Effect of Treatment of Orthostatic Hypotension on a Rehabilitation Unit

描述(由申请人提供)： 项目摘要/摘要对于从急性疾病中恢复的患者来说，站立、行走、参与治疗和爬楼梯的能力对于他们的康复和最终出院到限制最少的环境至关重要。直立性低血压(OH)是导致跌倒、头晕、晕厥和功能状态受损的多种情况之一。此外，OH很容易识别，并且是一个潜在的可逆风险因素。我们的初步数据(在我们最近完成的RRD资助的非随机观察性队列研究中收集)显示，患有OH的受试者入院前跌倒的比率更高，参与治疗的人数更少，FIM(功能独立性测量)的收益更少，出院后的死亡率更高。此外，我们还确定，大约三分之一的康复患者入院时患有OH，在常规护理下，这一比例在出院时不会下降。此外，我们确定一个跨学科的治疗方案可以降低出院时的OH率。这些发现刺激了这项拟议的为期4年的研究，这是一项针对康复/疗养院收治对象的预防/治疗OH的随机对照试验。在为期39个月的研究期间，预计将有530名受试者被分成干预组和对照组，每组265名受试者。干预将从入院时开始，一直持续到出院。出院后将继续进行6个月的跟踪评估。我们假设，在疗养院/康复住院期间，旨在预防和治疗OH的多学科干预计划将改善出院时OH的功能、结果和患病率。此外，我们假设治疗方案将降低出院后受试者跌倒的比率。这项研究计划将确定OH的治疗是否可以改善功能状态。这种改善可能与跌倒和髋部骨折的减少有关。即使这项建议侧重于疗养院和康复患者，其结果也应该适用于整个退伍军人群体，包括65岁以上使用康复服务的人、患有慢性病的年轻退伍军人和患有非典型血压疾病的人(例如直立不耐受的OIF/OEF退伍军人)。我们的医疗系统如何解决直立性低血压的筛查和治疗方面的重大变化将是退伍军人管理局如何在患者安全和最大化功能状态方面处于领先地位的又一个例子。

DESCRIPTION (provided by applicant): Project Summary/Abstract For patients recovering from acute illness, the ability to stand, walk, participate in therapy, and climb stairs is critical to their recovery and eventual discharge to the least restrictive environment. Orthostatic hypotension (OH) is one of multiple conditions that contribute to falls, dizziness, syncope, and impaired functional status. In addition, OH is easily identifiable, and is a potentially reversible risk factor. Our preliminary data (collected during our recently completed RRD-funded non-randomized, observational cohort study) show subjects with OH had higher preadmission fall rates, less participation in therapy, less FIM (Functional Independence Measure) gain, and higher mortality after discharge. Also, we determined that approximately 1/3 of all rehabilitation patients were admitted with OH, and that with usual care, this rate did not decrease at discharge. Furthermore, we determined that an interdisciplinary treatment program could reduce discharge OH prevalence. These findings have stimulated this proposed 4 year study that is a randomized control trial directed at the prevention/treatment of OH in subjects admitted to our rehabilitation/nursing home. Predicted enrollment for the 39-month study period is 530 subjects that will be divided into intervention, and control groups of 265 subjects each. The intervention will begin on admission, and continue through discharge. Follow-up assessments will continue for 6 months after discharge. We hypothesize that a multidisciplinary intervention program designed to prevent and treat OH during a nursing home/rehabilitation stay will improve function, outcomes, and prevalence of OH at discharge. In addition, we hypothesize that the treatment protocol will decrease subject fall rates after discharge. This research program will determine if treatment of OH can improve functional status. This improvement could be associated with a reduction of falls, and hip fracture. Even though this proposal is focused on nursing home and rehabilitation patients, its findings should be applicable to the entire Veteran population, including those over 65 who use Rehabilitation Services, younger veterans with chronic diseases, and those with atypical blood pressure disorders (e.g. OIF/OEF veterans with orthostatic intolerance). A major change in how our health system addresses the screening and treatment of orthostatic hypotension would be another example of how the VA is a leader in patient safety and maximizing functional status.