Frailty, Strength, and Mobility in Older Hernia Patients: A Novel Abdominal Wall Physical Therapy Program

老年疝气患者的虚弱、力量和活动能力：一种新颖的腹壁物理治疗方案

• 批准号: 10302868
• 负责人: Courtney Collins
• 金额: $ 15.75万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10302868
• 关键词: Abdomen; Accounting; Affect; Age; Aging; American College of Surgeons; Climacteric; Clinical Trials; Data; Decision Making; Dose; Elderly; Enrollment; Exercise; Face; Foundations; Future; Goals; Health; Healthcare; Hernia; Hernia of abdominal cavity; Home; Impairment; Individual; Intervention; Interview; Joint repair; Lead; Life; Literature; Measures; Medical; Methodology; Methods; Morbidity - disease rate; Morphology; Operative Surgical Procedures; Orthopedics; Outcome; Patient Outcomes Assessments; Patient-Centered Care; Patients; Perioperative; Perioperative complication; Persons; Physical therapy; Play; Population; Postoperative Pain; Postoperative Period; Procedures; Process; Quality of life; Registries; Reporting; Risk; Role; Scientist; Structure; Surgeon; Surgical complication; Testing; Time; Tissues; United States; abdominal wall; adverse outcome; aged; career; cohort; comorbidity; cost; design; exercise program; experience; frailty; functional status; hospital readmission; human old age (65+); improved; indexing; loss of function; mortality; novel; older patient; patient population; programs; prospective; randomized trial; repaired; satisfaction; skills; surgery outcome; tertiary care; tool

PROJECT SUMMARY ABSTRACT The Frailty, Strength, and Mobility in Older Hernia Patients: A Novel Abdominal Wall Physical Therapy Program study aims to understand the role of frailty to surgical outcomes and postoperative quality of life (QOL) for older adults undergoing elective abdominal hernia repair (AHR). Additionally, we seek to evaluate the feasibility and utility of a novel perioperative abdominal wall physical therapy (AWPT) for AHR patients over 65. Current literature is scarce on the relationship of frailty to long-term postoperative outcomes in older AHR patients and, crucially, no studies describe peri-operative QOL changes in older hernia patients despite the fact that it is a key consideration for AHR patients and their surgeons. Because of the profound influence QOL gains have on the surgical decision making process, and with the rapid aging of the hernia patient population, we believe that understanding the relationship of frailty to QOL outcomes after AHR is essential. We will undertake a retrospective review of prospectively collected data from a national registry of AHR patients to assess the effect of frailty on patient-reported QOL, as well as standard postoperative outcomes (such as morbidity, mortality, complications, readmissions) for AHR patients over the age of 65 (Aim 1). We hypothesize that increasing frailty will confer a dose-dependent risk of adverse outcomes following AHR, as well as an inverse relationship with quality of life gains. We believe these results may be used in the future to develop surgical decision making tools for older patients considering elective AHR. Pre-surgical optimization is especially important in older, frail patients who decide to undergo operative interventions such as AHR. To that end, we propose to pilot test a novel abdominal wall physical therapy (AWPT) program in a cohort of older patients undergoing elective AHR at a major tertiary care center (Aim 2). Hernia patients over the age of 65 will be offered enrollment in an AWPT program consisting of both home exercises and in-person physical therapy. We will utilize validated measures to assess the effect of AWPT on both strength (Timed Up and Go Test, Sit to Stand Test) and mobility (Life Space Assessment) in AHR patients before and after surgery. We will also use semi-structured interviews to explore older AHR patients’ perspectives on the feasibility and utility of AWPT. We believe that at the completion of this study we will have a better understanding of how frailty affects QOL gains after AHR and, additionally, will be able to utilize our AWPT pilot data to undertake a larger trial examining the effects of peri- operative AWPT on outcomes after AHR in an older cohort.

项目摘要摘要 老年疝患者的脆弱，力量和流动性：一种新型的腹壁物理疗法 计划研究旨在了解脆弱的手术结果和术后质量的作用 接受腹部腹腔疝修复（AHR）的老年人的生活（QOL）。此外，我们试图评估 AHR患者的新型周期性腹壁物理治疗（AWPT）的可行性和实用性 超过65岁。当前的文献对脆弱的长期术后结局的关系很少 AHR患者，至关重要的是，没有研究描述疝气患者的围手术期QOL变化 尽管这是AHR患者及其外科医生的关键考虑因素。因为 QOL的影响对手术决策过程产生了深远的影响，并且随着年龄的迅速衰老 疝气患者人数，我们认为了解脆弱的关系与质量结果之后 啊，是必不可少的。我们将对来自国家的前瞻性收集数据进行回顾性审查 AHR患者的注册表评估脆弱对患者报告的QOL的影响以及标准 AHR患者的术后结局（例如发病率，死亡率，并发症，再入院） 年龄65岁（目标1）。我们假设增加的脆弱将赋予剂量依赖的敌人风险 AHR之后的结果，以及与生活质量增长的逆关系。我们相信这些结果 未来可能会使用考虑选择性的老年患者开发手术决策工具 啊。术前优化在决定进行操作的老年患者中尤为重要 诸如AHR之类的干预措施。为此，我们建议试行测试一种新型的腹壁物理治疗 （AWPT）计划在大三级大三级的老年患者队列中 护理中心（目标2）。 65岁以上的疝气患者将入学 由家庭运动和面对面的物理疗法组成。我们将利用经过验证的措施评估 AWPT对强度（计时和进行测试，坐下来进行测试）和流动性（寿命空间）的影响 评估手术前后AHR患者。我们还将使用半结构化访谈 探索年龄较大的AHR患者对AWPT的可行性和实用性的看法。我们相信 这项研究的完成，我们将更好地了解脆弱性如何影响AHR之后的QoL收益 此外，将能够利用我们的AWPT Pilot数据进行更大的试验，以研究周期的影响 AHR在一个较旧的队列中的AHR之后的结果。