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: 6100426
• 负责人: JOHN P ALLEGRANTE
• 金额: --
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-07-01 至 1999-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6100426
• 关键词: behavioral /social science research tag; 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.

美国每年有超过 250,000 名患者住院治疗 髋部骨折，治疗和康复费用超过 7 美元 每年十亿。 该项目的具体目标是： a) 实施干预 注重自我效能和力量的患者教育计划 旨在改善老年人术后康复的培训 患有髋部骨折的人（> 65 岁）；和 b) 在前瞻性随机试验中评估该方法的功效 改善术后整体功能的干预计划 此类患者的状况并降低其后续发生率 制度化。 该研究还将 a) 描述并记录 功能恶化、反复跌倒的危险因素，以及 随后将此类患者纳入收容机构； b) 评估 自我效能信念及其影响和预测的能力 此类患者的术后功能能力； c) 记录 与实施该计划相关的费用并产生 为后续成本效益分析提供依据。 我们假设 a) 患者教育计划重点关注自我 功效和力量训练可以提高功能能力和 降低髋关节置换术后老年人的住院率 断裂; b) 临床、社会心理因素、肌肉力量和 平衡是功能能力、经常性的多因素决定因素 跌倒，以及随后髋部骨折患者的住院治疗。 我们将随机抽取 200 名患有原发性单侧疾病的患者 髋部骨折患者的多成分干预方案 教育和高强度力量训练或标准医疗 关心。 干预计划将包括四个主要部分：(1) 事先进行的院内术后患者指导方案 与患者及其家人或护理人员一起出院； (2) 一个 以医院为基础的为期 8 周的高强度等速力量计划 患者培训； (3) 在家步行计划旨在使 患者在治疗后保持体力和体力活动 干预中以医院为基础的部分； (4) 支持电话 患者及其家人或护理人员可以通过电话获得 定期、持续地与医院的干预医生联系，如 以及其他髋部骨折患者。 主要成果在 患者的身体、社会和角色功能分量表的变化 SF36。 结果的次要衡量标准包括肌肉力量、平衡、 卡明斯量表的功能状态、日常生活活动、 反复跌倒，收容率将评估为 基线和出院后一年。 该项目的长期目标是提高整体水平 功能能力并减少反复跌倒和需要 通过发展和培训将髋部骨折患者收容入院 评估干预计划的可行性和成本 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。