REhabilitation Promoting Prevention And Improved Resilience (REPPAIR)

为了优化退伍军人的功能和独立性，关键是开发积极主动的治疗方法 改善和预防残疾以及由此导致的生活质量损失和高昂的医疗保健费用 随着慢性病的发展。1理想情况下，这些预防性治疗的设计应该有针对性。 退伍军人面临的风险最大，并根据他们的需求进行个性化。这对退伍军人管理局来说至关重要，因为 退伍军人的年龄是，退伍军人表现出比他们的年龄更大的损伤和功能限制- 与平民同行相匹配。个性化的2、3个方面包括对损害的关注，不仅与 身体但认知功能；并认识到预防性护理的关键步骤包括注重 患者的行为改变。1促进长期成功的治疗通常强调这些 接近了。康复护理可以在这种二级预防性护理模式中发挥主导作用。4. 预防性康复护理称为康复前护理。5这一术语传统上指的是预防性的事前 外科治疗，较少侧重于预防和改善退伍军人的残疾 慢性病。然而，还有一个巨大的未得到满足的需求，即开发能够 最大限度地提高老年退伍军人的功能能力，从而提高生活质量并防止 残疾和过度利用医疗保健。康复中心(PreHC)将优先考虑 制定康复前护理策略优化有功能障碍的退伍军人的功能 衰弱和残疾。通过三个组织核心的领导和资格化相结合 研究和试点研究，PreHC将开发一个单一的数据存储库，支持三个方案 研究目的：1)测试新的治疗方法对三种重要的康复治疗方法的疗效 结果(即3M)：认知功能(思维)、身体功能(行动能力)和成功的行为改变 (动机)；2)将确定调节治疗反应的生物亚型和表型；3)将 使用来自我们集体研究的大量数据资源来确认和验证这些关系 通过与退伍军人管理局国家数据库的数据链接。我们中心将推进VA的临床研究和 通过为各级调查人员提供核心资源和培训，提供康复前护理。在领导下 在项目主任(Bean博士)中，将建立三个业务核心：1)领导、能力和 高级核心，将包括REAP的行政领导，并监督所有培训和 由PreHC赞助的教育活动，包括管理受训人员试点赠款方案和 初级教员；2)科学发现核心，将提供最先进的神经认知评估 功能(思维)、身体功能(行动)和行为变化的衡量标准(动机)；以及3)数据 支持收集、监控、管理和传输复杂数据的管理核心， 开发由合格和试点研究以及生物统计支助产生的单一数据储存库 协助研究设计和分析。一个内部指导委员会将帮助监督日常工作 业务和方案的成功以及一个由内容专家组成的外部咨询委员会将帮助指导 实现短期和长期目标。我们将利用这些结果信息来开发更多 个性化康复前治疗方法将接受测试，以更好地满足个性化需求 退伍军人。此外，由此产生的数据储存库将成为基于VA的RR&D的可用资源 将随着PreHC的进步而发展和壮大的研究人员。总而言之，在未来五年， PreHC将发展成为一个全国性的资源中心，将在康复护理方面进行尖端研究。 从这项研究中获得的知识将填补我们目前治疗学中的空白，以促进和维持 老年退伍军人的长期健康。

To optimize the function and independence of Veterans, it is critical to develop proactive treatments that ameliorate and prevent disability and the resulting loss of quality of life and high cost health care associated with the progression of chronic disease. 1 Ideally, these preventative treatments should be designed to target Veterans at greatest risk and be personalized to their needs. This is critical for the VA since the mean age of Veterans is 64 years and Veterans manifest greater impairment and functional limitations than their age- matched civilian counterparts. 2,3 Aspects of personalization include a focus on impairments linked to not only physical but cognitive function; and acknowledging that critical steps to preventative care include a focus on behavior change of the patient. 1 Treatments promoting long term success commonly emphasize these approaches. Rehabilitative care can play a leading role in this model of secondary preventative care. 4 Preventative rehabilitative care is known as prehabilitation. 5 This term traditionally refers to preventative pre- surgical care and less frequently focuses on prevention and amelioration of disability among Veterans with chronic disease. However, there is a tremendous unmet need to develop prehabilitative care treatments that maximize the functional capacity of aging veterans and thereby extend quality of life as well as prevent disability and excessive health care utilization. The Prehabilitation Center (PreHC) REAP will prioritize the development of Prehabilitative Care strategies optimizing functioning among Veterans at risk for functional decline and disability. Through the leadership of three organizational cores and the combination of qualifying studies and pilot studies, the PreHC will develop a single data repository supporting three programmatic research aims: 1) It will test the efficacy of novel therapeutic approaches on three important prehabilitative outcomes (i.e., 3M’s): cognitive function (Mind); physical function (Mobility) and successful behavioral change (Motivation); 2) It will identify biologic subtypes and phenotypes that mediate treatment response; 3) It will confirm and validate these relationships using the large data resource derived from our collective studies and through linkage with data from VA national databases. Our center will advance VA clinical research and prehabilitative care by providing core resources and training for investigators of all levels. Under the leadership of the Project Director (Dr. Bean), three operational cores will be created: 1) a Leadership, Capacity and Advancement Core that will include the administrative leadership of the REAP and oversee all training and education activities sponsored by PreHC, including administration of the pilot grant program for trainees and junior faculty; 2) a Scientific Discovery Core that will provide state of the art assessment of neurocognitive function (mind), physical function (mobility) and measures of behavior change (motivation); and 3) a Data Management Core supporting the collection, monitoring, management and transfer of complex data, the development of single data repository resulting from the qualifying and pilot studies and biostatistical support assisting with study design and analysis. An internal steering committee will help oversee day to day operations and programmatic success and an external advisory board of content experts will help guide the achievement of the short- and long-term goals. We will use this resulting information to develop more personalized Prehabilitative treatment approaches that will be tested for better meeting the personalized needs of Veterans. Additionally, the resulting data repository will be an available resource for VA-based RR&D researchers that will develop and grow with advancement of PreHC. In sum, over the next five years, the PreHC will evolve into a national resource center that will conduct cutting-edge research in prehabilitative care. The knowledge gained from this research will fill gaps in our current therapeutics to advance and maintain the long-term health of aging Veterans.