ENHANCED MEDICAL REHABILITATION FOR OLDER ADULTS

描述（由申请人提供）：对于每年数百万的残疾老年人来说，在熟练护理设施（SNF）中进行急性康复是一个狭窄的机会窗口，可以重新获得足够的功能以返回家园并独立生活-但由于抑郁症等问题，他们经常失败，这些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是行为改变科学的现实世界适应，是物理和职业治疗师（PT/OT）的一套综合技能，通过以下方式改变标准急性期后康复：（1）以患者为导向的互动方法（2）增加康复强度（3）经常反馈患者的努力和进展。我们开发了培训和监督技术，以便PT/OT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是高强度和吸引人的：与标准护理康复相比，在EMR中接受培训和监督的PT/OT的治疗在强度和患者参与度方面大大增强。(2)EMR改善了功能和情感恢复：随机接受EMR的患者在功能、身体表现以及积极和消极情感方面有更好的改善。(3)EMR克服了康复障碍：与标准治疗相比，患有抑郁症状、认知障碍和多种医学合并症的患者从EMR中获益最多。我们提出了一个随机试验，将测试EMR的好处，超过标准的护理康复的情感和功能恢复。我们的目的是（1）检查EMR对改善252名接受SNF进行急性期后康复的老年人的功能和情感结局的有效性，以及（2）检查EMR克服患者水平障碍（如抑郁症）的能力，以成功康复。这个项目的创新性很高：它是行为改变理论的一个新的应用，以改善影响和功能。它响应了国家精神卫生研究所战略计划目标3，“为精神障碍制定新的和更好的干预措施，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：残疾康复是一个具有巨大人类和经济意义的健康问题。这一研究的成功将使康复更有效。这样做将有利于所有老年人在这一领域的护理，特别是那些抑郁症，认知障碍和其他并发症。该项目解决了NIMH的干预目标，以改善心理健康和现实世界中的相关健康结果。

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.