Towards Precision Rehabilitation for Ventral Hernia

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PROJECT SUMMARY Hernia repairs are one of the most common surgeries performed in the United States, with over 350,000 ventral hernia repairs (VHR) performed yearly. Beyond the high health care system expenditure on VHR, patients report poor quality of life, post-operative pain, and time loss at work. Management traditionally includes surgical restoration of the abdominal wall, and short-term physician follow-up to ensure surgical site healing. Even once surgery has restored the abdominal wall, individuals post-operatively demonstrate major impairments of the musculoskeletal system including poor strength and function which contributes to reduced activities of daily living and a lower self-reported quality of life. Participation in physical therapy (PT) post- operatively may directly address and improve overall strength, function, and post-operative pain, in turn improving self-reported quality of life. There is a need to characterize recovery of function after VHR, specifically with the addition of objective measures of function to standard of care. Notably, we do not know the modifiable clinical characteristics of patients who will benefit the most from undergoing standardized post- operative PT. As a step towards this, we must understand the patient- and surgery-specific factors linked to a likelihood of a successful outcome following VHR. This mentored training plan will use data from a CMS Qualified Clinical Data Registry and an NIH/NIDDK funded registry-based clinical trial to understand the complex relationships between patient- and surgical-characteristics as they relate to post-operative function. Findings from this fellowship will provide (1) robust predictive models to understand characteristics of patients who have a good or poor self-reported quality of life 1 year after ventral hernia repair and (2) foundational evidence in understanding treatment response to physical therapy using objective measures of function. This fellowship proposes a paradigm shift of the current approach to hernia disease by considering objective and patient-reported measures of function of as a primary post-operative outcome. Meeting the objectives of this fellowship will afford the applicant the knowledge and skills required of an independent investigator and provide requisite preparation for a faculty position at a research-intensive university.