The Live Long Walk Strong rehabilitation program: What features improve mobility skills?

步速慢在中年开始的退伍军人中非常普遍。它是一个主要的预测因子 功能独立，独立于疾病状态，是随后住院的预测因素， 伤残和死亡。虽然康复护理是那些步速较慢的人的标准治疗，但 最佳治疗模式尚未确定。我们有强大的临床支持，认为这是一种新的物理模型 对于那些接受筛查的人来说，被称为长距离强健行走(LLWS)的治疗护理可能是一种有效的治疗方法 步态速度很慢。LLWS具有很高的创新性，因为它优先考虑非常规治疗目标 在标准护理中解决，包括以下方面的损害：1)腿部力量；2)躯干肌肉耐力；3)步态 协调性(行走顺畅)；4)锻炼自我效能感。通过先前的研究，我们 发现这四个治疗目标中的每一个都与受损时的行动能力下降有关，并且 仅在每种情况下的改善就可以带来超过标准护理的行动能力提升。无治疗靶向 这些属性是共同建立的，尽管LLWS在概念上是为此而设计的。因此，我们建议 一项针对50岁及以上退伍军人的II期随机对照临床试验(RCT)，以确定LLWS 护理增强了这些属性，如果通过增强这些属性，步态速度就会得到持续的改善。] 在一个基于民用的临床示范项目中，观察了LLWS概念的临床验证。 LLWS的目标是居住在社区的老年人。在完成LLWS护理时，我们观察到 移动性能的改善超过了临床上有意义的差异。这些差异是 即使在考虑了可能减少康复收益的健康因素后也可以观察到。[LLWS有很好的 对退伍军人来说意义重大，因为步速慢在中年退伍军人中很普遍，而且 我们观察到的程度预示着较低的医疗保健成本和残疾。然而，当LLWS 临床上设想通过增强这些属性中的每一个来提高步态速度，关键是要知道是否有两个 基本假设是正确的：1)LLWS是否改善了这四个属性？以及2)执行这些操作 从中年开始，改进会立即并持续地改变退伍军人的步态速度吗？ 因此，本研究将在中年开始的退伍军人中建立LLWS的有效性和概念证明； 在以前针对步态速度的临床试验中，年龄范围基本上被忽视了。] LLWS与退伍军人管理局有着巨大的相关性。[例如，在我们对174名退伍军人的前期工作中 50-98岁的初级保健患者50%表现为步速&1.0m/S，这一速度表明 造成不良健康后果的风险。]考虑到退伍军人的损伤程度比匹配的老年人更高 对于平民来说，护理应该尽可能地节俭和有效。因此，这项提议的主要目标是 将LLWS建立为一种非侵入性的新疗法，针对各种VHA环境中的慢步速。 在拟议的第二阶段区域工作队中，我们将招募[198名社区居民，退伍军人50岁及以上] 来自VA波士顿医疗系统的门诊，表现为步速缓慢(&lt；1.0米/S)和 将他们随机分为8周的LLWS或8周的常规护理，在此之后步速较慢的人 LLWS将启动8周。在LLWS治疗16周后，对两组的结果进行跟踪观察 结束了。[所有三个目标的主要结果将是改变通常的步态速度。次要结果将包括 治疗8周后目标属性的变化。] 我们将致力于实现这些目标： [目的1：进行LLWS的II期随机对照试验，并评价其疗效 社区居住退伍军人50岁及以上。 目的2：评估在LLWS治疗8周后导致步态速度提高的属性。 目标3：确定与LLWS结束16周后持续步态速度增加相关的属性。]

Slow walking speed is highly prevalent among Veterans beginning in midlife. It is a major predictor of functional independence, independent of disease status and a predictor for subsequent hospitalization, disability and death. While rehabilitative care is the standard treatment for those with slow gait speed, the optimal mode of treatment is not yet identified. We have strong clinical support that a new model of physical therapy care known as Live Long Walk Strong (LLWS) may be an efficacious treatment for those screened with slow gait speed. LLWS is highly innovative, as it prioritizes unconventional treatment targets not typically addressed in standard care, including impairments in: 1) leg power; 2) trunk muscle endurance; 3) gait coordination (smoothness of walking); and 4) self-efficacy to engage in exercise. Through prior research, we identified that each of these four therapeutic targets are linked to mobility decline when impaired and that improvements in each alone can lead to mobility gains that surpasses standard care. No treatment targeting these attributes collectively is established, though LLWS is conceptually designed to do so. [Thus, we propose a phase II randomized controlled clinical trial (RCT) among Veterans 50 years and older to identify if LLWS care enhances these attributes and if by augmenting each, sustained improvements in gait speed result.] In a civilian-based clinical demonstration project, clinical proof of concept of LLWS was observed. LLWS targeted community-dwelling older adults. At the completion of LLWS care, we observed large improvements in mobility performance that exceeded clinically meaningful differences. These differences were observed even after accounting for health factors that may mitigate rehabilitative gains. [LLWS has great significance for the VA, because slow gait speed is prevalent in middle aged Veterans and improvements of the magnitude we observed are predictive lower health care costs and disability. However, while LLWS was clinically conceived to improve gait speed by enhancing each of these attributes, it is critical to know if two basic suppositions are true: 1) Are each of these four attributes improved by LLWS? and 2) Do these improvements induce immediate and sustained changes in gait speed among veterans beginning in midlife? Therefore, this study will establish efficacy and proof of concept of LLWS among Veterans beginning in midlife; an age-range largely ignored in prior clinical trials targeting gait speed.] LLWS has tremendous relevance for the VA. [For example, in our preliminary work among 174 Veteran primary care patients aged 50-98, >50% manifested a gait speed < 1.0 m/s, a speed indicating a heightened risk for adverse health outcomes.] Given Veteran’s higher levels of impairment compared to aged matched civilians, care should be as parsimonious and efficacious as possible. Thus, the major goal of this proposal is to establish LLWS as a non-invasive, new therapy targeting slow gait speed across a variety of VHA settings. In the proposed phase II RCT, we will recruit [198 community-dwelling, Veterans 50 years and older] from the outpatient clinics of the VA Boston Healthcare system that manifest slow gait speed (< 1.0 m/s) and randomize them to either 8 weeks of LLWS or 8 weeks of usual care for those with slow gait speed after which LLWS will be initiated for 8 weeks. Both groups will be followed for outcomes 16 weeks after LLWS treatment ends. [The primary outcome for all 3 aims will be change in usual gait speed. Secondary outcomes will include changes in the targeted attributes after 8 weeks of treatment.] We will address these aims: [Aim 1: To conduct a phase II RCT of LLWS in comparison to controls and evaluate its efficacy among community dwelling Veterans 50 years and older. Aim 2: Evaluate the attributes that lead to improved gait speed after 8 weeks of LLWS treatment. Aim 3: Identify the attributes that are associated with sustained gait speed gains 16 weeks after LLWS ends.]