacology; Phase; Population; Postoperative Period; Predisposition; Preparation; Process; Protocols documentation; Provider; Psyche structure; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Research Personnel; Risk; Testing; Time; Walking; adverse outcome; age group; anxiety symptoms; anxiety treatment; anxious; base; clinical practice; clinically significant; compare effectiveness; depressive symptoms; dosage; effective intervention; effectiveness outcome; effectiveness testing; experience; falls; group intervention; hip replacement arthroplasty; hospital readmission; human old age (65+); implementation outcomes; improved; innovation; interactive feedback; knee replacement arthroplasty; multidisciplinary; older patient; opioid use; physically handicapped; programs; protocol development; psychologic; reduce symptoms; shared decision making; symptomatic improvement; therapy development; time interval; treatment as usual; trial design

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)，这是最 旨在减轻该年龄段疼痛和身体残疾的常见选择性外科手术。精神的 这些患者普遍存在健康问题，20-30% 的患者报告有明显的焦虑症状 以及术前和术后的抑郁症。抑郁和焦虑会通过 (i) 恶化 THA/TKA 结局 减少对康复的参与，从而阻碍康复，(ii) 增加对疼痛的敏感性，从而 增加修复手术的风险并增加长期使用阿片类药物的可能性，以及 (iii) 提高 谵妄和神经认知恢复延迟的风险。尽管有记录对个人和我们的影响 医疗保健系统中，治疗焦虑和抑郁的有效干预措施尚未得到应用， 对接受 THA/TKA 的老年人进行评估。在本提案中，我们将优化并测试药理学 针对因骨关节炎而接受全关节置换术的老年患者的行为干预组合 临床上显着的抑郁和焦虑症状。在本提案中，我们将建立围手术期心理 医疗保健包包括：(1) 应用行之有效的行为干预、行为激活 (BA)， 基于患者偏好和需求的策略； (2) 药物优化和取消处方 (MOD)， 旨在优化抗抑郁药物的剂量，并停止有害或无效的药物。 目标 1（适应）：通过协作规划方法，我们将适应、开发和实施 接受重大骨科治疗的老年人的最佳围手术期心理健康干预方案 程序。通过利益相关者的意见，我们将开发并迭代调整行为和药物治疗 在此人群中实施的优化干预组合。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迭代优化干预措施 来自接受重大骨科干预的 65 岁以上患者和其他利益相关者，注意到 计划完成的障碍和促进因素。目标 2（测试）：使用 1 型混合随机对照 试验设计中，我们将比较干预组合与常规护理在减轻症状方面的有效性 接受骨科手术的老年患者的抑郁和焦虑。为了实现这一目标，100 名患者 抑郁和焦虑症状将被随机分配到药物和行为 干预捆绑或常规护理。术前抑郁和焦虑与一系列不良反应有关 手术后的结果，包括并发症、跌倒、谵妄和疼痛。因此，药物优化， 接受全关节治疗的老年人抑郁和焦虑的减少处方和行为治疗 关节置换术可以改善抑郁和焦虑以及其他重要的术后症状 结果。