Helping Adults with RA PREVAIL: Developing a model to Preserve Valued Activities In Life

项目摘要。 尽管20年前的药物治疗取得了进展，但残疾在成年RA患者中仍然很常见 疾病活跃度降低。物理治疗和锻炼在减少成人类风湿关节炎患者残疾方面是有效的， 然而，它们在风湿病护理中没有得到充分利用，特别是在美国。这其中的主要贡献者 利用不足包括缺乏足够的针对性的物理治疗和锻炼建议 治疗指南使风湿科医生不清楚什么时候应该参考，也缺乏系统的流程 将康复纳入常规类风湿关节炎护理。促进适当的转介至物理治疗和锻炼 对于患有类风湿关节炎的成年人，我们基于以下前提创建了一个模型来保存生活中有价值的活动(盛行) 及早发现功能衰退将有助于指导物理治疗和运动转介，以解决 在不可逆转的残疾接踵而至之前的损害。Prevail将残疾筛查纳入常规RA护理 并使用筛查的结果来指导与残疾水平和RA匹配的物理治疗转介 具体的运动指导。该研究计划的目标是开发和试运行可扩展的模型 (盛行)将康复纳入常规护理，以保留功能和延迟残疾的成年人 拉。这些目标将(1)确定患有RA的成年人的残疾水平和相关功能需求的分布， (2)从患者和提供者那里获得关于该方案的可接受性和可行性的关键信息 模式；及(3)进行试验，以确定精炼普惠模式在香港的可行性和可接受性。 至少50名成人类风湿关节炎患者。成功完成这项建议将确立可行性和可接受性，以及 为在更大范围内将盛行纳入风湿病护理奠定基础。我的长期目标是 减轻患有风湿性和肌肉骨骼疾病的成年人的残疾。这份职业的目标是 发展奖是为了(1)加深我目前对风湿病，特别是风湿病的了解 关节炎(RA)护理，以更好地了解如何整合康复，(2)培训卫生服务研究， 特别是干预开发和临床试验，以及(3)准备设计和实施更大的临床 在我下一阶段的审判中。我的导师是健康服务研究、风湿病护理和类风湿关节炎方面的专家 残疾测量。我们共同制定了这项研究建议和职业发展计划，以 加速我的科学发展，朝着我的长远目标和研究独立性迈进。

PROJECT ABSTRACT. Disability continues to be common in adults with RA despite pharmacological advances two decades ago that reduced disease activity. Physical therapy and exercise are effective in reducing disability in adults with RA, however they are underutilized in rheumatologic care, particularly in the United States. Key contributors to this underutilization includes lack of sufficient specificity for physical therapy and exercise recommendations in treatment guidelines leaving rheumatologists unclear when to refer and lack of systematic processes for integrating rehabilitation in routine RA care. To facilitate appropriate referral to physical therapy and exercise for adults with RA, we created a model to PREserve Valued Activities In Life (PREVAIL) based on the premise that early identification of functional decline will help direct physical therapy and exercise referrals to address impairments before irreversible disability ensues. PREVAIL inserts disability screening into routine RA care and uses the results of the screening to direct a physical therapy referral matched to disability level and RA- specific exercise guidance. The objective of this research proposal is to develop and pilot test a scalable model (PREVAIL) for integrating rehabilitation into routine care to preserve function and delay disability in adults with RA. The aims will (1) define the distribution of disability levels and related functional needs in adults with RA, (2) obtain key information from patients and providers on the acceptability and feasibility of the PREVAIL model, and (3) conduct a pilot trial to determine feasibility and acceptability of the refined PREVAIL model in at least 50 adults with RA. Successful completion of this proposal will establish feasibility and acceptability, and set the stage for to integrate PREVAIL into rheumatologic care on a larger scale. My long-term goal is to mitigate disability in adults with rheumatic and musculoskeletal diseases. The objectives of this career development award are to (1) deepen my current knowledge of rheumatic disease, specifically in rheumatoid arthritis (RA) care to better understand how to integrate rehabilitation, (2) train in health services research, particularly intervention development and clinical trials, and (3) prepare to design and execute a larger clinical trial in my next phase. My mentors are experts in health services research, rheumatologic care, and RA disability measurement. Together, we developed this research proposal and career development plan to accelerate my scientific development towards my long-term goal and research independence.