Timing And Intensity Of Strengthening After Hip Fracture

描述(申请人提供)：尽管髋部骨折的医疗管理有了很大的改善，但我们在减少老年人骨折后残留的显著残废方面并不成功。这种看似简单的疾病带来的迅速增长的经济成本以及照顾者和社会承担的护理负担预计将会升级。需要对有希望的干预措施进行系统调查。干预措施应针对阻碍康复的缺陷，即肌肉质量和力量，应具有正确的强度，并在最适当的时间引入，以实现最有益的结果。这笔计划拨款将用于完善未来的试验，即基于家庭的锻炼计划。研究人员建议评估锻炼计划的强度和时机，以降低髋部骨折后的残疾水平。这项计划工作将被用来设计一项随机对照试验(RCT)，将骨折后不同时间进行的两种不同强度的下肢运动与假注意对照组进行比较。在这项未来的试验中，研究人员计划纳入比之前研究中包括的更广泛的髋部骨折患者，而不是只关注最有可能康复的个人。他们还将记录当前康复护理的各个方面，并确定预测干预成功的因素。 该规划项目汇集了研究髋部骨折结果和临床方法的一组充满活力的研究人员。研究小组由髋部骨折结果、临床方法和物理干预方面的专家组成，设计和领导髋部骨折后锻炼计划的随机对照试验。目前申请规划和发展补助金的具体目的是：(1)完善未来试验的研究设计；(2)为在未来试验中成功招募受试者制定详细的方案；(3)建立可靠的程序，确保治疗依从性；(4)制定详细的方案，以便在未来试验中进行有意义的结果评估；以及(5)制定未来试验预算。

DESCRIPTION (provided by applicant): Despite dramatic improvements in medical management of hip fracture, we have been unsuccessful in reducing the significant residual disability that remains in older persons post-fracture. The burgeoning economic cost of this seemingly simple condition and the burden of care borne by caregivers and society are predicted to escalate. Systematic investigations of promising interventions are needed. The interventions should be specific to the deficits that impede recovery, i.e., muscle mass and strength, should be of the correct intensity and be introduced at the most appropriate time to achieve the most beneficial outcome. This planning grant will be used to refine a future trial, a home-based exercise program. The investigators propose to evaluate the intensity and timing of an exercise program to reduce the level of disability post-hip fracture. This planning effort will be used to design a randomized controlled trial (RCT) to compare two different intensities of lower extremity exercise delivered at different times post-fracture to a sham, attention control group. In this future trial the investigators plan to include a broader range of patients with hip fracture than has been included in previous studies instead of focusing only on individuals with the best chance for recovery. They also will document aspects of current rehabilitation care, and identify the factors that predict success of this intervention. The planning project brings together a dynamic group of investigators expert in studying hip fracture outcomes and clinical methodologies. The investigative team consists of experts in hip fracture outcomes, clinical methodologies, and physical intervention required to design and lead a randomized controlled trial of an exercise program following hip fracture. Specific aims of the present application for a planning and development grant are to (1) refine the study design of the future trial; (2) prepare detailed protocols for successful enrollment of subjects in the future trial; (3) establish reliable procedures to ensure treatment adherence; (4) prepare detailed protocols to enable meaningful outcome assessment in the future trial; and (5) develop the future trial budget.