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.]

在中年开始的退伍军人中，步行速度缓慢的现象非常普遍。它是一个主要预测因素 功能独立性，独立于疾病状态和随后住院的预测因素， 残疾和死亡。虽然康复护理是步态缓慢者的标准治疗方法， 最佳治疗方式尚未确定。我们有强有力的临床支持，新的物理模型 被称为“Live Long Walk Strong (LLWS)”的治疗护理可能是对那些接受筛查的人的有效治疗方法 步态速度缓慢。 LLWS 具有高度创新性，因为它优先考虑通常不常见的非常规治疗目标 标准护理中解决的问题，包括以下方面的损伤：1) 腿部力量； 2）躯干肌肉耐力； 3）步态 协调性（行走的平稳性）； 4）锻炼的自我效能感。通过之前的研究，我们 确定这四个治疗目标中的每一个都与受损时的活动能力下降有关，并且 每一项的改进都可以带来超越标准护理的行动能力提升。无治疗目标 尽管 LLWS 在概念上就是为了这样做而设计的，但这些属性是共同建立的。 [因此，我们建议 在 50 岁及以上退伍军人中进行的一项 II 期随机对照临床试验 (RCT)，旨在确定 LLWS 是否存在 护理可以增强这些属性，如果通过增强每一项属性，可以持续改善步态速度。] 在一个民用临床示范项目中，观察到了 LLWS 概念的临床验证。 LLWS 针对社区老年人。在完成 LLWS 护理后，我们观察到大量 移动性能的改善超出了具有临床意义的差异。这些差异是 即使在考虑了可能会削弱康复效果的健康因素之后，仍观察到这一情况。 [LLWS 有很棒的 这对退伍军人事务部来说意义重大，因为中年退伍军人普遍存在步态缓慢的现象，而且 我们观察到的幅度预示着医疗保健成本和残疾率的降低。然而，虽然 LLWS 临床上认为通过增强这些属性中的每一个来提高步态速度，了解是否有两个属性至关重要 基本假设是正确的： 1) 这四个属性中的每一个都通过 LLWS 得到改善吗？ 2）执行这些操作 改善是否会导致中年退伍军人的步态速度发生立即和持续的变化？ 因此，本研究将确定退伍军人中年开始的 LLWS 的功效和概念证明； 在之前针对步态速度的临床试验中很大程度上忽略了年龄范围。] LLWS 与 VA 有着巨大的相关性。 [例如，在我们对 174 名退伍军人进行的初步工作中 50-98 岁的初级保健患者，>50% 表现出步态速度 < 1.0 m/s，该速度表明步态速度加快 不良健康结果的风险。] 鉴于退伍军人的损伤程度高于年龄匹配的人 对于平民，护理应尽可能节俭和有效。因此，该提案的主要目标是 将 LLWS 确立为一种非侵入性新疗法，针对各种 VHA 设置中的慢步速。 在拟议的第二阶段 RCT 中，我们将招募 [198 名社区居民、50 岁及以上退伍军人] 来自 VA Boston Healthcare 系统的门诊诊所，表现出缓慢的步态速度 (< 1.0 m/s) 以及 将他们随机分配到 8 周的 LLWS 组或对于步态速度慢的患者进行 8 周的常规护理组，然后 LLWS 将启动为期 8 周。 LLWS 治疗后 16 周将对两组患者的结果进行随访 结束。 [所有 3 个目标的主要结果将是改变通常的步态速度。次要成果将包括 治疗8周后目标属性的变化。] 我们将实现以下目标： [目标 1：与对照相比，进行 LLWS 的 II 期随机对照试验，并评估其在 社区住宅 50 岁及以上退伍军人。 目标 2：评估 LLWS 治疗 8 周后导致步态速度改善的属性。 目标 3：确定 LLWS 结束 16 周后与持续步态速度增益相关的属性。]