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

基本信息

批准号：
10768215
负责人：
Jennifer E. Stevens-Lapsley
金额：
$ 6.18万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10768215
关键词：
Activities of Daily Living Acute Address Administrative Supplement Admission activity Adopted Adoption Adult Adverse event Award Behavioral Cessation of life Characteristics Client satisfaction Clinical Communities Complex Country Data Deterioration Dose Education Effectiveness Elderly Eligibility Determination Evaluation Event Funding Future Gait speed Health Home Hospitalization Institutionalization Instruction Intervention Length of Stay Long-Term Care Maintenance Measures Medical Methods Musculoskeletal Nursing Homes Outcome Parents 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

项目摘要

Project Summary Abstract (from funded parent award) 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（来自受资助的家长奖）在美国，837 万 65 岁以上的成年人明年将住院，这通常会产生严重而持久的后果，包括身体机能严重恶化。继住院期间，约 135 万身体状况不佳的患者需要在熟练的护理机构进行康复 (SNF) 每年都致力于解决因身体状况不佳而导致的有害的肌肉骨骼和功能缺陷。不幸的是，当前 SNF 的康复模式并不能充分恢复身体功能，这直接导致贫困社区的出院率。引人注目的是，只有 52% 的患者因 SNF 入院被释放到社区环境（例如家中），这表明需要进行范式转变来优化 SNF 内的康复。目前，SNF 的常规护理康复包括低强度康复生理上不足以引起骨骼肌力量有意义的变化的干预措施和身体机能。为了解决这些缺陷，高强度阻力康复模式已经被提出。被证明可以改善结果，包括更好的身体机能、提高社区出院率，以及缩短停留时间，具有成本效益。拟议的务实研究旨在应用这种康复多个 SNF 的范例，以进一步评估高强度阻力康复的有效性（目标 1)，同时评估成功实施的流程、机制和决定因素（目标 2）。我们提出一种整群随机实用试验设计，其中将进行高强度干预（15 个 SNF）与常规护理相比（15 个 SNF）。身体机能的有效性将通过变化来确定从入院到出院的患者步态速度（主要结果）。实施策略将是通过影响范围（接受干预治疗的患者比例）、采用率（治疗师比例）进行评估适当采取干预措施）、实施（保真度评估）和维护（长期保真度评估）的干预。这项研究将首次对高住院后入住 SNF 的患者的强度康复。此外，通过系统通过对各种 SNF 的实施进行比较和深入分析，本研究将提供关键的关于实施障碍和促进因素的见解。这项研究的总体结果有潜力 1) 转变 SNF 康复护理模式； 2) 优化患者治疗效果和独立性以及 3) 批判性地为今后在急性期后大规模实施高强度康复的工作提供信息设置。