Synergizing home health rehabilitation therapy to optimize patients’ activities of daily living

协同家庭健康康复治疗，优化患者的日常生活活动

• 批准号: 10429480
• 负责人: Chiung-ju NA Liu
• 金额: $ 22.5万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10429480
• 关键词: Activities of Daily Living; Acute; Adjuvant Therapy; Admission activity; Adverse event; Bathing; Caring; Communities; Data; Elderly; Emergency department visit; Exercise; Frail Elderly; Goals; Hand functions; Health; Health Care Costs; Health Personnel; Health Policy; Health Status; Home; Home Care Services; Home visitation; Hospitalization; Independent Living; Intervention; Intervention Trial; Investigation; Leg; Length of Stay; Long-Term Care; Lower Extremity; Measures; Medical; Mission; Modification; Motor; Motor Skills; Occupational Therapy; Outcome; Patient Care; Patient Outcomes Assessments; Patient Participation; Patients; Performance; Personal Satisfaction; Physical Capacity; Physical Exercise; Physical Function; Physical Performance; Physical therapy; Population; Porifera; Prevention; Process; Protocols documentation; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Research; Risk; Risk Factors; Rogaine; Scientist; Self Care; Services; Testing; Training Activity; Translating; Upper Extremity; Visit; acute care; age related; base; disability; effective intervention; effectiveness implementation study; effectiveness implementation trial; evidence base; experience; falls; follow-up; functional decline; functional status; health care service; health care settings; high risk; hospital readmission; improved; innovation; mortality; multiple chronic conditions; muscle strength; pilot test; premature; preservation; prevent; primary outcome; programs; rehabilitation service; rehabilitative care; resistance exercise; satisfaction; scale up; skills; success; treatment duration

Project Summary Regaining the ability to take care of oneself after an illness or medical episode is critical for older adults to maintain independent living at home in the community. Each year, 3 to 4.5 million older adults receive home health care services that provide skilled rehabilitation therapy in their home. These patients experience reduced capacity to perform activities of daily living (ADL) independently, which is a significant risk factor for long-term care placement. Recent data has shown that 42% of home health patients do not improve in ADL at discharge. There is currently a lack of evidence-based rehabilitation programs in home health. Increasing activity-based intervention in home health care rehabilitation could be the key to improve patients’ ADL independence. The objective of this R21 application is to pilot test an ADL-enhanced program as an adjuvant therapy to usual home health rehabilitation to improve patients’ ADL outcome. The ADL-enhanced program facilitates patients’ participation in ADL first by lowering the task demand using a compensatory approach. As the patient increases physical capacity as a result of physical therapy services, the ADL-enhanced program shifts to a restorative approach, which increases the task demand to help the patient channel the improved physical capacity to better activity performance. We will implement the activity grading principles to increase task demand, which has been tested in our prior study, in the proposed restorative approach. We found that older adults who practiced daily activities with increased activity demand after exercise have less decline in ADL than older adults who practiced physical exercise only. The ADL-enhanced program is innovative because it manipulates the gradient of activity challenge by delivering the compensatory approach and the restorative approach in sequence over a six-week treatment period. This activity-based paradigm does not exist in current home health care practice. Our central hypothesis is that the ADL-enhanced program will synergize with usual rehabilitation therapy and augment the outcome in ADL. We propose a pilot randomized controlled trial to investigate the preliminary effects of the ADL- enhanced program. Forty-eight home health patients will be randomly assigned to receive the ADL-enhanced program with usual rehabilitation therapy versus usual rehabilitation therapy only. Our specific aims are to: 1) estimate the preliminary effect of the ADL-enhanced program on improving ADL; 2) estimate the preliminary effect of the ADL-enhanced program on improving physical functioning of the upper extremity and the lower extremity; and 3) assess the program completion rate, satisfaction rate, and adverse event rate (e.g., falls and hospital admissions). The proposed project aligns with the NIA’s mission to develop effective interventions to maintain health, well-being, and function as well as to prevent or reduce the burden of age-related disabilities. Research findings will be used to develop a hybrid effectiveness-implementation trial of the ADL-enhanced program, laying the groundwork for potential large-scale implementation in the home health care setting.

项目摘要 恢复在疾病或医学发作后照顾自己的能力对老年人至关重要 维持社区中独立生活。每年，3至450万老年人都会收到家 提供熟练的康复疗法的医疗保健服务。这些患者的经历减少了 独立执行日常生活活动（ADL）的能力，这是长期的重要危险因素 护理安置。最近的数据表明，有42％的家庭健康患者在出院时没有改善ADL。 目前，家庭健康中缺乏基于证据的康复计划。基于活动的增加 干预家庭医疗保健康复可能是改善患者独立性的关键。这 此R21应用的目的是试用ADL增强程序作为对常规家庭的调整疗法 健康康复以改善患者的ADL结果。 ADL增强程序促进了患者的 首先使用补偿方法来降低任务需求，从而参与ADL。随着患者的增加 由于物理疗法服务，ADL增强程序转向恢复 方法，这增加了任务的需求，以帮助患者引导身体的提高能力以更好 活动表现。我们将实施活动分级原则以增加任务需求，这已经是 在我们先前的研究中测试了拟议的恢复方法。我们发现每天练习的老年人 与实践的老年人相比 仅体育锻炼。 ADL增强程序具有创新性，因为它操纵了活动的梯度 通过在六个星期内交付补偿方法和恢复方法来挑战 治疗期。这种基于活动的范式在当前的家庭医疗保健实践中不存在。我们的中心 假设是，ADL增强计划将与通常的康复疗法协同作用，并增加 ADL的结果。我们提出了一项飞行员随机对照试验，以研究ADL-的初步影响 增强程序。将随机分配48名家庭健康患者接受ADL增强 仅使用通常的康复疗法与通常的康复疗法的计划。我们的具体目的是：1） 估计ADL增强程序对改善ADL的初步效果； 2）估计初步 ADL增强程序对改善上肢和下肢的身体功能的影响 末端; 3）评估计划完成率，满意度和不良事件率（例如跌倒和 住院）。拟议的项目与NIA的使命保持一致，以制定有效的干预措施 保持健康，福祉和功能，并防止或减少与年龄相关的残疾的燃烧。 研究发现将用于开发ADL增强的混合有效性试验 计划，为家庭医疗保健环境中潜在的大规模实施奠定了基础。