Towards Precision Rehabilitation for Ventral Hernia

项目摘要 疝修补术是美国最常见的手术之一， 每年进行腹疝修补术（VHR）。除了卫生保健系统在VHR上的高额支出外， 患者报告生活质量差、术后疼痛和工作时间损失。传统管理 包括腹壁的手术修复和短期医生随访，以确保手术部位 治愈即使手术恢复了腹壁，术后患者也会表现出严重的 肌肉骨骼系统的损伤，包括力量和功能差，这有助于减少 日常生活活动和自我报告的生活质量较低。参加物理治疗（PT） 可直接解决和改善整体强度、功能和术后疼痛， 改善自我报告的生活质量。需要表征VHR后的功能恢复， 特别是在护理标准中增加了客观的功能测量。值得注意的是，我们不知道 患者的可改变的临床特征，这些患者将从接受标准化后 手术PT。作为实现这一目标的一步，我们必须了解与患者和手术相关的特定因素， VHR后成功结局的可能性。该指导培训计划将使用来自CMS的数据 合格的临床数据登记和NIH/NIDDK资助的基于登记的临床试验，以了解 患者和外科医生特征之间的复杂关系，因为它们与术后功能有关。 该研究的结果将提供（1）强大的预测模型，以了解患者的特征 腹壁疝修补术后1年自我报告的生活质量良好或较差的患者，以及（2）基础 使用功能的客观测量来理解物理治疗的治疗反应的证据。这 奖学金提出了一个范式的转变，目前的做法，疝疾病，考虑客观和 患者报告的功能指标作为主要术后结局。实现这一目标 奖学金将为申请人提供独立调查员所需的知识和技能，并提供 在一所研究型大学担任教职的必要准备。

PROJECT SUMMARY Hernia repairs are one of the most common surgeries performed in the United States, with over 350,000 ventral hernia repairs (VHR) performed yearly. Beyond the high health care system expenditure on VHR, patients report poor quality of life, post-operative pain, and time loss at work. Management traditionally includes surgical restoration of the abdominal wall, and short-term physician follow-up to ensure surgical site healing. Even once surgery has restored the abdominal wall, individuals post-operatively demonstrate major impairments of the musculoskeletal system including poor strength and function which contributes to reduced activities of daily living and a lower self-reported quality of life. Participation in physical therapy (PT) post- operatively may directly address and improve overall strength, function, and post-operative pain, in turn improving self-reported quality of life. There is a need to characterize recovery of function after VHR, specifically with the addition of objective measures of function to standard of care. Notably, we do not know the modifiable clinical characteristics of patients who will benefit the most from undergoing standardized post- operative PT. As a step towards this, we must understand the patient- and surgery-specific factors linked to a likelihood of a successful outcome following VHR. This mentored training plan will use data from a CMS Qualified Clinical Data Registry and an NIH/NIDDK funded registry-based clinical trial to understand the complex relationships between patient- and surgical-characteristics as they relate to post-operative function. Findings from this fellowship will provide (1) robust predictive models to understand characteristics of patients who have a good or poor self-reported quality of life 1 year after ventral hernia repair and (2) foundational evidence in understanding treatment response to physical therapy using objective measures of function. This fellowship proposes a paradigm shift of the current approach to hernia disease by considering objective and patient-reported measures of function of as a primary post-operative outcome. Meeting the objectives of this fellowship will afford the applicant the knowledge and skills required of an independent investigator and provide requisite preparation for a faculty position at a research-intensive university.