The Impact of Cognition on Rehabilitative Treatment for Slow Gait Speed

认知对慢步速康复治疗的影响

• 批准号: 10417480
• 负责人: Elisa Ogawa
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417480
• 关键词: Activities of Daily Living; Address; Adherence; Age; Aging; Attention; Award; Behavioral; Boston; Caring; Cessation of life; Characteristics; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Communities; Coupled; Data; Dementia; Elderly; Environment; Executive Dysfunction; Exercise; Foundations; Future; Gait; Gait speed; Goals; Grant; Healthcare Systems; Hospitalization; Impaired cognition; Impairment; Individual; K-Series Research Career Programs; Knowledge; Learning; Memory; Mentors; Mentorship; Morbidity - disease rate; Neurobiology; Neuropsychological Tests; Neuropsychology; New England; Outcome; Participant; Pathology; Patients; Performance; Phase; Physician Executives; Positioning Attribute; Prevalence; Quasi-experiment; Rehabilitation therapy; Research; Research Design; Research Methodology; Research Project Grants; Research Support; Research Training; Role; Self Efficacy; Therapeutic exercise; Time; Training; Treatment outcome; United States National Institutes of Health; Veterans; Walking; Work; Writing; base; bean; career; cognitive ability; cognitive benefits; compliance behavior; design; disability; evidence base; executive function; experience; functional decline; functional disability; functional status; hands on research; improved; improved mobility; individualized medicine; innovation; insight; medical schools; multidisciplinary; novel; personalized approach; professor; programs; rehabilitation research; rehabilitation science; rehabilitative care; response; secondary analysis; skills; treatment adherence; treatment optimization; treatment response; walking speed

Slow walking and cognitive impairment are prevalent among aging Veterans and are independent predictors for subsequent hospitalization, disability, and death. Recent scientific evidence suggests that walking and cognition are interrelated whereby their declines may share a common underlying neurobiological pathology. Thus, treating slow walking speed may not only improve mobility but also cognition. Live Long Walk Strong (LLWS) is a new innovative rehabilitative care program targeting Veterans (≥50yrs) with slow walking speed. LLWS treatment primarily focuses on mobility problems. However, it is estimated that 40% of LLWS participants have manifested cognitive deficits; thus, it is uncertain whether current LLWS treatment is designed to optimally serve the unique characteristics of Veterans who have cognitive problems. For example, we do not know whether Veterans with cognitive challenges will adhere to the rehabilitative program. Likewise, we are unsure whether the treatment response will be the same across cognitive status. Therefore, the study objective is to understand the treatment adherence, compliance, and response among older Veterans with and without cognitive problems participating in the LLWS clinical trial. The present study will 1) provide insight into whether LLWS treatment needs to be modified to increase compliance and adherence, 2) examine the association between baseline cognitive status and change in gait speed after LLWS treatment, and 3) discover the influence of LLWS treatment on cognition. The long-term goal of this proposed Career Development Award (CDA-1) is to advance research and educational training in order for the PI to establish an independent line of research developing personalized rehabilitative treatment to maintain safe mobility and cognition among aging Veterans with varying functional abilities. The PI previously was the study coordinator of a NIH supported R21 exercise treatment study and later conducted her own feasibility and quasi-experimental studies. Currently, she is mentored by Jonathan Bean, MD, MPH, a professor of PM&R at Harvard Medical School and Director of New England GRECC at VA Boston Healthcare System. The short-term goals of this CDA-1 are to acquire experience in 1) rehabilitation science, 2) mobility assessment and treatment, 3) neuropsychological assessment and analysis, 4) personalized rehabilitation treatment (geriatric care principles), and 5) research methods and grant writing skills to establish a strong foundation for a VA-research career. The PI will use the combination of didactic coursework provided from a rich academic research environment, hands-on research training, and mentorships from a team of experts who can offer extensive knowledge and support her research. The proposed research is significant and innovative as it provides information about how to tailor innovative rehabilitative care to better suit the individual needs of Veterans.

缓慢行走和认知障碍在老年退伍军人中普遍存在，并且是独立的预测因素 随后的住院、残疾和死亡。最近的科学证据表明步行和 认知是相互关联的，因此它们的下降可能具有共同的潜在神经生物学病理学。 因此，治疗慢速步行不仅可以改善活动能力，还可以改善认知能力。活得长久 走得坚强 (LLWS) 是一项针对步行速度较慢的退伍军人（≥50 岁）的新型创新康复护理计划。 LLWS 治疗主要集中于行动问题。然而，据估计 40% 的 LLWS 参与者表现出认知缺陷；因此，目前的 LLWS 治疗是否有效还不确定。 旨在最佳地服务于有认知问题的退伍军人的独特特征。例如， 我们不知道有认知障碍的退伍军人是否会坚持康复计划。同样地， 我们不确定不同认知状态下的治疗反应是否相同。因此，本研究 目的是了解老年退伍军人的治疗依从性、依从性和反应 参加 LLWS 临床试验时没有认知问题。本研究将 1）深入了解 是否需要修改 LLWS 治疗以提高依从性和依从性，2) 检查 基线认知状态与 LLWS 治疗后步态速度变化之间的关联，以及 3) 发现 LLWS 治疗对认知的影响。本拟议职业发展的长期目标 奖项（CDA-1）旨在推进研究和教育培训，以便 PI 建立独立的 开发个性化康复治疗以维持安全活动和认知的研究线 具有不同功能能力的老年退伍军人。该 PI 之前是 NIH 的研究协调员 支持R21运动治疗研究，随后进行了自己的可行性和准实验 研究。目前，她的导师是哈佛医学院 PM&R 教授 Jonathan Bean（医学博士、公共卫生硕士） VA 波士顿医疗系统新英格兰 GRECC 学校和主任。本次活动的短期目标 CDA-1 将获得 1) 康复科学、2) 活动能力评估和治疗、3) 方面的经验 神经心理学评估与分析，4）个性化康复治疗（老年护理 原则），以及 5）研究方法和拨款写作技巧，为 VA 研究奠定坚实的基础 职业。 PI 将结合丰富的学术研究提供的教学课程 环境、实践研究培训以及专家团队的指导，他们可以提供广泛的 知识并支持她的研究。拟议的研究具有重要意义和创新性，因为它提供了 有关如何定制创新康复护理以更好地满足退伍军人个人需求的信息。