REhabilitation Promoting Prevention And Improved Resilience (REPPAIR)

康复促进预防和提高复原力 (REPPAIR)

• 批准号: 9994582
• 负责人: JONATHAN F BEAN
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9994582
• 关键词: Achievement; Activities of Daily Living; Age; Aging; Behavioral; Biological; Biometry; Caring; Chronic Disease; Clinical Research; Cognition; Collection; Data; Databases; Development; Faculty; Goals; Grant; Health; Health Care Costs; Ideal 1; Impairment; Injury; Knowledge; Leadership; Link; Longevity; Measures; Mediating; Mind; Modeling; Monitor; Motivation; Neurocognitive; Operative Surgical Procedures; Outcome; Patients; Phenotype; Physical Function; Pilot Projects; Play; Prevention; Preventive care; Preventive treatment; Qualifying; Quality of life; Rehabilitation therapy; Research; Research Design; Research Personnel; Resources; Risk; Role; Sum; Testing; Therapeutic; Training and Education; Veterans; base; bean; behavior change; cognitive function; complex data; data management; data repository; data resource; design; disability; efficacy testing; functional decline; functional disability; health care service utilization; high risk; improved; investigator training; meetings; novel therapeutic intervention; operation; personalized medicine; prevent; programs; rehabilitative care; resilience; success; treatment response

To optimize the function and independence of Veterans, it is critical to develop proactive treatments that ameliorate and prevent disability and the resulting loss of quality of life and high cost health care associated with the progression of chronic disease. 1 Ideally, these preventative treatments should be designed to target Veterans at greatest risk and be personalized to their needs. This is critical for the VA since the mean age of Veterans is 64 years and Veterans manifest greater impairment and functional limitations than their age- matched civilian counterparts. 2,3 Aspects of personalization include a focus on impairments linked to not only physical but cognitive function; and acknowledging that critical steps to preventative care include a focus on behavior change of the patient. 1 Treatments promoting long term success commonly emphasize these approaches. Rehabilitative care can play a leading role in this model of secondary preventative care. 4 Preventative rehabilitative care is known as prehabilitation. 5 This term traditionally refers to preventative pre- surgical care and less frequently focuses on prevention and amelioration of disability among Veterans with chronic disease. However, there is a tremendous unmet need to develop prehabilitative care treatments that maximize the functional capacity of aging veterans and thereby extend quality of life as well as prevent disability and excessive health care utilization. The Prehabilitation Center (PreHC) REAP will prioritize the development of Prehabilitative Care strategies optimizing functioning among Veterans at risk for functional decline and disability. Through the leadership of three organizational cores and the combination of qualifying studies and pilot studies, the PreHC will develop a single data repository supporting three programmatic research aims: 1) It will test the efficacy of novel therapeutic approaches on three important prehabilitative outcomes (i.e., 3M’s): cognitive function (Mind); physical function (Mobility) and successful behavioral change (Motivation); 2) It will identify biologic subtypes and phenotypes that mediate treatment response; 3) It will confirm and validate these relationships using the large data resource derived from our collective studies and through linkage with data from VA national databases. Our center will advance VA clinical research and prehabilitative care by providing core resources and training for investigators of all levels. Under the leadership of the Project Director (Dr. Bean), three operational cores will be created: 1) a Leadership, Capacity and Advancement Core that will include the administrative leadership of the REAP and oversee all training and education activities sponsored by PreHC, including administration of the pilot grant program for trainees and junior faculty; 2) a Scientific Discovery Core that will provide state of the art assessment of neurocognitive function (mind), physical function (mobility) and measures of behavior change (motivation); and 3) a Data Management Core supporting the collection, monitoring, management and transfer of complex data, the development of single data repository resulting from the qualifying and pilot studies and biostatistical support assisting with study design and analysis. An internal steering committee will help oversee day to day operations and programmatic success and an external advisory board of content experts will help guide the achievement of the short- and long-term goals. We will use this resulting information to develop more personalized Prehabilitative treatment approaches that will be tested for better meeting the personalized needs of Veterans. Additionally, the resulting data repository will be an available resource for VA-based RR&D researchers that will develop and grow with advancement of PreHC. In sum, over the next five years, the PreHC will evolve into a national resource center that will conduct cutting-edge research in prehabilitative care. The knowledge gained from this research will fill gaps in our current therapeutics to advance and maintain the long-term health of aging Veterans.

为了优化退伍军人的功能和独立性，建立主动治疗至关重要 改善和预防残疾以及导致的生活质量丧失和相关的高成本医疗保健 随着慢性疾病的进展。 1理想情况下，这些预防性治疗应设计为目标 退伍军人处于最大的风险，并对他们的需求进行个性化。这对于VA至关重要 退伍军人是64岁，退伍军人比其年龄更大的障碍和功能局限 匹配的平民同行。 2,3个个性化方面包括关注与与与之相关的障碍的关注 身体但认知功能；并承认预防性护理的关键步骤包括关注 患者的行为改变。 1促进长期成功的治疗通常强调这些 方法。康复护理可以在这种二级预防保健模式中发挥领导作用。 4 预防性康复护理被称为预居住。 5这个术语传统上是指预防性 手术护理，不太频繁地专注于预防和改善残疾人的残疾 慢性病。但是，有巨大的未满足需要开发预先居住的护理疗法 最大化老年退伍军人的功能能力，从而扩大生活质量并防止 残疾和过多的医疗保健利用。居民中心（PREHC）将优先考虑 制定居留权护理策略，优化具有职能风险的退伍军人的功能 衰落和残疾。通过三个组织核心的领导和合格的结合 研究和试点研究，PREHC将开发一个单个数据存储库，支持三个程序化 研究目的：1）它将测试新的治疗方法对三种重要的预居住的有效性 结果（即3M）：认知功能（心理）；身体功能（移动性）和成功的行为改变 （动机）; 2）它将确定介导治疗反应的生物学亚型和表型； 3）会 使用从我们的集体研究中得出的大量数据资源确认并验证这些关系 通过与VA国家数据库的数据链接。我们的中心将推进VA临床研究和 通过为各个级别的调查人员提供核心资源和培训，预先护理。在领导下 在项目总监（Bean博士）中，将创建三个操作核心：1）领导力，能力和 进步核心将包括收获的行政领导和监督所有培训和 PREHC赞助的教育活动，包括管理培训的试点赠款计划和 初级教师； 2）科学发现核心将提供神经认知的最先进的评估 功能（思维），身体功能（移动性）和行为改变的度量（动机）； 3）数据 管理核心支持集合，监视，管理和传输复杂数据， 由合格和试点研究以及生物统计支持产生的单个数据存储库的开发 协助研究设计和分析。内部指导委员会将帮助日常监督 运营和程序化成功以及内容专家的外部顾问委员会将有助于指导 实现短期和长期目标。我们将使用这些结果信息来开发更多 个性化的居留治疗方法，将测试以更好地满足个性化需求 退伍军人。此外，最终的数据存储库将是基于VA的RR＆D的可用资源 随着PREHC的发展将发展和成长的研究人员。总而言之，在接下来的五年中 PREHC将发展成为一个国家资源中心，该中心将在居民护理领域进行尖端研究。 这项研究所获得的知识将填补我们当前的治疗剂的空白，以提高和维护 老化退伍军人的长期健康。