Progressing Home Health Rehabilitation Paradigms for Older Adults

 描述(由申请人提供)：由于急性疾病导致的身体功能下降与老年人的一些不良健康事件有强烈和独立的联系。家庭健康(HH)理疗可能是解决这些身体功能下降的理想场所，因为大约300万老年人在从急性或急性后设施出院后获得HH服务。然而，按照目前的结构，这些服务似乎没有充分恢复功能，长期结果不佳和再次住院率高就是明证。身体机能减弱尤其被认为是再次住院的风险因素--水平较低的老年人 有较多活动的患者再次住院的可能性是有较大活动的患者的6倍。对老年人进行更密集的HH物理治疗具有最大限度地发挥身体功能和减少再次住院的巨大潜力。因此，我们开发了一种基于家庭的、渐进的、跨学科的、多成分的高强度(PMC)干预措施，直接解决住院后出现的功能缺陷。我们建议 进行一项双臂随机临床试验(RCT)，研究对象为200名从急性期或急性期设施入院的老年人。参与者将接受1)密集的PMC干预，使用阻力练习和基于证据的运动控制训练来改善身体功能，或者2)常规护理(UC)物理治疗。这项调查的主要目标是确定在进入HH时开始的PMC干预是否比UC物理治疗更能改善通过表现和自我报告评估衡量的身体功能。还将检查PMC干预对再住院率、养老院安置、急诊室就诊和出院后跌倒的影响。治疗将在从急性或急性后设施进入HH后的头60天内在家中进行，测试时间为：基线(HH入院时)、30天、60天(主要终点)、90天和180天。如果在改善患者功能和降低再住院率方面取得成功，PMC干预具有未来节省医疗成本的潜力。

 DESCRIPTION (provided by applicant): Declines in physical function as a result of acute illness are strongly and independently associated with a number of adverse health events for older adults. Home Health (HH) physical therapy may be the ideal venue for addressing these declines in physical function because around 3 million older adults receive access to HH services following discharge from acute or post-acute facilities. However, as currently structured, these services do not appear to adequately restore function, as evidenced by poor long-term outcomes and high rates of hospital readmission. Diminished physical function has been particularly implicated as a risk factor for re-hospitalization-older adults with lower levels of ambulatory activity are 6 times more likely to be re-hospitalized than those with greater ambulatory activity. A more intensive approach to HH physical therapy for older adults has great potential to maximize physical function and reduce hospital readmissions. Therefore, we have developed a high intensity home-based, progressive, interdisciplinary, multi-component (PMC) intervention that directly addresses the functional deficits seen after hospitalization. We propose to conduct a two-arm, randomized clinical trial (RCT) of 200 older adults admitted to HH from an acute or post-acute facility. Participants will receive either 1) an intensive, PMC intervention using resistance exercise and evidenced-based motor control training to improve physical function or 2) usual care (UC) physical therapy. The primary goal of this investigation is to determine if PMC intervention, initiated upon admission to HH, improves physical function, as measured by performance and self-report assessments, more than UC physical therapy. The effects of the PMC intervention on re-hospitalization rates, nursing home placement, emergency room visits, and falls after discharge from the acute care hospital will also be examined. Treatment will occur at home during the first 60 days following admission to HH from acute or post-acute facility with testing at: baseline (upon HH admission), 30 days, 60 days (primary endpoint), 90 days, and 180 days. If successful in improving patient function and decreasing re-hospitalization rates, PMC intervention holds potential for future health care cost savings.