Development of a stratified model of care for acute rehabilitation after hip fracture

髋部骨折后急性康复分层护理模式的开发

• 批准号: MR/S032819/2
• 负责人: Katie Sheehan
• 金额: $ 31.44万
• 依托单位: Queen Mary University of London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS032819%2F2
• 关键词: Development; stratified; model; care; acute

BACKGROUNDGlobally, an estimated 4.5 million people will fracture their hip in 2050. Even with surgery, 30% of patients die within a year. Among survivors, 25% never walk again and 22% change from living at home to a nursing home. Rehabilitation assists patients 'to achieve and maintain optimal functioning'. Yet, there is limited evidence to guide effective rehabilitation after hip fracture. This uncertainty may be due to between patient differences. A stratified approach could improve outcomes by tailoring rehabilitation to patient needs. Hip fracture survivors describe a tailored approach as key to recovery. Further, the NHS recommends a stratified approach as central to healthcare progress.AIMSWe aim to improve patient and carer outcomes of rehabilitation after hip fracture. Supported by patients and carers at each step, the objectives are to:1. identify patient groups with different risk of poor outcomes2. design an intervention which matches these groups to rehabilitation tailored to their needs3. feasibility test the intervention in acute hospital4. create a collaborative group with patients, carers, and the public in older adult trauma rehabilitation researchINVESTIGATION PLANIdentify patient groups: We completed a systematic review and interviewed 20 patients and carers to identify 4 factors that influence patients risk of poor outcome after rehabilitation for hip fracture- age, sex, cognition, and mobility. We will analyse of National Hip Fracture Database (NHFD) and Physiotherapy Hip Fracture Sprint Audit (PHFSA) to estimate the prediction accuracy of poor outcome following rehabilitation according to combinations of these factors. Analyses will be supported by the National Institute for Health Research (NIHR) Statistics Group at Kings College London. We will use results to classify multifactorial strata as low-, medium-, or high- risk of poor outcome. We will discuss classification acceptability with patient, carers, and allied health professionals.Intervention development and testing: Supported by patients and carers, we will design and feasibility test the intervention per the MRC framework for the development of complex interventions.We will update the Cochrane systematic review of rehabilitation after hip fracture. We will complete an overview of reviews on acute rehabilitation for adults with frailty. We will use NHFD and PHFSA to quantify current rehabilitation provision for patients classified as low-, medium-, and high- risk. We will interview allied health professionals to obtain their views on this provision. These interviews will complement completed patient interviews. We will hold stakeholder workshops to assess patient, carer, and allied health professional views on reviews, current provision, and interviews, and to design an intervention which matches low-, medium-, and high- risk strata to rehabilitation tailored to their needs. The intervention will include behaviour change techniques and allied health care. There will be a decreasing emphasis on behaviour change from low- to high- risk strata. We will obtain approvals prior to intervention testing in acute hospital to determine1. the number of eligible, recruited, and retained patients2. the acceptability of randomization, assessments, and intervention to patients, carers, and allied health professionals3. compliance with the intervention and fidelity of its delivery4. adverse events5. estimate of an effect size for a future definitive trialSackley (KCL mentor, NIHR Senior Investigator, £50,000,000 awarded for complex intervention trials) will support intervention development.Create a collaborative group: We will create a group, website, and strategy for sustained collaboration with patients, carers, and the public in older adult trauma rehabilitation research. The group will be modeled on the Stroke Research Patient and Family Group at KCL which has sustained public engagement since 2005.

背景全球估计，到2050年，将有450万人髋部骨折。即使做了手术，30%的患者也会在一年内死亡。在幸存者中，25%的人再也不会走路了，22%的人从家里住到了养老院。康复帮助患者“实现并维持最佳功能”。然而，指导髋部骨折后有效康复的证据有限。这种不确定性可能是由于患者之间的差异造成的。分层的方法可以通过根据患者的需求量身定做康复来改善结果。髋部骨折幸存者称，量身定做的方法是康复的关键。此外，NHS建议将分层方法作为医疗进步的核心。AIMSWe的目标是改善髋部骨折后患者和护理人员的康复结果。在患者和照顾者的支持下，每一步的目标是：1.确定具有不同不良结果风险的患者群体2。设计一种干预措施，使这些群体与根据他们的需求量身定做的康复相匹配。在急诊医院对干预措施进行可行性检验。在老年创伤康复研究中创建一个与患者、护理者和公众合作的小组研究计划确定患者组：我们完成了一项系统的综述，采访了20名患者和护理者，以确定影响患者髋部骨折康复后预后不良风险的4个因素--年龄、性别、认知和活动能力。我们将分析国家髋部骨折数据库(NHFD)和物理疗法髋部骨折冲刺审计(PHFSA)，根据这些因素的组合来评估康复术后不良结果的预测准确性。分析将得到伦敦国王学院国家健康研究所(NIHR)统计小组的支持。我们将根据结果将多因素层级划分为低、中、高不良结局风险。我们将与患者、护理人员和专职卫生专业人员讨论分类的可接受性。干预开发和测试：在患者和护理人员的支持下，我们将根据MRC框架设计和可行性测试干预措施，以开发复杂的干预措施。我们将更新Cochrane对髋部骨折后康复的系统评估。我们将完成对成年虚弱患者急性康复的综述。我们将使用NHFD和PHFSA来量化目前为低、中、高风险患者提供的康复服务。我们将访问相关的医疗专业人员，以了解他们对这一条款的意见。这些面谈将补充已完成的患者面谈。我们将举办利益相关者研讨会，评估患者、护理人员和相关卫生专业人员对审查、当前供应和访谈的意见，并设计一种干预措施，使低、中、高风险阶层与根据他们的需求量身定做的康复相匹配。干预措施将包括行为改变技术和联合医疗保健。从低风险阶层到高风险阶层的行为转变将受到越来越多的重视。我们将在急诊医院进行干预试验之前获得批准，以确定1。符合条件的、招募的和保留的患者数量2。患者、护理人员和相关卫生专业人员对随机化、评估和干预的可接受性3。遵守其干预和交付的保真度4.不利事件5.未来最终试验的效果规模估计Sackley(KCL导师，NIHR高级研究员，因复杂干预试验而获得5000万GB)将支持干预开发。创建协作小组：我们将创建一个小组、网站和战略，以便在老年创伤康复研究中与患者、护理人员和公众持续合作。该小组将仿照KCL的中风研究患者和家庭小组，该小组自2005年以来一直保持公众参与。