REhabilitation Promoting Prevention And Improved Resilience (REPPAIR)

为了优化退伍军人的功能和独立性，开发积极的治疗方法至关重要， 改善和预防残疾，以及由此造成的生活质量下降和相关的高成本医疗保健 随着慢性病的发展。1理想情况下，这些预防性治疗应该针对 退伍军人面临最大的风险，并根据他们的需要进行个性化。这对退伍军人事务部至关重要，因为退伍军人事务部的平均年龄为 退伍军人是64岁，退伍军人表现出更大的损害和功能限制比他们的年龄- 匹配的平民2.3个性化的各个方面包括关注与以下方面有关的障碍： 身体但认知功能;并承认预防保健的关键步骤包括重点关注 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。在这种二级预防保健模式中，康复保健可以发挥主导作用。4 预防性康复护理被称为预防性康复。5.这个词传统上指的是预防性的， 外科护理，较少关注预防和改善退伍军人残疾， 慢性病然而，对于开发预防性护理治疗存在巨大的未满足的需求， 最大限度地提高老年退伍军人的功能能力，从而延长生活质量， 残疾和过度使用卫生保健。Prehistory Center（PreHC）REAP将优先考虑 制定预防性护理策略，优化有功能性疾病风险的退伍军人的功能 衰退和残疾。通过三个组织核心的领导和资格认证相结合 在研究和试点研究中，PreHC将开发一个单一的数据库，支持三个项目 研究目的：1）将测试新的治疗方法对三种重要的预防性疾病的疗效 结果（即，3 M）：认知功能（心智）;身体功能（移动性）和成功的行为改变 （动机）; 2）它将鉴定介导治疗反应的生物亚型和表型; 3）它将 使用我们集体研究中得出的大数据资源确认和验证这些关系， 通过与VA国家数据库的数据链接。我们的中心将推进VA临床研究， 通过为各级调查人员提供核心资源和培训，提供预防性护理。领导下 在项目主任（Bean博士）的领导下，将创建三个运营核心：1）领导力，能力和 推进核心，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，包括管理学员的试点赠款计划， 初级教师; 2）科学发现核心，将提供最先进的神经认知评估 功能（心智）、身体功能（活动性）和行为变化的测量（动机）;以及3）数据 管理核心支持复杂数据的收集、监控、管理和传输， 通过资格鉴定和试点研究以及生物统计支持，开发单一数据储存库 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 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。我们将利用这些信息来开发更多 个性化预防性治疗方法，将进行测试，以更好地满足个性化需求 退伍军人。此外，由此产生的数据存储库将成为基于VA的RR&D的可用资源 研究人员将随着PreHC的进步而发展和成长。总之，在未来五年， PreHC将发展成为一个国家资源中心，将在预防保健方面进行尖端研究。 从这项研究中获得的知识将填补我们目前治疗方法的空白，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.