Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities

项目概要/摘要 在美国，8.37 65岁以上的成年人将在未来一年内经历住院， 具有严重和持久的后果，包括身体功能的严重恶化。后 住院期间，约有135万名失调患者需要在专业护理机构进行康复 (SNF)以解决因失调而造成的有害肌肉骨骼和功能缺陷。 不幸的是，目前SNF的康复范例不能充分恢复身体功能， 直接导致社区排放率低下。引人注目的是，只有52%的患者入住SNF 被排放到社区环境（例如，家），这表明需要进行范式转变，以优化 在SNF中恢复。目前，SNF中的常规护理康复包括低强度康复 生理上不足以引起骨骼肌强度发生有意义变化的干预措施 和身体功能。为了解决这些问题，一个高强度的阻力康复范例已经被 显示改善结果，包括更好的身体功能，增加社区出院率， 降低住院时间的成本效益。拟议的务实研究旨在应用这种康复 多个SNF的范例，以进一步评估高强度阻力康复的有效性（目的 1），同时评估成功实施的过程、机制和决定因素（目标2）。我们 提出了一个集群随机化的实用试验设计，其中高强度干预（15 SNF）将 与常规护理相比（15个SNF）。身体功能方面的有效性将通过变更来确定 患者从入院到出院的步态速度（主要结果）。实施战略将是 通过达到（接受干预治疗的患者比例）、采用（治疗师比例）进行评估 适当地采取干预措施）、实施（忠诚度评估）和维护（长期 （二）干预的真实性。这项研究将提供第一个大规模的评估高- 住院后接受SNF治疗的患者的强度康复。此外，通过系统 通过对各种SNF实施情况的比较和深入分析，本研究将提供关键的 深入了解执行的障碍和促进因素。这项研究的总体结果有可能 1）转变SNF康复护理模式; 2）优化患者结局和独立性; 3）关键 为未来工作提供信息，以便在急性期后大规模实施高强度康复 设置.

Project Summary/Abstract In the U.S., 8.37 million adults over age 65 will experience a hospital stay during the next year, which often has serious and long-lasting consequences including profound deterioration in physical function. Following a hospital stay, around 1.35 million patients with deconditioning require rehabilitation in a skilled nursing facility (SNF) each year to address the deleterious musculoskeletal and functional deficits from deconditioning. Unfortunately, current rehabilitation paradigms in SNFs do not adequately restore physical function, which directly contributes to poor community discharge rates. Strikingly, only 52% of all patients admitted to SNFs are discharged to a community setting (e.g., home), which suggests a paradigm shift is required to optimize rehabilitation within SNFs. Currently, usual care rehabilitation in SNFs consists of low-intensity rehabilitation interventions, which are physiologically inadequate to induce meaningful changes in skeletal muscle strength and physical function. To address these pitfalls, a high-intensity resistance rehabilitation paradigm has been shown to improve outcomes including better physical function, increased community discharge rates, and cost-effective reductions in length of stay. The proposed pragmatic study seeks to apply this rehabilitation paradigm to multiple SNFs to further evaluate the effectiveness of high-intensity resistance rehabilitation (Aim 1), while evaluating processes, mechanisms, and determinants of successful implementation (Aim 2). We propose a cluster randomized pragmatic trial design in which a high-intensity intervention (15 SNFs) will be compared to usual care (15 SNFs). Effectiveness in terms of physical function will be determined via change in patient gait speed (primary outcome) from admission to discharge. Implementation strategies will be evaluated by reach (proportion of patients treated with the intervention), adoption (proportion of therapists appropriately adopting the intervention), implementation (fidelity assessments), and maintenance (long-term fidelity assessments) of the intervention. This study will provide the first large-scale evaluation of high- intensity rehabilitation for patients admitted to SNFs following hospitalization. Additionally, through systematic comparison and in-depth analysis of implementation across a variety of SNFs, this study will provide critical insight regarding barriers and facilitators of implementation. Overall findings from this study have the potential to 1) shift SNF rehabilitation care paradigms; 2) optimize patient outcomes and independence and 3) critically inform future work aimed at wide-scale implementation of high-intensity rehabilitation across post-acute settings.