Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities

推进熟练护理机构中老年人的康复模式

• 批准号: 10659131
• 负责人: Jennifer E. Stevens-Lapsley
• 金额: $ 56.25万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659131
• 关键词: Activities of Daily Living; Acute; Address; Admission activity; Adopted; Adoption; Adult; Adverse event; Behavioral; Cessation of life; Characteristics; Client satisfaction; Clinical; Communities; Complex; Country; Data; Deterioration; Dose; Education; Effectiveness; Elderly; Eligibility Determination; Evaluation; Event; Future; Gait speed; Health; Home; Hospitalization; Institutionalization; Instruction; Intervention; Length of Stay; Long-Term Care; Maintenance; Measures; Medical; Methods; Musculoskeletal; Nursing Homes; Outcome; Patient Admission; Patient Discharge; Patient-Focused Outcomes; Patients; Phase; Physical Function; Physical Performance; Physical activity; Physiological; Population; Predictive Factor; Process; Quality of Care; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Rehabilitation therapy; Resistance; Site; Skeletal Muscle; Skilled Nursing Facilities; Standardization; Therapeutic; Time; Training; Variant; Work; acute care; appropriate dose; clinical practice; community setting; contextual factors; cost effective; deconditioning; disability; effectiveness evaluation; experience; functional improvement; hospital readmission; human old age (65+); implementation context; implementation facilitators; implementation strategy; improved; improved outcome; indexing; innovation; insight; muscle strength; nursing skill; poor communities; pragmatic randomized trial; pragmatic study; pressure; primary endpoint; primary outcome; provider adoption; readmission rates; rehabilitation paradigm; rehabilitation strategy; rehabilitative care; resistance exercise; standard of care; success; theories; treatment as usual; trial design

Project Summary/Abstract In the U.S., 8.37 million adults over age 65 will experience a hospital stay during the next year, which often has serious and long-lasting consequences including profound deterioration in physical function. Following a hospital stay, around 1.35 million patients with deconditioning require rehabilitation in a skilled nursing facility (SNF) each year to address the deleterious musculoskeletal and functional deficits from deconditioning. Unfortunately, current rehabilitation paradigms in SNFs do not adequately restore physical function, which directly contributes to poor community discharge rates. Strikingly, only 52% of all patients admitted to SNFs are discharged to a community setting (e.g., home), which suggests a paradigm shift is required to optimize rehabilitation within SNFs. Currently, usual care rehabilitation in SNFs consists of low-intensity rehabilitation interventions, which are physiologically inadequate to induce meaningful changes in skeletal muscle strength and physical function. To address these pitfalls, a high-intensity resistance rehabilitation paradigm has been shown to improve outcomes including better physical function, increased community discharge rates, and cost-effective reductions in length of stay. The proposed pragmatic study seeks to apply this rehabilitation paradigm to multiple SNFs to further evaluate the effectiveness of high-intensity resistance rehabilitation (Aim 1), while evaluating processes, mechanisms, and determinants of successful implementation (Aim 2). We propose a cluster randomized pragmatic trial design in which a high-intensity intervention (15 SNFs) will be compared to usual care (15 SNFs). Effectiveness in terms of physical function will be determined via change in patient gait speed (primary outcome) from admission to discharge. Implementation strategies will be evaluated by reach (proportion of patients treated with the intervention), adoption (proportion of therapists appropriately adopting the intervention), implementation (fidelity assessments), and maintenance (long-term fidelity assessments) of the intervention. This study will provide the first large-scale evaluation of high- intensity rehabilitation for patients admitted to SNFs following hospitalization. Additionally, through systematic comparison and in-depth analysis of implementation across a variety of SNFs, this study will provide critical insight regarding barriers and facilitators of implementation. Overall findings from this study have the potential to 1) shift SNF rehabilitation care paradigms; 2) optimize patient outcomes and independence and 3) critically inform future work aimed at wide-scale implementation of high-intensity rehabilitation across post-acute settings.

项目摘要/摘要 在美国，65岁以上的837万成年人将在明年经历住院住院 具有严重且持久的后果，包括身体机能的严重恶化。遵循 医院住院，约有135万患者需要在熟练的护理设施中康复 （SNF）每年解决有害的肌肉骨骼和功能性缺陷，从而解决。 不幸的是，SNF中当前的康复范例不能充分恢复身体功能，这 直接导致社区出院率不佳。令人惊讶的是，只有52％的所有患者被接纳为SNF 被排放到社区环境（例如家庭），这表明需要进行范式转变以进行优化 SNF中的康复。目前，SNFS中常规护理康复由低强度康复组成 干预措施在生理上不足以引起骨骼肌肉力量有意义的变化 和身体功能。为了解决这些陷阱，高强度的抵抗性康复范式已经 证明可以改善结果，包括更好的身体机能，提高社区出院率和 降低住院时间的成本效益。拟议的务实研究旨在应用此康复 范式到多个SNF，以进一步评估高强度抗性康复的有效性（AIM 1），同时评估成功实施的过程，机制和决定因素（AIM 2）。我们 提出簇随机务实的试验设计，其中高强度干预（15 SNF）为 与通常的护理相比（15个SNF）。在身体机能方面的有效性将通过变更确定 从入院到出院的患者步态速度（主要结果）。实施策略将是 通过触及（接受干预治疗的患者比例）评估，采用（治疗师的比例） 适当采用干预措施），实施（保真度评估）和维护（长期 干预措施的保真度评估。这项研究将提供第一个对高级的大规模评估 住院后接受SNF的患者的强度康复。另外，通过系统 对各种SNF的实施的比较和深入分析，本研究将提供关键 有关实施障碍和促进者的见解。这项研究的总体发现具有潜力 到1）转移SNF康复护理范例； 2）优化患者的结果和独立性以及3）批判性 告知未来的工作，旨在广泛实施高强度的康复 设置。