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Synergizing home health rehabilitation therapy to optimize patients’ activities of daily living

协同家庭健康康复治疗，优化患者的日常生活活动

基本信息

批准号：
10621820
负责人：
Chiung-ju NA Liu
金额：
$ 18.65万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10621820
关键词：
Activities of Daily Living Acute Adjuvant Therapy Admission activity Adverse event Bathing Caring Collaborations Communities Data Elderly Emergency department visit Exercise Frail Elderly Goals Hand functions Health Health Care Costs Health Personnel Health Policy Health Status Home Home Care Services Home visitation Hospitalization Independent Living Intervention Intervention Trial Investigation Leg Length of Stay Long-Term Care Lower Extremity Measures Medical Mission Modification Motor Motor Skills Occupational Therapy Outcome Patient Care Patient Outcomes Assessments Patient Participation Patients Performance Personal Satisfaction Physical Capacity Physical Exercise Physical Function Physical Performance Physical therapy Population Porifera Prevention Process Protocols documentation Randomized Randomized, Controlled Trials Rehabilitation therapy Research Risk Risk Factors Scientist Self Care Services Testing Training Activity Translating Upper Extremity Visit acute care age related disability effective intervention effectiveness/implementation trial evidence base experience falls follow-up functional decline functional status health care service health care settings high risk hospital readmission improved innovation mortality motor learning multiple chronic conditions muscle strength patient engagement pilot test premature preservation prevent primary outcome programs rehabilitation service rehabilitative care resistance exercise satisfaction scale up skills success synergism treatment duration

项目摘要

Project Summary Regaining the ability to take care of oneself after an illness or medical episode is critical for older adults to maintain independent living at home in the community. Each year, 3 to 4.5 million older adults receive home health care services that provide skilled rehabilitation therapy in their home. These patients experience reduced capacity to perform activities of daily living (ADL) independently, which is a significant risk factor for long-term care placement. Recent data has shown that 42% of home health patients do not improve in ADL at discharge. There is currently a lack of evidence-based rehabilitation programs in home health. Increasing activity-based intervention in home health care rehabilitation could be the key to improve patients’ ADL independence. The objective of this R21 application is to pilot test an ADL-enhanced program as an adjuvant therapy to usual home health rehabilitation to improve patients’ ADL outcome. The ADL-enhanced program facilitates patients’ participation in ADL first by lowering the task demand using a compensatory approach. As the patient increases physical capacity as a result of physical therapy services, the ADL-enhanced program shifts to a restorative approach, which increases the task demand to help the patient channel the improved physical capacity to better activity performance. We will implement the activity grading principles to increase task demand, which has been tested in our prior study, in the proposed restorative approach. We found that older adults who practiced daily activities with increased activity demand after exercise have less decline in ADL than older adults who practiced physical exercise only. The ADL-enhanced program is innovative because it manipulates the gradient of activity challenge by delivering the compensatory approach and the restorative approach in sequence over a six-week treatment period. This activity-based paradigm does not exist in current home health care practice. Our central hypothesis is that the ADL-enhanced program will synergize with usual rehabilitation therapy and augment the outcome in ADL. We propose a pilot randomized controlled trial to investigate the preliminary effects of the ADL- enhanced program. Forty-eight home health patients will be randomly assigned to receive the ADL-enhanced program with usual rehabilitation therapy versus usual rehabilitation therapy only. Our specific aims are to: 1) estimate the preliminary effect of the ADL-enhanced program on improving ADL; 2) estimate the preliminary effect of the ADL-enhanced program on improving physical functioning of the upper extremity and the lower extremity; and 3) assess the program completion rate, satisfaction rate, and adverse event rate (e.g., falls and hospital admissions). The proposed project aligns with the NIA’s mission to develop effective interventions to maintain health, well-being, and function as well as to prevent or reduce the burden of age-related disabilities. Research findings will be used to develop a hybrid effectiveness-implementation trial of the ADL-enhanced program, laying the groundwork for potential large-scale implementation in the home health care setting.

项目摘要在疾病或医疗事件后恢复照顾自己的能力对老年人至关重要，在社区的家中保持独立生活。每年有300万至450万老年人获得家庭在家中提供熟练康复治疗的医疗保健服务。这些患者经历减少独立进行日常生活活动（ADL）的能力，这是长期的一个重要风险因素。护理安置。最近的数据显示，42%的家庭健康患者在出院时ADL没有改善。目前，在家庭健康方面缺乏循证康复计划。增加基于活动的家庭保健康复干预是提高患者ADL独立性的关键。的这项R21申请的目的是对日常生活能力增强计划进行试点测试，作为对普通家庭的辅助治疗。健康康复改善患者日常生活活动能力。ADL增强计划有助于患者首先通过使用补偿方法降低任务需求来参与ADL。随着患者的增加，由于物理治疗服务的结果，ADL增强计划转向恢复性方法，这增加了任务的需求，以帮助病人渠道改善体能，以更好地活动绩效。我们将实施活动分级原则，以增加任务需求，在我们之前的研究中，在建议的恢复方法中进行了测试。我们发现每天练习的老年人运动后增加活动需求的活动比练习的老年人ADL下降更少只有体育锻炼。ADL增强计划是创新的，因为它操纵活动的梯度通过在六周内依次提供补偿性方法和恢复性方法，治疗期。这种以活动为基础的模式在目前的家庭医疗保健实践中并不存在。我们的中央一种假设是，ADL增强计划将与常规康复治疗协同作用， ADL的结果我们提出了一个试点随机对照试验，以调查ADL的初步影响，增强方案。48名家庭健康患者将被随机分配接受ADL增强治疗。常规康复治疗与仅常规康复治疗。我们的具体目标是：1）估计ADL增强计划对改善ADL的初步效果; 2）估计初步的 ADL增强计划对改善上肢和下肢身体功能的影响肢体;以及3）评估程序完成率、满意率和不良事件率（例如，福尔斯和住院）。拟议的项目与国家信息评估的使命一致，即制定有效的干预措施，维持健康、福祉和功能，以及预防或减轻与年龄有关的残疾的负担。研究结果将被用来开发一个混合的有效性，实施试验的ADL增强计划，奠定了基础，为潜在的大规模实施，在家庭保健设置。