Progressing Home Health Rehabilitation Paradigms for Older Adults

 描述（由申请人提供）：急性疾病导致的身体功能下降与老年人的许多不良健康事件密切相关。家庭健康（HH）物理治疗可能是解决这些身体功能下降的理想场所，因为大约有300万老年人在从急性或急性后设施出院后获得HH服务。然而，按照目前的结构，这些服务似乎不能充分恢复功能，长期结果不佳和再入院率高就是证明。身体功能下降是再次住院的一个危险因素， 的患者再次住院的可能性是那些具有更大的走动活动的患者的6倍。对老年人进行更密集的HH物理治疗具有极大的潜力，可以最大限度地提高身体功能并减少再次入院。因此，我们开发了一种高强度的、以家庭为基础的、渐进式的、跨学科的、多组分（PMC）干预措施，直接解决住院后出现的功能缺陷。我们提出 对200名从急性或急性后机构入住HH的老年人进行一项双臂随机临床试验（RCT）。受试者将接受1）使用阻力运动和循证运动控制训练的强化PMC干预，以改善身体功能或2）常规护理（UC）物理治疗。本研究的主要目的是确定在进入HH后开始的PMC干预是否比UC物理治疗更能改善身体功能（通过表现和自我报告评估进行测量）。还将检查PMC干预对再住院率、疗养院安置、急诊室就诊和急性护理医院出院后福尔斯跌倒的影响。从急性或急性后设施入住HH后的前60天内，将在家中进行治疗，并在以下时间点进行检测：基线（HH入住时）、30天、60天（主要终点）、90天和180天。如果成功改善患者功能和降低再住院率，PMC干预具有未来医疗保健成本节约的潜力。

 DESCRIPTION (provided by applicant): Declines in physical function as a result of acute illness are strongly and independently associated with a number of adverse health events for older adults. Home Health (HH) physical therapy may be the ideal venue for addressing these declines in physical function because around 3 million older adults receive access to HH services following discharge from acute or post-acute facilities. However, as currently structured, these services do not appear to adequately restore function, as evidenced by poor long-term outcomes and high rates of hospital readmission. Diminished physical function has been particularly implicated as a risk factor for re-hospitalization-older adults with lower levels of ambulatory activity are 6 times more likely to be re-hospitalized than those with greater ambulatory activity. A more intensive approach to HH physical therapy for older adults has great potential to maximize physical function and reduce hospital readmissions. Therefore, we have developed a high intensity home-based, progressive, interdisciplinary, multi-component (PMC) intervention that directly addresses the functional deficits seen after hospitalization. We propose to conduct a two-arm, randomized clinical trial (RCT) of 200 older adults admitted to HH from an acute or post-acute facility. Participants will receive either 1) an intensive, PMC intervention using resistance exercise and evidenced-based motor control training to improve physical function or 2) usual care (UC) physical therapy. The primary goal of this investigation is to determine if PMC intervention, initiated upon admission to HH, improves physical function, as measured by performance and self-report assessments, more than UC physical therapy. The effects of the PMC intervention on re-hospitalization rates, nursing home placement, emergency room visits, and falls after discharge from the acute care hospital will also be examined. Treatment will occur at home during the first 60 days following admission to HH from acute or post-acute facility with testing at: baseline (upon HH admission), 30 days, 60 days (primary endpoint), 90 days, and 180 days. If successful in improving patient function and decreasing re-hospitalization rates, PMC intervention holds potential for future health care cost savings.