SELF EFFICACY AND STRENGTH TRAINING TO IMPROVE POSTOP REHAB OF HIP FRACTURE

自我效能和力量训练改善髋部骨折术后康复

• 批准号: 5206188
• 负责人: JOHN P ALLEGRANTE
• 金额: --
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/5206188
• 关键词: body physical activity; clinical trials; exercise; functional ability; health education; hip fractures; human old age (65+); human subject; human therapy evaluation; injury prevention; muscle strength; postoperative state; questionnaires; rehabilitation; self help

Over 250,000 patients are hospitalized each year in the United States for a fractured hip, with treatment and rehabilitation costs exceeding $7 billion per year. The specific aims of this project are to: a) implement an intervention program of patient education focused on self-efficacy and strength training designed to improve the postoperative rehabilitation of older persons (> 65 years of age) who have sustained a fracture of the hip; and b) evaluate in a prospective randomized trial the efficacy of this intervention program to improve the overall postoperative functional status of such patients and decrease the rate of their subsequent institutionalization. The study will also a) describe and document the risk factors for functional deterioration, recurrent falls, and subsequent institutionalization in a cohort of such patients; b) assess self-efficacy beliefs and their ability to influence and predict postoperative functional capacity in such patients; and c) document the costs associated with the implementation of the program and to generate data that can provide the basis for subsequent cost-benefit analysis. We hypothesize that a) a program of patient education focusing on self- efficacy and strength training can improve the functional capacity and reduce the rate of institutionalization of older persons following hip fracture; and b) clinical, psychosocial factors, muscle strength and balance are multifactorial determinants of functional capacity, recurrent falls, and subsequent institutionalization in hip fracture patients. We will randomize 200 patients who have sustained a primary unilateral hip fracture to the multiple-component intervention program of patient education and high-intensity strength training or to standard medical care. The intervention program will comprise four major components: (1) an in-hospital postoperative patient instruction protocol conducted prior to discharge with the patient and a family member or caregiver; (2) a hospital-based, 8-week program of high-intensity isokinetic strength training for patients; (3) an at-home walking program designed to enable patients to maintain strength and physical activity following the hospital-based portion of the intervention; and (4) supportive telephone calls through which patients and their families or caregivers will have regular and ongoing contact with a hospital-based interventionist, as well as other hip fracture patients. The principal outcome is within patient change in the physical, social and role function subscales of the SF36. Secondary measures of outcome include muscle strength, balance, functional status on the Cummings scale, activities of daily living, recurrent falls, and rate of institutionalization will be assessed at baseline and one year postdischarge. The long-term objective of the project is to improve the overall functional capacity and reduce both recurrent falls and the need for institutionalization of hip fracture patients through development and evaluation of an intervention program whose feasibility and cost has the potential for application in a wide range of institutional settings involved in the treatment and rehabilitation of such patients.

在美国，每年有超过250，000名患者住院， 髋部骨折，治疗和康复费用超过7美元 每年10亿。 该项目的具体目标是：a）实施干预措施 病人教育计划侧重于自我效能和力量 旨在改善老年人术后康复的训练 髋部骨折的人（> 65岁）;以及 B）在前瞻性随机试验中评估这种方法的疗效， 改善术后整体功能的干预方案 这类患者的状况，并降低其随后的发病率 制度化。 该研究还将a）描述和记录 功能恶化、复发性福尔斯的风险因素，以及 随后在此类患者队列中进行机构化; B）评估 自我效能信念及其影响和预测能力 此类患者的术后功能能力;以及c）记录 与该计划的实施相关的成本，并产生 这些数据可以为随后的成本效益分析提供基础。 我们假设a）一个专注于自我的病人教育计划， 效能和力量训练能提高功能能力， 降低老年人接受髋关节置换术后的机构化比率 骨折;和B）临床、心理社会因素、肌肉力量和 平衡是功能能力的多因素决定因素， 福尔斯，以及随后在髋部骨折患者中的机构化。 我们将随机抽取200名原发性单侧 髋部骨折患者的多组分干预程序 教育和高强度力量训练或标准医疗 在乎 干预计划将包括四个主要部分：（1） 之前进行的住院术后患者指导方案 与患者和家庭成员或护理人员一起出院;（2）a 以医院为基础，为期8周的高强度等速肌力训练 （3）居家步行计划，旨在使 患者在术后保持体力和体力活动， 基于医院的干预部分;（4）支持性电话 通过这些电话，患者及其家属或护理人员将 定期和持续接触医院的干预，如 以及其他髋部骨折患者。 主要成果是在 患者的身体、社会和角色功能子量表的变化 SF36 结果的次要指标包括肌肉力量，平衡， Cummings量表的功能状态，日常生活活动， 经常性的福尔斯，机构化率将评估为 基线和出院后1年。 该项目的长期目标是改善 功能能力和减少两个经常性的福尔斯和需要 通过发展和将髋部骨折患者制度化 评估干预方案的可行性和成本， 在广泛的机构环境中应用的潜力 参与此类患者的治疗和康复。