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.

全膝关节置换术 (TKA) 后的康复治疗通常比较通用且效率低下； 无论他们的个人需求、偏好或期望如何，康复的内容和剂量都是相同的。 这种通用治疗模式在退伍军人健康管理局 (VHA) 中将是不可持续的，因为 在不久的将来，全膝关节置换手术和术后护理的需求将呈指​​数级增长。 提高 TKA 康复效率的策略，像 VHA 这样的组织将很难满足和 支付这种手术需求，退伍军人可能无法及时获得他们所需的术后护理 为了实现最佳恢复，我们开发了一种创新的临床决策支持 (CDS) 工具来优化。 利用类似历史患者的实际康复数据，该工具可以预测 TKA 康复的效率。 新患者 TKA 后的康复轨迹这使得步兵能够 (1) 分配康复资源。 根据个人需求，(2) 确定手术后早期面临次优结果风险的退伍军人，(3) 量身定制 根据退伍军人的独特目标和临床表现制定治疗策略，以及 (4) 监测退伍军人的康复情况 相对于整个项目的预期术后康复，我们建议扩大 CDS。 通过根据个人退伍军人的预测恢复情况制定使用指南（目标 1). 随后，这些指南将通过三轮德尔菲流程获得专家共识。 我们将在四个 VHA 中测试 CDS 工具对退伍军人功能恢复和康复利用的影响 使用前后设计的门诊物理治疗诊所（目标 2）我们将比较患者报告的功能。 接受治疗的退伍军人群体之间的（下肢功能量表）和物理治疗就诊利用率 此外，我们还将收集参与 VHA 的新人和退伍军人的数据。 关于将我们的工具转化为临床实践，以评估其在整个范围内传播的准备情况 VHA（目标 3）这将包括来自参与者焦点小组的定性数据和定量过程数据。 最终，我们希望这项研究能够作为扩展我们工具的模板。 为众多 VHA 人群提供康复及其他方面的能力。