Development of a stratified model of care for acute rehabilitation after hip fracture

髋部骨折后急性康复分层护理模式的开发

• 批准号: MR/S032819/2
• 负责人: Katie Sheehan
• 金额: $ 31.44万
• 依托单位: Queen Mary University of London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS032819%2F2
• 关键词: Development; stratified; model; care; acute

BACKGROUNDGlobally, an estimated 4.5 million people will fracture their hip in 2050. Even with surgery, 30% of patients die within a year. Among survivors, 25% never walk again and 22% change from living at home to a nursing home. Rehabilitation assists patients 'to achieve and maintain optimal functioning'. Yet, there is limited evidence to guide effective rehabilitation after hip fracture. This uncertainty may be due to between patient differences. A stratified approach could improve outcomes by tailoring rehabilitation to patient needs. Hip fracture survivors describe a tailored approach as key to recovery. Further, the NHS recommends a stratified approach as central to healthcare progress.AIMSWe aim to improve patient and carer outcomes of rehabilitation after hip fracture. Supported by patients and carers at each step, the objectives are to:1. identify patient groups with different risk of poor outcomes2. design an intervention which matches these groups to rehabilitation tailored to their needs3. feasibility test the intervention in acute hospital4. create a collaborative group with patients, carers, and the public in older adult trauma rehabilitation researchINVESTIGATION PLANIdentify patient groups: We completed a systematic review and interviewed 20 patients and carers to identify 4 factors that influence patients risk of poor outcome after rehabilitation for hip fracture- age, sex, cognition, and mobility. We will analyse of National Hip Fracture Database (NHFD) and Physiotherapy Hip Fracture Sprint Audit (PHFSA) to estimate the prediction accuracy of poor outcome following rehabilitation according to combinations of these factors. Analyses will be supported by the National Institute for Health Research (NIHR) Statistics Group at Kings College London. We will use results to classify multifactorial strata as low-, medium-, or high- risk of poor outcome. We will discuss classification acceptability with patient, carers, and allied health professionals.Intervention development and testing: Supported by patients and carers, we will design and feasibility test the intervention per the MRC framework for the development of complex interventions.We will update the Cochrane systematic review of rehabilitation after hip fracture. We will complete an overview of reviews on acute rehabilitation for adults with frailty. We will use NHFD and PHFSA to quantify current rehabilitation provision for patients classified as low-, medium-, and high- risk. We will interview allied health professionals to obtain their views on this provision. These interviews will complement completed patient interviews. We will hold stakeholder workshops to assess patient, carer, and allied health professional views on reviews, current provision, and interviews, and to design an intervention which matches low-, medium-, and high- risk strata to rehabilitation tailored to their needs. The intervention will include behaviour change techniques and allied health care. There will be a decreasing emphasis on behaviour change from low- to high- risk strata. We will obtain approvals prior to intervention testing in acute hospital to determine1. the number of eligible, recruited, and retained patients2. the acceptability of randomization, assessments, and intervention to patients, carers, and allied health professionals3. compliance with the intervention and fidelity of its delivery4. adverse events5. estimate of an effect size for a future definitive trialSackley (KCL mentor, NIHR Senior Investigator, £50,000,000 awarded for complex intervention trials) will support intervention development.Create a collaborative group: We will create a group, website, and strategy for sustained collaboration with patients, carers, and the public in older adult trauma rehabilitation research. The group will be modeled on the Stroke Research Patient and Family Group at KCL which has sustained public engagement since 2005.

背景预计到 2050 年，全球将有 450 万人发生髋部骨折。即使进行手术，仍有 30% 的患者在一年内死亡，其中 25% 的人再也无法行走，22% 的人从家里搬到疗养院接受康复治疗。然而，指导髋部骨折后有效康复的证据有限，这可能是由于患者之间的差异所致。髋部骨折幸存者将量身定制的方法视为康复的关键。此外，NHS 建议采用分层方法作为医疗保健进步的核心。目标我们的目标是在患者和护理人员的支持下改善患者和护理人员的康复效果。患者护理人员在每个步骤中的目标是： 1. 确定具有不同不良结果风险的患者群体 2. 设计符合这些群体需求的干预措施 3. 测试急性医院干预措施的可行性 4.患者、护理人员和老年人创伤康复研究中的公众调查计划确定患者群体：我们完成了系统回顾并采访了 20 名患者和护理人员，以确定影响患者髋部骨折康复后不良结果风险的 4 个因素——年龄、性别、认知和活动能力。分析国家髋部骨折数据库（NHFD）和物理治疗髋部骨折冲刺审核（PHFSA），根据这些因素的组合来估计康复后不良结果的预测准确性。将得到伦敦国王学院国家健康研究所 (NIHR) 统计小组的支持，我们将使用结果将多因素分层分类为低、中或高风险不良结果。我们将与患者讨论分类的可接受性。干预措施开发和测试：在患者和护理人员的支持下，我们将根据 MRC 框架设计干预措施并进行可行性测试，以开发复杂的干预措施。我们将更新髋部骨折后康复的 Cochrane 系统评价.我们将完成对虚弱成人急性康复的审查概述 我们将使用 NHFD 和 PHFSA 来量化当前为低、中和高风险患者提供的康复服务 我们将采访专职医疗专业人员以获取他们对此的看法。这些访谈将补充已完成的患者访谈，以评估患者、护理人员和专职医疗专业人员对审查、当前提供和访谈的看法，并设计与低、中和高相匹配的干预措施。 - 针对康复的风险层干预措施将包括行为改变技术和联合医疗保健，从低风险阶层到高风险阶层，我们将获得批准，以确定1。合格、招募和保留的患者2.患者、护理人员和专职医疗人员对随机化、评估和干预的接受程度3。萨克利（KCL 导师、NIHR 高级研究员，复杂干预试验奖励 50,000,000 英镑）将支持干预措施的开发。创建一个协作小组：我们将创建一个小组、网站和策略，以便与老年人的患者、护理人员和公众进行持续合作该小组将以 KCL 的中风研究患者和家庭小组为蓝本，该小组自 2005 年以来一直持续受到公众参与。