Perioperative intervention to improve post-TKR support and function

围手术期干预以改善 TKR 后的支持和功能

基本信息

批准号：
7314819
负责人：
PATRICIA D FRANKLIN
金额：
$ 48.84万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-17 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7314819
关键词：
Accounting Address Adult Age Algorithms Anxiety Arthritis Behavioral Sciences Blinded Caring Communities Consensus Daily Data Effectiveness of Interventions Elements Emotional Exercise Frequencies Future Goals Health Health Knowledge, Attitudes, Practice Health behavior change Home environment Intervention Knee Maintenance Measures Medical Mental Depression Mental Health Minority Modeling Numbers Operative Surgical Procedures Orthopedics Outcome Pain Pain management Participant Patient Care Patients Perioperative Phase Phase II Clinical Trials Physical Function Physical activity Population Printing Protocols documentation Randomized Rehabilitation therapy Reporting Research Research Personnel Role SF-36 Sampling Score Self Care Self Efficacy Self Management Societies Structure Surgeon Telephone Testing Time Translating Treatment Protocols United States National Institutes of Health Variant Week base chronic care model clinically significant cost day design functional gain functional improvement functional outcomes improved improved functioning knee replacement arthroplasty outreach patient oriented programs theories therapy design trait

项目摘要

DESCRIPTION (provided by applicant): More than 350,000 adults elect primary Total Knee Replacement (TKR) surgery each year to eliminate knee arthritis pain that persists despite comprehensive medical treatment. The 2003 NIH TKR Consensus Panel concluded that TKR effectively eliminates knee pain with few complications. In contrast to the uniform surgical outcomes and pain relief, significant variation remains in functional outcome after TKR. An estimated 15-30 percent of patients report no clinically significant functional improvement at 12 months after. TKR. No one patient attribute or surgical factor satisfactorily accounts for this variation. Our pilot data documents that higher quantities of post-TKR exercise and stronger pre-TKR emotional health are associated with greater improvement in function after TKR. Based on evidence in non-surgical arthritis care, we hypothesize that a peri-TKR self-care support intervention designed to enhance patient self-efficacy for independent exercise and activity will significantly increase post-TKR physical function (measured by SF-36/ Physical Component Score) and knee function (measured by WOMAC score) at 6 and 12 months. In addition, we hypothesize that increased arthritis self-efficacy at 8 and 26 weeks post-TKR (measured by Stanford scale) and increased knee exercise (quantity, frequency) and activity (mean steps/day) at 8 and 26 weeks will be associated with improved 6 and 12 month function after TKR. The proposed research will develop a 12- session pre and post-TKR patient intervention (English and Spanish) incorporating proven arthritis self-care elements. Telephone delivery will accommodate patients' physical limitations. The program's efficacy will be tested in a surgeon blinded RCT allocating a stratified random sample to intervention (n=90) and usual care (n=90). The intervention is theory-based and extends successful health-behavior change intervention algorithms and established arthritis self-management strategies to the peri-TKR patient. This research is the first to extend behavioral science theory to the peri-operative TKR patient and extrapolates a chronic care model to orthopedic practice. This peri-TKR intervention changes the paradigm for TKR care to include patient self-management support for independent activity and exercise to assure uniform, optimal improvement in post- TKR function and patient autonomy- the ultimate goals of TKR.

描述（由申请人提供）：每年有35万名成年人选出原发性总膝盖置换（TKR）手术，以消除尽管进行了全面的治疗，但仍能持续进行膝关节炎。 2003年NIH TKR共识小组得出结论，TKR有效地消除了膝盖疼痛，几乎没有并发症。与均匀的手术结局和缓解疼痛相反，TKR后功能结果显着差异。估计有15-30％的患者在12个月后报告没有临床显着的功能改善。 TKR。没有一个患者属性或手术因素令人满意地解释这种变异。我们的试点数据文件表明，较高数量的TKR运动和更强的TKR前情绪健康与TKR后功能的改善有关。根据非手术关节炎护理中的证据，我们假设旨在提高旨在提高患者自我效能的自我效能的自我护理支持干预措施将显着提高TKR后身体功能后（通过SF-36/物理成分得分来衡量）和膝盖功能（通过WOMAC评分测量），在6和12个月中在WOMAC评分中进行测量）。此外，我们假设在TKR后8和26周（通过Stanford量表测量）在8和26周时提高关节炎的自我效能感以及在8和26周时增加的膝关节运动（数量，频率）和活动（平均步骤/天）将与TKR后的6个月和12个月的功能有关。拟议的研究将开发12个会话前和TKR后患者干预（英语和西班牙语），其中包含了良好的关节炎自我保健元素。电话输送将适应患者的身体局限性。该程序的功效将在外科医生盲目的RCT中进行测试，将分层的随机样品分配给干预措施（n = 90）和常规护理（n = 90）。该干预是基于理论的，并扩展了成功的健康行为变化干预算法，并向Peri-TKR患者建立了关节炎的自我管理策略。这项研究是第一个将行为科学理论扩展到围手术期TKR患者并将慢性护理模型推断到骨科实践的研究。这种THE-TKR干预改变了TKR护理的范例，包括患者的自我管理支持独立活动和锻炼，以确保统一，最佳改善后TKR功能和患者自主权 - TKR的最终目标。