Self-management to improve function following amputation

自我管理以改善截肢后的功能

• 批准号: 9108888
• 负责人: JOSEPH M CZERNIECKI
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9108888
• 关键词: Adopted; Affect; Amputation; Amputees; Awareness; Behavior Therapy; Caring; Chronic; Chronic Disease; Communities; Diabetes Mellitus; Disease; Ensure; Evaluation; Foundations; Future; Health; Healthcare; Healthcare Systems; Individual; Intervention; Life; Life Style; Limb structure; Lower Extremity; Measures; Mental Depression; Modeling; Morbidity - disease rate; Musculoskeletal; Outcome; Outcome Assessment; Participant; Patient-Focused Outcomes; Patients; Perception; Peripheral Vascular Diseases; Physical Function; Prevalence; Problem Solving; Process; Provider; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recruitment Activity; Role; Self Efficacy; Self Management; Support Groups; Time; United States Department of Veterans Affairs; Veterans; base; care burden; care systems; cohort; cost; disability; follow-up; health care service utilization; improved; improved functioning; loss of function; member; mortality; post intervention; primary outcome; programs; prospective; psychosocial; secondary outcome; skills; symptom management; symptom treatment; treatment as usual

DESCRIPTION (provided by applicant): Lower extremity amputations in the Veterans Administration Health Care System (VA) are a significant cause of morbidity, mortality, loss of function and reduced quality of life. The health care burden of limb loss is projected to rise over time as the increasing prevalence of diabetes and dysvascular disease result in a greater numbers of amputations. Consequently, the care of Veterans with amputation results in significant health care utilization and costs, and optimization of the VA Amputation System of Care remains an important priority. Adaptation to limb loss is a long-term process. There is increasing awareness that models of chronic illness care that facilitate an ongoing partnership between providers and patients offer an important framework to guide improvements in health and reductions in disability over time. One key ingredient of this partnership is self-management, the process by which an individual adopts an active role in managing the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition. The overall objective of this study is to evaluate the efficacy of a 6-week group-based self- management intervention for Veterans with lower extremity limb loss (VETPALS). VETPALS is an adaptation of an empirically-supported self-management program (Promoting Amputee Life Skills: "PALS") developed by members of the current study team. The PALS program has been shown to improve physical and psychosocial functioning when delivered in existing community- based support groups for amputees. However, the efficacy of this program, when adapted for the needs of Veterans and when delivered within the VA healthcare system, remains to be established. The first aim of this study is to determine the impact of VETPALS upon the physical and psychosocial functioning of Veterans within the first 6 months of lower extremity limb loss. The second aim is to determine the impact upon the outcomes of patient activation, self-efficacy, problem solving, quality of life and positive affect. The third aim examines factors that impact treatment fidelity and implementation. Sequential cohorts of 8 participants will be randomized to receive the intervention or enhanced usual care. A total of 408 participants will be recruited. Outcome assessment for both groups will be conducted at baseline, post-intervention, and at 6 month follow-up. The VA Amputation System of Care has already committed support to the future implementation of a self-management program for individuals with limb loss. However, this study is a necessary preliminary component of this roll-out effort and is expected to provide the specific empirical foundation for ensuring this program is effective and that it can be disseminated and implemented within VA in a way that provides maximal benefit and access to Veterans with limb loss.

描述(由申请人提供)： 在退伍军人管理局医疗保健系统(VA)中，截肢是导致发病率、死亡率、功能丧失和生活质量下降的重要原因。健康 随着糖尿病和血管疾病患病率的增加导致更多的截肢，肢体丧失的护理负担预计会随着时间的推移而增加。因此，对截肢退伍军人的护理产生了显著的卫生保健利用率和成本，并使之最优化 实施退伍军人管理局截肢护理系统仍然是一个重要的优先事项。对肢体丧失的适应是一个长期的过程。人们越来越认识到，促进提供者和患者之间持续伙伴关系的慢性病护理模式提供了一个重要的框架，以指导随着时间的推移改善健康和减少残疾。这种伙伴关系的一个关键因素是自我管理，即个人在管理慢性病患者固有的症状、治疗、身体和心理社会后果以及生活方式变化方面发挥积极作用的过程。这项研究的总体目标是评估为期6周的基于团体的自我管理干预对患有肢体丧失的退伍军人的疗效。VETPALS是对目前研究团队成员开发的经验支持的自我管理计划(促进截肢者生活技能：PALS)的改编。PALS计划已被证明在现有的基于社区的截肢者支持小组中提供时，可以改善身体和心理社会功能。然而，当这项计划适应退伍军人的需要并在退伍军人医疗保健系统内实施时，其效力仍有待确定。这项研究的第一个目的是确定VETPALS对退伍军人在失去肢体的前6个月内的身体和心理社会功能的影响。第二个目标是确定患者活跃度、自我效能、问题解决、生活质量对结果的影响。 和积极的影响。第三个目标是审查影响治疗保真度和实施的因素。8名参与者的顺序队列将被随机分配到接受干预或强化常规护理。将招募408名参与者。两组的结果评估将在基线、干预后和6个月随访时进行。退伍军人管理局截肢护理系统已经承诺支持未来为肢体丧失患者实施自我管理计划。然而，这项研究是这一推广工作的必要的初步组成部分，预计将提供具体的经验基础，以确保这一计划是有效的，并确保它可以在退伍军人管理局内传播和实施，从而为肢体丧失的退伍军人提供最大的好处和机会。