Efficacy of a Post-Rehabilitation Exercise Intervention

描述(由申请人提供)：这个项目的总体目标是确定是否可以通过一个简单、易于传播的计划来减少或消除康复结束后许多髋部骨折患者仍然存在的重大功能问题。这项研究的具体目的是证明在正式的髋部骨折康复结束后，是否可以通过使用一种名为Strong for Life(SFL)的实用的家庭锻炼计划来实现功能改善。SFL干预将认知训练和行为强化与运动训练相结合，以实现高水平的坚持。与NIA和NCMMR的任务相关：该项目通过调查一种创新的多学科方法来处理这些机构的任务，以提高残疾老年人的独立性、福祉和生活质量。在之前对有功能限制的老年人进行的随机临床试验中，SFL参与者实现了高水平的依从性，并在与治疗师接触最少的情况下提高了力量、灵活性和减少了残疾。这项拟议的研究将通过在髋部骨折后接受正式康复服务的成年人样本中展示该计划的安全性和有效性来扩展先前的工作，这些成年人在正常康复过程结束时身体功能表现出局限性。参与者将随机接受为期6个月的SFL计划，或接受注意力控制干预(营养咨询)。SFL参与者将接受锻炼和认知训练，以及物理治疗师提供的后续行为强化。盲人结果评估员将在6个月和9个月的随访中使用体能测试和自我报告测量来评估该计划对身体功能和残疾的影响。所有的分析都将通过意向治疗进行。与公共健康相关：髋部骨折康复结束后，许多人仍有行走和日常活动方面的问题。这项研究将探讨康复结束后人们可以在自己家里进行的锻炼计划，其中包括增加人们动力和信心的特殊技巧是否有助于他们更独立。这一低成本的计划可以被许多髋部骨折后的人使用，并可能有助于减少需要搬到养老院或需要长期家务帮助的人数。

DESCRIPTION (provided by applicant): The overall objective of this project is to determine if the significant functional problems that remain for many hip fracture patients after rehabilitation ends can be reduced or eliminated by a simple, easily disseminated program. The specific aim of this study is to demonstrate if functional improvement can be achieved after formal hip fracture rehabilitation ends through the use of a practical, home-based exercise program, called Strong for Life (SFL). The SFL intervention incorporates cognitive training and behavioral reinforcements with exercise training to achieve high levels of adherence. Relevance to the missions of NIA and NCMMR: This project addresses the missions of these agencies by investigating an innovative, multidisciplinary approach to enhance the independence, well-being and quality of life of older adults with a disability. In previous randomized clinical trials with older adults with functional limitations, the SFL participants have achieved a high level of adherence, and improved strength, mobility and reduced disability with minima contact from a therapist. This proposed study will extend previous work by demonstrating this program's safety and effectiveness in a sample of adults who have received formal rehabilitation services following hip fracture and who display limitations in their physical function at the end of their normal course of rehabilitation. Participants will be randomized either to receive the SFL program for 6 months, or an attention control intervention (nutrition counseling). SFL participants will receive exercise and cognitive training and follow-up behavioral reinforcements from a physical therapist. Blinded outcome assessors will evaluate the program's impact on physical function and disability using physical performance tests and self- report measures at 6- and 9-month follow-up. All analyses will be by intention to treat. Relevance to public health: After rehabilitation for a hip fracture ends, many people continue to have problems walking and doing their daily activities. This study will find out whether an exercise program that people can do in their own home after their rehabilitation ends which includes special techniques to increase people's motivation and confidence helps them to be more independent. This low-cost program could be used by many people after hip fracture, and could potentially help to reduce the number of people who need to move to a nursing home or need long term home help.