The Live Long Walk Strong rehabilitation program: What features improve mobility skills?

Live Long Walk Strong 康复计划：哪些功能可提高行动能力？

• 批准号: 10454899
• 负责人: JONATHAN F BEAN
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10454899
• 关键词: Accounting; Address; Advocate; Aftercare; Age; Ambulatory Care Facilities; Boston; Caring; Cessation of life; Clinical; Clinical Trials; Communities; Disease; Elderly; Exercise; Funding; Future; Gait; Gender; Goals; Health; Health Care Costs; Healthcare Systems; High Prevalence; Hospitalization; Impaired cognition; Impairment; Lead; Leg; Link; Mediating; Modeling; Muscle; Outcome; Outpatients; Pain; Patient Care; Patients; Performance; Phase; Physical activity; Physical therapy; Prevalence; Preventive care; Primary Health Care; Randomized; Randomized Controlled Clinical Trials; Readiness; Recording of previous events; Rehabilitation therapy; Research; Risk; Self Efficacy; Speed; United States National Institutes of Health; Veterans; Waiting Lists; Walking; Work; aged; base; cohort; comorbidity; design; disability; efficacious treatment; falls; functional independence; health care settings; improved; improved mobility; innovation; middle age; new therapeutic target; novel therapeutics; physical model; primary outcome; programs; recruit; rehabilitation science; rehabilitative care; secondary outcome; skills; standard care; therapeutic target; treatment as usual; treatment duration; treatment effect; walking speed

Slow walking speed is highly prevalent among Veterans beginning in midlife. It is a major predictor of functional independence, independent of disease status and a predictor for subsequent hospitalization, disability and death. While rehabilitative care is the standard treatment for those with slow gait speed, the optimal mode of treatment is not yet identified. We have strong clinical support that a new model of physical therapy care known as Live Long Walk Strong (LLWS) may be an efficacious treatment for those screened with slow gait speed. LLWS is highly innovative, as it prioritizes unconventional treatment targets not typically addressed in standard care, including impairments in: 1) leg power; 2) trunk muscle endurance; 3) gait coordination (smoothness of walking); and 4) self-efficacy to engage in exercise. Through prior research, we identified that each of these four therapeutic targets are linked to mobility decline when impaired and that improvements in each alone can lead to mobility gains that surpasses standard care. No treatment targeting these attributes collectively is established, though LLWS is conceptually designed to do so. [Thus, we propose a phase II randomized controlled clinical trial (RCT) among Veterans 50 years and older to identify if LLWS care enhances these attributes and if by augmenting each, sustained improvements in gait speed result.] In a civilian-based clinical demonstration project, clinical proof of concept of LLWS was observed. LLWS targeted community-dwelling older adults. At the completion of LLWS care, we observed large improvements in mobility performance that exceeded clinically meaningful differences. These differences were observed even after accounting for health factors that may mitigate rehabilitative gains. [LLWS has great significance for the VA, because slow gait speed is prevalent in middle aged Veterans and improvements of the magnitude we observed are predictive lower health care costs and disability. However, while LLWS was clinically conceived to improve gait speed by enhancing each of these attributes, it is critical to know if two basic suppositions are true: 1) Are each of these four attributes improved by LLWS? and 2) Do these improvements induce immediate and sustained changes in gait speed among veterans beginning in midlife? Therefore, this study will establish efficacy and proof of concept of LLWS among Veterans beginning in midlife; an age-range largely ignored in prior clinical trials targeting gait speed.] LLWS has tremendous relevance for the VA. [For example, in our preliminary work among 174 Veteran primary care patients aged 50-98, >50% manifested a gait speed < 1.0 m/s, a speed indicating a heightened risk for adverse health outcomes.] Given Veteran’s higher levels of impairment compared to aged matched civilians, care should be as parsimonious and efficacious as possible. Thus, the major goal of this proposal is to establish LLWS as a non-invasive, new therapy targeting slow gait speed across a variety of VHA settings. In the proposed phase II RCT, we will recruit [198 community-dwelling, Veterans 50 years and older] from the outpatient clinics of the VA Boston Healthcare system that manifest slow gait speed (< 1.0 m/s) and randomize them to either 8 weeks of LLWS or 8 weeks of usual care for those with slow gait speed after which LLWS will be initiated for 8 weeks. Both groups will be followed for outcomes 16 weeks after LLWS treatment ends. [The primary outcome for all 3 aims will be change in usual gait speed. Secondary outcomes will include changes in the targeted attributes after 8 weeks of treatment.] We will address these aims: [Aim 1: To conduct a phase II RCT of LLWS in comparison to controls and evaluate its efficacy among community dwelling Veterans 50 years and older. Aim 2: Evaluate the attributes that lead to improved gait speed after 8 weeks of LLWS treatment. Aim 3: Identify the attributes that are associated with sustained gait speed gains 16 weeks after LLWS ends.]

缓慢的步行速度在中年开始的退伍军人中非常普遍。这是一个主要的预测， 功能独立性，独立于疾病状态和后续住院的预测因素， 残疾和死亡。虽然康复护理是那些步态速度慢的人的标准治疗， 最佳治疗模式尚未确定。我们有强有力的临床支持， 被称为“坚强生活”（LLWS）的治疗护理可能是对筛查患者的有效治疗 步态速度缓慢。LLWS具有高度创新性，因为它优先考虑非常规治疗目标， 在标准护理中得到解决，包括以下方面的损伤：1）腿部力量; 2）躯干肌肉耐力; 3）步态 协调性（行走的平稳性）;以及4）从事锻炼的自我效能。通过前期研究，我们 发现这四个治疗靶点中的每一个都与受损时的活动能力下降有关， 每一个方面的改善都可以带来超过标准护理的流动性收益。无治疗靶向 尽管LLWS在概念上是这样设计的，但这些属性是共同建立的。[Thus，我们建议 一项在50岁及以上退伍军人中进行的II期随机对照临床试验（RCT）， 护理增强了这些属性，并且如果通过增强每个属性，则导致步态速度的持续改善。 在一个以马达加斯加为基础的临床示范项目中，观察到了LLWS概念的临床证明。 LLWS针对社区居住的老年人。在LLWS护理完成时，我们观察到大 移动性能的改善超过了临床上有意义的差异。这些差异 即使在考虑了可能减少康复收益的健康因素后，也观察到了这一点。[LLWS具有重大 对于VA的意义，因为缓慢的步态速度在中年退伍军人中很普遍， 我们观察到的幅度是预测性的较低的医疗保健成本和残疾。然而，尽管LLWS 临床上设想通过增强这些属性中的每一个来提高步态速度，关键是要知道是否有两个 基本假设是正确的：1）这四个属性中的每一个都被LLWS改善了吗？（2）做这些 改善诱导立即和持续的变化，步态速度之间的退伍军人开始在中年？ 因此，本研究将在中年开始的退伍军人中建立LLWS的有效性和概念证明; 这一年龄范围在以前针对步态速度的临床试验中很大程度上被忽略了。 LLWS对VA有很大的意义。[For例如，在我们对174名退伍军人的初步工作中， 年龄在50-98岁的初级保健患者中，>50%表现出步态速度< 1.0 m/s，该速度表明步态速度加快， 造成不良健康后果的风险]。考虑到退伍军人的损伤程度高于年龄匹配的 对于平民来说，护理应尽可能节俭和有效。因此，这项建议的主要目标是 将LLWS确立为一种非侵入性的新疗法，目标是在各种VHA环境中实现缓慢步态速度。 在拟议的第二阶段随机对照试验中，我们将招募[198名社区居民，50岁及以上的退伍军人] 来自VA波士顿医疗保健系统的门诊诊所，表现出缓慢的步态速度（< 1.0 m/s）， 将他们随机分为8周LLWS组或8周常规护理组（对于步态速度较慢的患者）， LLWS将启动8周。两组均将在LLWS治疗后16周随访结局 形接头. [The所有3个目标的主要结局将是通常步态速度的变化。次要结局将包括 治疗8周后目标属性的变化。 我们将实现这些目标： [Aim 1：进行LLWS与对照组相比的II期RCT，并在以下人群中评价其疗效： 社区居住退伍军人50岁及以上。 目的2：评价LLWS治疗8周后导致步态速度改善的属性。 目标3：确定与LLWS结束后16周持续步态速度增加相关的属性。