ENHANCED MEDICAL REHABILITATION FOR OLDER ADULTS

描述(申请人提供)：对于每年数以百万计的残疾老年人来说，在熟练护理设施(SNF)进行急性康复是恢复足够功能、回家并独立生活的一个狭窄的机会之窗--但往往是因为抑郁症等问题破坏了康复的好处。因此，我们为老年人创建了增强型医疗康复(EMR)。EMR是对行为改变科学的现实适应，是物理和职业治疗师(PT/OT)的一套综合技能，通过以下方式转变标准的急性后康复：(1)以患者为导向的互动方法(2)增加康复强度(3)经常向患者反馈努力和进展。我们开发了培训和监督技术，以便PT/OTS以高度的治疗完整性执行这些技能。在NIMH R34试点工作中，我们发现：(1)EMR具有高强度和参与性：与标准护理康复相比，在EMR中培训和监督的PT/OTS治疗在强度和患者参与度方面大大增强。(2)EMR促进功能和情感恢复：随机分为EMR组的患者在功能、体能、积极和消极情绪方面均有较好的改善。(3)EMR克服了康复障碍：与标准治疗相比，有抑郁症状、认知障碍和多种内科合并症的患者从EMR中受益最多。我们提出了一项随机试验，将测试EMR在情感和功能恢复方面比标准护理康复的好处。我们的目标是(1)检查EMR在改善252名因急性后康复而入院SNFS的老年人功能和情感结果方面的有效性，以及(2)检查EMR克服患者层面障碍(如抑郁症)成功康复的能力。这个项目的创新性很高：它是行为改变理论在改善情感和功能方面的新应用。它响应了NIMH战略计划目标3，“开发新的更好的精神障碍干预措施，纳入精神疾病患者的不同需求和情况。”公共卫生的重要性也很高：从残疾中恢复是一个对人类和经济都具有重大意义的健康问题。在这方面的研究取得成功将使康复更有效。这样做将使这一护理部门的所有老年人受益，特别是那些患有抑郁症、认知障碍和其他并发症的老年人。该项目针对NIMH的干预目标，以改善现实世界环境中的精神健康和相关的健康结果。

DESCRIPTION (provided by applicant): For millions of disabled older adults each year, post-acute rehabilitation in skilled nursing facilities (SNFs) is a narrow window of opportunity to regain enough function to return home and live independently -- but all too often they fail due to problems such as depression that undermine rehabilitation's benefits. Therefore, we created Enhanced Medical Rehabilitation (EMR) for older adults. A real-world adaptation of the science of behavior change, EMR is an integrated set of skills for physical and occupational therapists (PT/OT) that transform standard post-acute rehabilitation through: (1) a patient-directed, interactive approach (2) increased rehabilitation intensity (3) frequent feedback to patients on effort and progress. We developed training and supervision techniques so that PT/OTs carry out these skills with high treatment integrity. In NIMH R34 pilot work, we found: (1) EMR is high-intensity and engaging: therapy by PT/OTs trained and supervised in EMR is greatly amplified in intensity and patient engagement compared to standard-of-care rehabilitation. (2) EMR improves functional and affective recovery: patients randomized to EMR had better improvement of function, physical performance, and positive and negative affect. (3) EMR overcomes barriers to rehabilitation: patients with depressive symptoms, cognitive impairment, and multiple medical comorbidities benefitted most from EMR relative to standard therapy. We propose a randomized trial that will test EMR's benefits over standard-of-care rehabilitation for affective and functional recovery. Our aims are (1) examine the effectiveness of EMR for improving functional and affective outcomes in 252 older adults admitted to SNFs for post-acute rehabilitation, and (2) examine EMR's ability to overcome patient-level barriers (such as depression) to successful rehabilitation. The innovation of this project is high: it is a novel application of theories of behavior change to improve both affect and function. It responds to NIMH strategic plan objective 3, "Develop new and better interventions for mental disorders that incorporate the diverse needs and circumstances of people with mental illness." The public health significance is also high: recovery from disablement is a health issue of enormous human and economic significance. Success in this line of research will make rehabilitation more effective. Doing so would benefit all older adults in this sector of care but particularly those wih depression, cognitive impairment, and other complications. This project addresses NIMH's goal of interventions to improve mental health and related health outcomes in real-world settings.