The Live Long Walk Strong rehabilitation program: What features improve mobility skills?

Live Long Walk Strong 康复计划：哪些功能可提高行动能力？

• 批准号: 10259727
• 负责人: JONATHAN F BEAN
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259727
• 关键词: Accounting; Address; Advocate; Aftercare; Age; Ambulatory Care Facilities; Boston; Caring; Cessation of life; Clinical; Clinical Trials; Communities; Disease; Elderly; Exercise; Funding; Future; Gait; Gender; Goals; Health; Health Care Costs; Healthcare Systems; High Prevalence; Hospitalization; Impaired cognition; Impairment; Lead; Leg; Link; Mediating; Modeling; Muscle; Outcome; Outpatients; Pain; Patient Care; Patients; Performance; Phase; Physical activity; Physical therapy; Prevalence; Preventive care; Primary Health Care; Randomized; Randomized Controlled Clinical Trials; Readiness; Recording of previous events; Rehabilitation therapy; Research; Risk; Self Efficacy; Speed; United States National Institutes of Health; Veterans; Waiting Lists; Walking; Work; aged; base; cohort; comorbidity; design; disability; efficacious treatment; falls; functional independence; health care settings; improved; improved mobility; innovation; middle age; new therapeutic target; novel therapeutics; physical model; primary outcome; programs; recruit; rehabilitation science; rehabilitative care; secondary outcome; skills; standard care; therapeutic target; treatment as usual; treatment duration; treatment effect; walking speed

Slow walking speed is highly prevalent among Veterans beginning in midlife. It is a major predictor of functional independence, independent of disease status and a predictor for subsequent hospitalization, disability and death. While rehabilitative care is the standard treatment for those with slow gait speed, the optimal mode of treatment is not yet identified. We have strong clinical support that a new model of physical therapy care known as Live Long Walk Strong (LLWS) may be an efficacious treatment for those screened with slow gait speed. LLWS is highly innovative, as it prioritizes unconventional treatment targets not typically addressed in standard care, including impairments in: 1) leg power; 2) trunk muscle endurance; 3) gait coordination (smoothness of walking); and 4) self-efficacy to engage in exercise. Through prior research, we identified that each of these four therapeutic targets are linked to mobility decline when impaired and that improvements in each alone can lead to mobility gains that surpasses standard care. No treatment targeting these attributes collectively is established, though LLWS is conceptually designed to do so. [Thus, we propose a phase II randomized controlled clinical trial (RCT) among Veterans 50 years and older to identify if LLWS care enhances these attributes and if by augmenting each, sustained improvements in gait speed result.] In a civilian-based clinical demonstration project, clinical proof of concept of LLWS was observed. LLWS targeted community-dwelling older adults. At the completion of LLWS care, we observed large improvements in mobility performance that exceeded clinically meaningful differences. These differences were observed even after accounting for health factors that may mitigate rehabilitative gains. [LLWS has great significance for the VA, because slow gait speed is prevalent in middle aged Veterans and improvements of the magnitude we observed are predictive lower health care costs and disability. However, while LLWS was clinically conceived to improve gait speed by enhancing each of these attributes, it is critical to know if two basic suppositions are true: 1) Are each of these four attributes improved by LLWS? and 2) Do these improvements induce immediate and sustained changes in gait speed among veterans beginning in midlife? Therefore, this study will establish efficacy and proof of concept of LLWS among Veterans beginning in midlife; an age-range largely ignored in prior clinical trials targeting gait speed.] LLWS has tremendous relevance for the VA. [For example, in our preliminary work among 174 Veteran primary care patients aged 50-98, >50% manifested a gait speed < 1.0 m/s, a speed indicating a heightened risk for adverse health outcomes.] Given Veteran’s higher levels of impairment compared to aged matched civilians, care should be as parsimonious and efficacious as possible. Thus, the major goal of this proposal is to establish LLWS as a non-invasive, new therapy targeting slow gait speed across a variety of VHA settings. In the proposed phase II RCT, we will recruit [198 community-dwelling, Veterans 50 years and older] from the outpatient clinics of the VA Boston Healthcare system that manifest slow gait speed (< 1.0 m/s) and randomize them to either 8 weeks of LLWS or 8 weeks of usual care for those with slow gait speed after which LLWS will be initiated for 8 weeks. Both groups will be followed for outcomes 16 weeks after LLWS treatment ends. [The primary outcome for all 3 aims will be change in usual gait speed. Secondary outcomes will include changes in the targeted attributes after 8 weeks of treatment.] We will address these aims: [Aim 1: To conduct a phase II RCT of LLWS in comparison to controls and evaluate its efficacy among community dwelling Veterans 50 years and older. Aim 2: Evaluate the attributes that lead to improved gait speed after 8 weeks of LLWS treatment. Aim 3: Identify the attributes that are associated with sustained gait speed gains 16 weeks after LLWS ends.]

从中年开始的退伍军人中，步行速度缓慢非常普遍。它是 功能独立性，独立于疾病状况和随后住院的预测因子， 残疾和死亡。虽然康复护理是那些速度缓慢的人的标准治疗方法，但 尚未确定最佳治疗方式。我们有强烈的临床支持，这是一种新的物理模型 治疗护理称为Live Long Walk Strong（LLW）可能是筛选者的有效治疗方法 速度缓慢。 LLWS具有很高的创新性，因为它优先考虑非常规治疗目标 在标准护理中解决，包括：1）腿部功率； 2）躯干肌肉耐力； 3）步态 协调（步行的平滑度）； 4）进行运动的自我效能。通过先前的研究，我们 确定这四个治疗目标中的每一个都与障碍时的出行下降有关，并且 单独的改进会导致出现标准护理的流动性增长。没有治疗靶向 尽管LLW在概念上是为此而设计的，但这些属性是共同建立的。 [因此，我们提出了建议 在50岁以上的退伍军人中，II期随机对照临床试验（RCT），以识别LLWS是否存在 护理可以增强这些属性，如果通过增强每个属性，获得速度结果的持续改进。] 在一个基于平民的临床演示项目中，观察到了LLW概念的临床证明。 LLW针对社区居住的老年人。 LLWS护理完成时，我们观察到很大 超出临床意义的差异的移动性能的改善。这些差异是 即使考虑到可能减轻康复益处的健康因素，也观察到。 [LLWS很棒 VA的重要性，因为在中年退伍军人中慢速获得速度是普遍的 我们观察到的幅度是预测性较低的医疗保健成本和残疾。但是，虽然LLW是 通过增强这些属性中的每一个，在临床上构想以提高增长速度，至关重要的是要知道两个 基本假设是正确的：1）LLWS这四个属性中的每个属性中的每个属性中的每个属性是否有改善？ 2）做这些 改进会导致从中年开始的退伍军人的立即和持续变化？ 因此，这项研究将在中年开始的退伍军人中建立有效性和LLW概念证明。 在针对AIT速度的先前临床试验中，年龄段很大程度上被忽略。] LLWS与VA具有巨大的意义。 [例如，在我们的174名老兵的初步工作中 50-98岁的初级保健患者表现出战斗速度<1.0 m/s，速度表明增长 与老年比赛相比，鉴于退伍军人更高的损害水平 平民，应尽可能地养育和高效。那是该提议的主要目标是 为了将LLW确定为一种非侵入性的新疗法，针对各种VHA设置的速度较慢。 在拟议的第二阶段RCT中，我们将招募[198个社区居民，50岁以上的退伍军人] 从VA波士顿医疗系统的门诊诊所，表现出缓慢的速度（<1.0 m/s）和 将它们随机为8周的LLW或为速度缓慢的人进行8周的通常护理 LLW将启动8周。 LLWS治疗后16周，将遵循两组的结果 结束。 [所有3个目标的主要结果将是通常的速度变化。次要结果将包括 治疗8周后，靶向属性的变化。] 我们将解决这些目标： [目标1：与对照相比，进行LLW的II期RCT并评估其在 社区住宅老兵50岁以上。 AIM 2：评估8周LLWS治疗后导致收集速度提高的属性。 目标3：确定LLW结束后16周后与持续收集速度增长相关的属性。]