Synergizing home health rehabilitation therapy to optimize patients’ activities of daily living

协同家庭健康康复治疗，优化患者的日常生活活动

基本信息

批准号：
10621820
负责人：
Chiung-ju NA Liu
金额：
$ 18.65万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10621820
关键词：
Activities of Daily Living Acute Adjuvant Therapy Admission activity Adverse event Bathing Caring Collaborations Communities Data Elderly Emergency department visit Exercise Frail Elderly Goals Hand functions Health Health Care Costs Health Personnel Health Policy Health Status Home Home Care Services Home visitation Hospitalization Independent Living Intervention Intervention Trial Investigation Leg Length of Stay Long-Term Care Lower Extremity Measures Medical Mission Modification Motor Motor Skills Occupational Therapy Outcome Patient Care Patient Outcomes Assessments Patient Participation Patients Performance Personal Satisfaction Physical Capacity Physical Exercise Physical Function Physical Performance Physical therapy Population Porifera Prevention Process Protocols documentation Randomized Randomized, Controlled Trials Rehabilitation therapy Research Risk Risk Factors Scientist Self Care Services Testing Training Activity Translating Upper Extremity Visit acute care age related disability effective intervention effectiveness/implementation trial evidence base experience falls follow-up functional decline functional status health care service health care settings high risk hospital readmission improved innovation mortality motor learning multiple chronic conditions muscle strength patient engagement pilot test premature preservation prevent primary outcome programs rehabilitation service rehabilitative care resistance exercise satisfaction scale up skills success synergism treatment duration

项目摘要

Project Summary Regaining the ability to take care of oneself after an illness or medical episode is critical for older adults to maintain independent living at home in the community. Each year, 3 to 4.5 million older adults receive home health care services that provide skilled rehabilitation therapy in their home. These patients experience reduced capacity to perform activities of daily living (ADL) independently, which is a significant risk factor for long-term care placement. Recent data has shown that 42% of home health patients do not improve in ADL at discharge. There is currently a lack of evidence-based rehabilitation programs in home health. Increasing activity-based intervention in home health care rehabilitation could be the key to improve patients’ ADL independence. The objective of this R21 application is to pilot test an ADL-enhanced program as an adjuvant therapy to usual home health rehabilitation to improve patients’ ADL outcome. The ADL-enhanced program facilitates patients’ participation in ADL first by lowering the task demand using a compensatory approach. As the patient increases physical capacity as a result of physical therapy services, the ADL-enhanced program shifts to a restorative approach, which increases the task demand to help the patient channel the improved physical capacity to better activity performance. We will implement the activity grading principles to increase task demand, which has been tested in our prior study, in the proposed restorative approach. We found that older adults who practiced daily activities with increased activity demand after exercise have less decline in ADL than older adults who practiced physical exercise only. The ADL-enhanced program is innovative because it manipulates the gradient of activity challenge by delivering the compensatory approach and the restorative approach in sequence over a six-week treatment period. This activity-based paradigm does not exist in current home health care practice. Our central hypothesis is that the ADL-enhanced program will synergize with usual rehabilitation therapy and augment the outcome in ADL. We propose a pilot randomized controlled trial to investigate the preliminary effects of the ADL- enhanced program. Forty-eight home health patients will be randomly assigned to receive the ADL-enhanced program with usual rehabilitation therapy versus usual rehabilitation therapy only. Our specific aims are to: 1) estimate the preliminary effect of the ADL-enhanced program on improving ADL; 2) estimate the preliminary effect of the ADL-enhanced program on improving physical functioning of the upper extremity and the lower extremity; and 3) assess the program completion rate, satisfaction rate, and adverse event rate (e.g., falls and hospital admissions). The proposed project aligns with the NIA’s mission to develop effective interventions to maintain health, well-being, and function as well as to prevent or reduce the burden of age-related disabilities. Research findings will be used to develop a hybrid effectiveness-implementation trial of the ADL-enhanced program, laying the groundwork for potential large-scale implementation in the home health care setting.

项目概要对于老年人来说，在生病或发生医疗事件后恢复自理能力至关重要每年有 3 至 450 万老年人在家中保持独立生活。在家中提供熟练康复治疗的医疗保健服务使这些患者的经历减少。独立进行日常生活活动（ADL）的能力，这是长期影响的一个重要风险因素最近的数据显示，42% 的家庭健康患者出院时 ADL 没有改善。目前，家庭健康领域缺乏基于证据的康复计划。家庭保健康复干预可能是提高患者 ADL 独立性的关键。此 R21 应用程序的目的是试点测试 ADL 增强计划作为普通家庭的辅助疗法健康康复以改善患者的 ADL 结果 ADL 增强计划有利于患者的康复。随着患者的增加，首先通过使用补偿方法降低任务需求来参与 ADL。由于物理治疗服务的影响，ADL 增强计划转向恢复性计划方法，增加任务需求，帮助患者将改善的身体能力更好地运用实行活动分级原则，增加任务要求。在我们之前的研究中，在所提出的恢复方法中进行了测试，我们发现每天练习的老年人。与进行锻炼的老年人相比，锻炼后活动需求增加的活动的 ADL 下降幅度较小仅体育锻炼。 ADL 增强计划具有创新性，因为它可以控制活动梯度。通过在六周内依次实施补偿性方法和恢复性方法来应对挑战我们当前的家庭医疗保健实践中不存在这种基于活动的模式。假设 ADL 增强计划将与常规康复治疗产生协同作用，并增强我们提出了一项随机对照试验来研究 ADL 的初步效果。 48 名家庭健康患者将被随机分配接受 ADL 增强计划。常规康复治疗计划与仅常规康复治疗的比较我们的具体目标是：1) 估计 ADL 增强计划对改善 ADL 的初步效果 2) 估计初步效果； ADL增强计划对改善上肢和下肢身体机能的效果肢体；3) 评估计划完成率、满意度和不良事件率（例如跌倒和拟议的项目符合 NIA 制定有效干预措施的使命。保持健康、福祉和功能，并预防或减轻与年龄相关的残疾负担。研究结果将用于开发 ADL 增强型的混合有效性实施试验计划，为家庭医疗保健环境中潜在的大规模实施奠定了基础。