Efficacy of a Post-Rehabilitation Exercise Intervention

描述（由申请人提供）：该项目的总体目标是确定在康复结束后，许多髋部骨折患者仍然存在的重要功能问题是否可以通过一个简单，易于传播的程序来减少或消除。本研究的具体目的是证明，在正式的髋部骨折康复结束后，通过使用一种实用的、以家庭为基础的锻炼计划，即坚强生活（SFL），是否可以实现功能改善。SFL干预将认知训练和行为强化与运动训练相结合，以达到高水平的依从性。与NIA和NCMMR任务的相关性：该项目通过研究一种创新的、多学科的方法来提高残疾老年人的独立性、福祉和生活质量，从而解决了这些机构的任务。在先前针对功能受限老年人的随机临床试验中，SFL参与者达到了高水平的依从性，并且在与治疗师接触最少的情况下改善了力量、活动能力和减少了残疾。这项拟议的研究将扩展先前的工作，通过在成年人样本中证明该计划的安全性和有效性，这些成年人在髋部骨折后接受了正式的康复服务，并且在正常康复过程结束时表现出身体功能的限制。参与者将被随机分为两组，一组接受为期6个月的SFL计划，另一组接受注意力控制干预（营养咨询）。SFL参与者将接受运动和认知训练，并由物理治疗师进行后续行为强化。盲法结果评估人员将在6个月和9个月的随访中使用身体表现测试和自我报告来评估该计划对身体功能和残疾的影响。所有的分析都将按意向进行处理。与公共卫生的相关性：髋部骨折康复结束后，许多人仍然有行走和日常活动的问题。这项研究将会发现一个锻炼计划，人们可以在他们的康复结束后在自己的家里做，包括特殊的技术，以增加人们的动机和信心，帮助他们更独立。这个低成本的项目可以被许多髋部骨折后的人使用，并且可能有助于减少需要搬到养老院或需要长期家庭帮助的人的数量。

DESCRIPTION (provided by applicant): The overall objective of this project is to determine if the significant functional problems that remain for many hip fracture patients after rehabilitation ends can be reduced or eliminated by a simple, easily disseminated program. The specific aim of this study is to demonstrate if functional improvement can be achieved after formal hip fracture rehabilitation ends through the use of a practical, home-based exercise program, called Strong for Life (SFL). The SFL intervention incorporates cognitive training and behavioral reinforcements with exercise training to achieve high levels of adherence. Relevance to the missions of NIA and NCMMR: This project addresses the missions of these agencies by investigating an innovative, multidisciplinary approach to enhance the independence, well-being and quality of life of older adults with a disability. In previous randomized clinical trials with older adults with functional limitations, the SFL participants have achieved a high level of adherence, and improved strength, mobility and reduced disability with minima contact from a therapist. This proposed study will extend previous work by demonstrating this program's safety and effectiveness in a sample of adults who have received formal rehabilitation services following hip fracture and who display limitations in their physical function at the end of their normal course of rehabilitation. Participants will be randomized either to receive the SFL program for 6 months, or an attention control intervention (nutrition counseling). SFL participants will receive exercise and cognitive training and follow-up behavioral reinforcements from a physical therapist. Blinded outcome assessors will evaluate the program's impact on physical function and disability using physical performance tests and self- report measures at 6- and 9-month follow-up. All analyses will be by intention to treat. Relevance to public health: After rehabilitation for a hip fracture ends, many people continue to have problems walking and doing their daily activities. This study will find out whether an exercise program that people can do in their own home after their rehabilitation ends which includes special techniques to increase people's motivation and confidence helps them to be more independent. This low-cost program could be used by many people after hip fracture, and could potentially help to reduce the number of people who need to move to a nursing home or need long term home help.