权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Defining Components of Physical Therapy Achieving Maximum Function after TKR

定义 TKR 后实现最大功能的物理治疗的组成部分

基本信息

批准号：
9912569
负责人：
PATRICIA D FRANKLIN
金额：
$ 22.47万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-02-01 至 2021-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912569
关键词：
Adult Age Aging American Physical Therapy Association Caring Clinic Clinical Clinical Trials Cohort Studies Comorbidity Consensus Data Dose Effectiveness Elderly Enrollment Exercise Future Geographic Locations Home environment Hospitals Implant Incentives Inpatients Intervention Knee Knowledge Location Measures Medical Medicare Modality Monitor Municipalities National Institute of Arthritis and Musculoskeletal and Skin Diseases Online Systems Operative Surgical Procedures Outcome Outcome Measure Outpatients Patient Participation Patient risk Patient-Focused Outcomes Patients Performance Perioperative Care Physical activity Physical therapy Physical therapy exercises Play Policy Maker Practice based research Procedures Process Protocols documentation Provider Public Health Recovery of Function Registries Rehabilitation therapy Reporting Research Resource Informatics Retrospective Studies Risk Risk Factors Role Sampling Services Site Statistical Models Supervision Surgeon System Testing Therapeutic Intervention Time Translating United States Agency for Healthcare Research and Quality United States National Institutes of Health Variant Visit Walking Work adverse outcome base bundled payment cohort compliance behavior cost design dosage electronic data capture system exercise intensity exercise program experience financial incentive follow-up functional gain functional outcomes improved informatics infrastructure knee pain knee replacement arthroplasty outcome prediction patient subsets physical therapist predictive modeling programs prospective randomized trial recruit societal costs sociodemographics strength training support tools tool web-based tool

项目摘要

ABSTRACT Functional outcomes vary following total knee replacement (TKR), the most common and costly inpatient procedure. Although post-surgical physical therapy (PT) is routinely prescribed in perioperative care, the actual PT content delivered to patients varies widely, and no consensus exists for the type, amount or intensity of PT following TKR. In 2016, Medicare will implement mandatory bundled payment for TKR in 67 municipalities across the U.S. making the surgeon and hospital responsible for all post-TKR costs, including physical therapy. These financial incentives may alter post-TKR physical therapy services without a clear understanding of the specific PT components that improve patient outcomes. Our recent retrospective study of PT care from 50 therapy sites in one geographic region documented a significant association between exercise type and progression and greater functional outcomes. Clinical trials demonstrate that muscle strengthening and functional exercises improve functional outcomes following TKR but the generalizability of these studies is limited. In contrast, practice-based research allows analysis of the variability of PT practice in a large patient sample and assessment of the association between PT care, patient participation, and functional outcomes. We propose a PT cohort study of TKR patients embedded within a national TKR cohort (FORCE-TJR) to collect specific details of all post-TKR physical therapy care from 360 patients treated by approximately 60 PTs in three geographical areas. Baseline patient attributes and outcome measures are routinely collected in the FORCE data. These data will be expanded to include the ambulatory PT intervention details as well as the patients’ participation in home exercise and physical activity. A web-based data capture system for use by physical therapists and patients will collect details of amount, type and intensity of physical therapy exercise and amount of patient participation in the rehabilitation process. The study aims are to: (1) Quantify the variation in outpatient PT components and progression in intensity, and the patient’s in home participation in prescribed rehabilitation activities following TKR in a multi-center prospective sample; (2) Identify PT components associated with optimal patient-reported functional outcomes at 6 and 12 months and knee performance measures at 6 months after TKR; and (3) Design and deploy a web-based decision support tool to predict functional outcome after TKR based on these analyses, to include patient pre-operative factors, levels of patient participation, and PT components to reinforce best practice PT and patient in-home participation. We hypothesize that a set of potentially modifiable PT practice components, such as a higher number of closed chain exercises and progressions in exercise intensity, will be positively associated with better gain in functional and performance outcomes after adjusting for patient sociodemographic and comorbidity factors and that patient adherence to daily at-home participation in physical activity will modify the effects of the PT components on knee performance and function at 6 months. Statistical modeling will examine the role PT timing, content and intensity and patient demographic and clinical factors including rehabilitation participation play in explaining the variations in functional outcomes following TKR. Predictive models of long term functional outcomes based on both PT and patient factors will identify modifiable factors of the PT intervention that contribute to optimal functional outcomes. The data and knowledge generated by this study will inform the design and content of a prospective randomized trial of best practice PT after TKR among patients at risk for poor functional gain. Moreover, the knowledge is timely and essential as policy makers and clinicians work to control the rising societal cost of total knee replacement surgery, while assuring optimal patient outcomes.

抽象的全膝关节置换术（TKR）是最常见且费用最高的住院患者，其功能结果会有所不同程序。尽管术后物理治疗 (PT) 是围手术期护理中的常规规定，但实际情况为患者提供的 PT 内容差异很大，并且对于 PT 的类型、数量或强度尚无共识遵循 TKR。 2016年，Medicare将在67个城市实行TKR强制捆绑支付在美国各地，外科医生和医院负责所有 TKR 后的费用，包括物理治疗。这些经济激励措施可能会改变 TKR 后物理治疗服务，而无需清楚了解改善患者治疗效果的特定 PT 组成部分。我们最近对 50 名 PT 护理人员进行的回顾性研究一个地理区域的治疗地点记录了运动类型和运动强度之间的显着关联。进步和更好的功能结果。临床试验表明，增强肌肉和功能锻炼可以改善 TKR 后的功能结果，但这些研究的普遍性是有限的。相比之下，基于实践的研究可以分析大型患者 PT 实践的变异性 PT 护理、患者参与和功能结果之间关联的样本和评估。我们建议对纳入国家 TKR 队列 (FORCE-TJR) 的 TKR 患者进行 PT 队列研究，以收集大约 60 名 PT 治疗的 360 名患者的所有 TKR 后物理治疗护理的具体细节在三个地理区域。基线患者属性和结果测量通常收集在强制数据。这些数据将扩大到包括门诊 PT 干预细节以及患者参与家庭锻炼和身体活动。一个基于网络的数据采集系统，供以下人员使用物理治疗师和患者将收集物理治疗练习的数量、类型和强度的详细信息以及患者参与康复过程的数量。研究目的是： (1) 量化门诊 PT 组成部分和强度进展的变化，以及患者在家中参与的情况在多中心前瞻性样本中规定 TKR 后的康复活动； (2) 识别PT 与 6 个月和 12 个月时患者报告的最佳功能结果以及膝关节相关的组成部分 TKR 后 6 个月的绩效评估； (3) 设计和部署基于网络的决策支持工具根据这些分析预测 TKR 后的功能结果，包括患者术前因素，患者参与水平和 PT 组成部分，以加强 PT 和患者在家的最佳实践参与。我们假设一组潜在可修改的 PT 实践组件，例如更高的闭链练习的数量和运动强度的进展将与根据患者的社会人口特征和情况进行调整后，功能和表现结果将获得更好的提高合并症因素以及患者坚持每天在家参加体育活动将改变 PT 成分对 6 个月时膝关节表现和功能的影响。统计模型将检查 PT 时间、内容和强度以及患者人口统计和临床因素（包括康复）的作用参与在解释 TKR 后功能结果的变化方面发挥作用。长期预测模型基于 PT 和患者因素的术语功能结果将确定 PT 的可修改因素有助于实现最佳功能结果的干预。本研究产生的数据和知识将为前瞻性研究的设计和内容提供信息对有功能增益不良风险的患者进行 TKR 后最佳实践 PT 的随机试验。此外，随着政策制定者和临床医生努力控制不断上升的社会总成本，知识是及时且必要的。膝关节置换手术，同时确保最佳的患者治疗效果。