Effect of Treatment of Orthostatic Hypotension on a Rehabilitation Unit

康复中心体位性低血压的治疗效果

• 批准号: 8893928
• 负责人: MARK HELFAND
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8893928
• 关键词: Acute; Address; Admission activity; Adult; Blood Pressure; Caring; Chronic Disease; Clinical; Cohort Studies; Control Groups; Data; Development; Diagnosis; Disease; Dizziness; Enrollment; Environment; Equilibrium; Funding; Guidelines; Health system; High Prevalence; Hip Fractures; Home Nursing Care; Hospitals; Inpatients; Intervention; Length of Stay; Location; Long-Term Care; Measurement; Measures; Monitor; Nursing Homes; Orthostatic Hypotension; Outcome; Patient Admission; Patients; Pharmaceutical Preparations; Population; Prevalence; Prevention; Randomized; Randomized Controlled Trials; Recommendation; Recovery; Recovery of Function; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk Factors; Symptoms; Syncope; Time; Treatment Protocols; Veterans; Walking; abstracting; base; design; experience; falls; follow-up; functional disability; functional outcomes; functional status; group intervention; high risk; improved; improved functioning; intervention program; mortality; multi-component intervention; multidisciplinary; older patient; patient population; patient safety; prevent; programs; rehabilitation service; screening; stroke rehabilitation; treatment as usual; treatment effect; treatment program

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.

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，站立、行走、参与治疗和爬楼梯的能力对于他们的恢复和最终出院到限制最少的环境至关重要。体位性低血压（OH）是导致福尔斯、头晕、晕厥和功能状态受损的多种疾病之一。此外，OH很容易识别，是一种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的）显示，OH受试者入院前跌倒率较高，参与治疗较少，功能独立性测量（Functional Independence Measure）增益较少，出院后死亡率较高。此外，我们确定约1/3的康复患者入院时患有OH，并且在常规护理下，出院时该比率并未降低。此外，我们确定跨学科的治疗方案可以降低出院OH患病率。这些发现刺激了这项拟议的4年研究，这是一项针对入住我们康复/疗养院的受试者的OH预防/治疗的随机对照试验。39个月研究期预计入组530例受试者，分为干预组和对照组，每组265例受试者。干预将在入院时开始，并持续到出院。随访评估将在出院后持续6个月。我们假设，旨在预防和治疗OH在疗养院/康复住院期间的多学科干预计划将改善功能，结果和OH在出院时的患病率。此外，我们假设治疗方案将降低受试者出院后的跌倒率。这项研究计划将确定OH的治疗是否可以改善功能状态。这种改善可能与减少福尔斯和髋部骨折有关。尽管该提案的重点是疗养院和康复患者，但其研究结果应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，患有慢性疾病的年轻退伍军人以及患有非典型血压疾病的人（例如OIF/OEF退伍军人直立不耐受）。我们的卫生系统如何解决直立性低血压的筛查和治疗的一个重大变化将是VA如何成为患者安全和最大化功能状态的领导者的另一个例子。