Improving Rehabilitation for Veterans After Total Knee Arthroplasty Using Individualized Recovery Trajectories

使用个性化恢复轨迹改善退伍军人全膝关节置换术后的康复

• 批准号: 10424875
• 负责人: Jennifer E. Stevens-Lapsley
• 金额: --
• 依托单位: VA EASTERN COLORADO 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: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424875
• 关键词: Address; Affect; Ambulatory Care Facilities; Caring; Clinic; Clinical; Consensus; Data; Effectiveness; Ensure; Expenditure; Focus Groups; Future; Goals; Guidelines; Health; Healthcare; Improve Access; Individual; Knee Osteoarthritis; Lower Extremity; Methods; Monitor; Operative Surgical Procedures; Orthopedics; Outcome; Outpatients; Pain; Participant; Patient Self-Report; Patients; Persons; Physical therapy; Population; Postoperative Care; Postoperative Period; Procedures; Process; Readiness; Recommendation; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Resources; Risk; Services; Statistical Models; Surveys; System; Testing; Time; Translations; Veterans; Veterans Health Administration; Visit; Waiting Lists; barrier to care; base; clinical application; clinical decision support; clinical practice; cohort; comorbidity; cost; design; disability; dosage; expectation; functional outcomes; improved; improved outcome; individual patient; individualized medicine; innovation; knee replacement arthroplasty; patient oriented; patient population; physical therapist; point of care; post-operative rehabilitation; preference; prospective; rehabilitation service; support tools; tool; treatment strategy; usability

Rehabilitation after total knee arthroplasty (TKA) is typically generic and inefficient; most patients receive the same contents and dosage of rehabilitation regardless of their individual needs, preferences, or expectations. This generic treatment paradigm will be unsustainable in the Veterans Health Administration (VHA) as the demand for TKA surgery and postoperative care increase exponentially in the near future. Without new strategies to improve the efficiency of TKA rehabilitation, organizations like the VHA will struggle to meet and pay for this surging demand, and Veterans may be denied timely access to the postoperative care they need for optimal recovery. We have developed an innovative new clinical decision support (CDS) tool to optimize efficiency in TKA rehabilitation. Using the actual recovery data of similar historical patients, the tool can predict the recovery trajectory for new patients after TKA. This allows clinicians to (1) allocate rehabilitation resources based upon individual need, (2) identify Veterans at risk for suboptimal outcomes early after surgery, (3) tailor treatment strategies to Veterans’ unique goals and clinical presentation, and (4) monitor Veterans’ recovery relative to expected throughout postoperative rehabilitation. In this project, we propose to expand the CDS tool’s capabilities by establishing utilization guidelines based upon individual Veteran’s predicted recovery (Aim 1). These guidelines will be established by expert consensus in a three round Delphi process. Subsequently, we will test the CDS tool’s impact on Veteran’s functional recovery and rehabilitation utilization in four VHA outpatient physical therapy clinics using a pre-post design (Aim 2). We will compare patient-reported function (Lower Extremity Functional Scale) and physical therapy visit utilization between cohorts of Veterans treated with and without the CDS tool. Additionally, we will gather data from participating VHA clinicians and Veterans regarding the translation of our tool into clinical practice to assess its readiness for dissemination throughout the VHA (Aim 3). This will include qualitative data from participant focus groups and quantitative process data regarding the tool’s utilization. Ultimately, we expect this study will serve as a template for expanding our tool’s capabilities into numerous VHA populations in rehabilitation and beyond.

总膝关节置换术（TKA）后的康复通常是通用且效率低下的；大多数患者接受 无论他们的个人需求，偏好或期望如何，康复的内容和剂量相同。 在退伍军人卫生管理局（VHA）中，这种通用治疗范式将是不可持续的 在不久的将来，对TKA手术和术后护理的需求呈指数增长。没有新的 提高TKA康复效率的策略，VHA等组织将难以见面和 支付这一激增的需求，而退伍军人可能会及时拒绝获得他们需要的术后护理 用于最佳恢复。我们已经开发了一种创新的新临床决策支持（CDS）工具来优化 TKA康复的效率。使用类似历史患者的实际恢复数据，该工具可以预测 TKA后新患者的恢复轨迹。这使临床医生可以（1）分配康复资源 基于个人需求，（2）确定手术后早期出现次优结果风险的退伍军人，（3）裁缝 为退伍军人的独特目标和临床表现的治疗策略，以及（4）监测退伍军人的恢复 相对于整个术后康复的预期。在这个项目中，我们建议扩展CD 通过基于个人退伍军人的预测恢复来建立利用指南，通过建立使用指南（AIM） 1）。这些准则将由专家共识在三轮Delphi过程中建立。随后， 我们将测试CD工具对退伍军人的功能恢复和康复利用的影响 使用前设计的门诊物理治疗诊所（AIM 2）。我们将比较患者报告的功能 （下肢功能量表）和物理疗法访问经过治疗的退伍军人队列之间的利用 使用和不使用CD工具。此外，我们将从参与的VHA临床医生和退伍军人那里收集数据 关注我们将工具转化为临床实践，以评估其在整个过程中的反射准备 VHA（目标3）。这将包括来自参与焦点小组的定性数据和定量过程数据 关于该工具的利用。最终，我们希望这项研究将成为扩展工具的模板 在康复及以后的许多VHA人群中的能力。