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

项目摘要 对于老年人来说，在疾病或医疗事故后恢复照顾自己的能力是至关重要的 在社区中保持独立的居家生活。每年，有300万到450万老年人收到家 在家中提供熟练康复治疗的医疗保健服务。这些患者的经历减少了 独立进行日常生活活动(ADL)的能力，这是长期存在的一个重要风险因素 看护安置。最近的数据显示，42%的家庭健康患者出院时ADL没有改善。 目前在家庭健康方面缺乏循证康复计划。以活动为基础的增加 家庭保健康复干预可能是提高患者ADL独立性的关键。这个 此R21应用程序的目的是试行测试ADL增强计划作为对普通家庭的辅助治疗 健康康复以改善患者的日常生活能力。ADL增强计划方便了患者 首先通过补偿性的方法降低任务需求，从而参与ADL。随着患者数量的增加 体能由于物理治疗服务的结果，ADL增强计划转变为恢复性 方法，这增加了任务需求，帮助患者更好地引导改善的体能 活动表现。我们将落实活动分级原则，增加任务需求，这已经被 在我们之前的研究中，在拟议的恢复性方法中进行了测试。我们发现，每天练习的老年人 锻炼后活动需求增加的活动比锻炼的老年人ADL下降得更少 仅限体育锻炼。ADL增强计划是创新的，因为它操纵了活动的梯度 通过在六周内依次提供补偿性方法和恢复性方法来应对挑战 治疗期。这种以活动为基础的模式在当前的家庭保健实践中并不存在。我们的中央 假设ADL增强计划将与通常的康复治疗协同，并增加 ADL评分结果。我们提出了一项试点随机对照试验，以研究ADL-1的初步疗效。 增强的程序。48名家庭健康患者将被随机分配接受ADL增强版 常规康复治疗方案与仅常规康复治疗方案。我们的具体目标是：1) 评估ADL增强计划对改善ADL的初步效果；2)初步评估 日常生活能力增强计划对改善上肢和下肢身体功能的作用 3)评估计划完成率、满意率和不良事件发生率(例如，跌倒和 入院)。拟议的项目与NIA制定有效干预措施的使命相一致 保持健康、幸福和功能，以及预防或减轻与年龄相关的残疾的负担。 研究结果将被用于开发ADL增强的混合有效性-实施试验 计划，为可能在家庭保健环境中大规模实施奠定了基础。

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.