The Impact of Cognition on Rehabilitative Treatment for Slow Gait Speed

认知对慢步速康复治疗的影响

• 批准号: 10557853
• 负责人: Elisa Ogawa
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557853
• 关键词: Activities of Daily Living; Address; Adherence; Age; Aging; Attention; Award; Behavioral; Boston; Caring; Cessation of life; Characteristics; Cladribine; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Communities; Coupled; Data; Dementia; Elderly; Environment; Executive Dysfunction; Exercise; Foundations; Future; Gait; Gait speed; Goals; Grant; Healthcare Systems; Hospitalization; Impaired cognition; Impairment; Individual; K-Series Research Career Programs; Knowledge; Learning; Memory; Mentors; Mentorship; Morbidity - disease rate; Neurobiology; Neuropsychological Tests; Neuropsychology; New England; Outcome; Participant; Pathology; Patients; Performance; Phase; Physician Executives; Positioning Attribute; Prevalence; Quasi-experiment; Rehabilitation therapy; Research; Research Design; Research Methodology; Research Project Grants; Research Support; Research Training; Role; Self Efficacy; Therapeutic exercise; Time; Training; Training and Education; Treatment outcome; United States National Institutes of Health; Veterans; Walking; Work; Writing; bean; career; cognitive ability; cognitive benefits; compliance behavior; design; disability; evidence base; executive function; experience; functional decline; functional disability; functional status; hands on research; improved; improved mobility; individualized medicine; innovation; insight; medical schools; multidisciplinary; novel; personalized approach; professor; programs; rehabilitation research; rehabilitation science; rehabilitative care; response; secondary analysis; skills; treatment adherence; treatment optimization; treatment response; walking speed

Slow walking and cognitive impairment are prevalent among aging Veterans and are independent predictors for subsequent hospitalization, disability, and death. Recent scientific evidence suggests that walking and cognition are interrelated whereby their declines may share a common underlying neurobiological pathology. Thus, treating slow walking speed may not only improve mobility but also cognition. Live Long Walk Strong (LLWS) is a new innovative rehabilitative care program targeting Veterans (≥50yrs) with slow walking speed. LLWS treatment primarily focuses on mobility problems. However, it is estimated that 40% of LLWS participants have manifested cognitive deficits; thus, it is uncertain whether current LLWS treatment is designed to optimally serve the unique characteristics of Veterans who have cognitive problems. For example, we do not know whether Veterans with cognitive challenges will adhere to the rehabilitative program. Likewise, we are unsure whether the treatment response will be the same across cognitive status. Therefore, the study objective is to understand the treatment adherence, compliance, and response among older Veterans with and without cognitive problems participating in the LLWS clinical trial. The present study will 1) provide insight into whether LLWS treatment needs to be modified to increase compliance and adherence, 2) examine the association between baseline cognitive status and change in gait speed after LLWS treatment, and 3) discover the influence of LLWS treatment on cognition. The long-term goal of this proposed Career Development Award (CDA-1) is to advance research and educational training in order for the PI to establish an independent line of research developing personalized rehabilitative treatment to maintain safe mobility and cognition among aging Veterans with varying functional abilities. The PI previously was the study coordinator of a NIH supported R21 exercise treatment study and later conducted her own feasibility and quasi-experimental studies. Currently, she is mentored by Jonathan Bean, MD, MPH, a professor of PM&R at Harvard Medical School and Director of New England GRECC at VA Boston Healthcare System. The short-term goals of this CDA-1 are to acquire experience in 1) rehabilitation science, 2) mobility assessment and treatment, 3) neuropsychological assessment and analysis, 4) personalized rehabilitation treatment (geriatric care principles), and 5) research methods and grant writing skills to establish a strong foundation for a VA-research career. The PI will use the combination of didactic coursework provided from a rich academic research environment, hands-on research training, and mentorships from a team of experts who can offer extensive knowledge and support her research. The proposed research is significant and innovative as it provides information about how to tailor innovative rehabilitative care to better suit the individual needs of Veterans.

慢速步行和认知障碍在老年退伍军人中普遍存在，并且是独立的预测因素 随后的住院，残疾和死亡。最近的科学证据表明，步行和 认知相互关联，它们的下降可能具有共同的基本神经生物学病理学。 那样，治疗缓慢的步行速度不仅可以提高流动性，而且可以提高认知。长途悠久 （LLWS）是一种针对退伍军人（≥50年）的新创新康复护理计划，步行速度缓慢。 LLWS治疗主要关注流动性问题。但是，据估计有40％的LLW 参与者表现出认知的定义；因此，尚不确定当前的LLWS治疗是 旨在最佳地服务具有认知问题的退伍军人的独特特征。例如， 我们不知道有认知挑战的退伍军人是否会遵守康复计划。同样地， 我们不确定治疗反应在认知状态下是否相同。因此，研究 目的是了解老年退伍军人的治疗依从性，合规性和反应 没有认知问题参加LLWS临床试验。本研究将为1）提供有关 是否需要修改LLWS治疗以提高依从性和依从性，2）检查 LLWS治疗后基线认知状况与速度变化之间的关联，3）发现 LLWS治疗对认知的影响。这项提议的职业发展的长期目标 奖项（CDA-1）是提高研究和教育培训，以便PI建立独立 研究线开发了个性化的康复治疗，以维持安全的流动性和认知 具有不同功能能力的老年退伍军人。 PI以前是NIH的研究协调员 支持R21运动治疗研究，后来进行了自己的可行性和准实验性 研究。目前，她被哈佛医学PM＆R教授MPH的Jonathan Bean召集 弗吉尼亚州波士顿医疗保健系统的新英格兰GRECC的学校和主任。短期目标 CDA-1将获得1）康复科学的经验，2）流动性评估和治疗，3） 神经心理评估和分析，4）个性化康复治疗（老年护理 原理）和5）研究方法和授予写作技巧，为VA研究建立了强大的基础 职业。 PI将使用丰富的学术研究提供的教学课程的组合 一组专家团队的环境，动手研究培训以及可以提供广泛的专家 知识和支持她的研究。拟议的研究具有重要的和创新的作用 有关如何量身定制创新的康复护理的信息，以更好地适应退伍军人的个人需求。