Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities
Project Number5R01AG072693-04
Contact PI/Project LeaderSTEVENS-LAPSLEY, JENNIFER E.
Awardee OrganizationUNIVERSITY OF COLORADO DENVER
Description
Abstract Text
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.
Public Health Relevance Statement
PROJECT NARRATIVE
This study seeks to provide large-scale, foundational evidence that high-intensity rehabilitation is effective and
can be systematically implemented to improve functional outcomes for patients admitted to skilled nursing
facilities following hospitalization. Additionally, this study will generate a descriptive overview of factors that
predict implementation success while informing effective implementation strategies for future skilled nursing
facilities innovation. Overall, this study is a critical step in advancing clinical practice to establish high-intensity
rehabilitation as an effective standard of care in skilled nursing facilities to shift current treatment away from
low-intensity, conservative interventions.
NIH Spending Category
No NIH Spending Category available.
Project Terms
Activities of Daily LivingAcuteAddressAdmission activityAdoptedAdoptionAdultAdverse eventBehavioralCessation of lifeCharacteristicsClient satisfactionClinicalCommunitiesComplexCountryDataDeteriorationDoseEducationEffectivenessEligibility DeterminationEvaluationEventFutureGait speedHealthHomeHospitalizationInstitutionalizationInstructionInterventionLength of StayLong-Term CareMaintenanceMeasuresMedicalMethodsMusculoskeletalNursing HomesOutcomePatient AdmissionPatient DischargePatient-Focused OutcomesPatientsPhasePhysical FunctionPhysical PerformancePhysical activityPhysiologicalPopulationPredictive FactorProcessQuality of CareRandomized, Controlled TrialsReach, Effectiveness, Adoption, Implementation, and MaintenanceRehabilitation therapyResistanceSiteSkeletal MuscleSkilled Nursing FacilitiesStandardizationTherapeuticTimeTrainingVariantWorkacute careappropriate doseclinical practicecommunity settingcontextual factorscost effectivedeconditioningdisabilityeffectiveness evaluationexperiencefunctional improvementhospital readmissionhuman old age (65+)implementation contextimplementation facilitatorsimplementation strategyimprovedimproved outcomeindexinginnovationinsightmuscle strengthnursing skillolder adultpoor communitiespragmatic randomized trialpragmatic studypressureprimary endpointprimary outcomeprovider adoptionreadmission ratesrehabilitation paradigmrehabilitation strategyrehabilitative careresistance exercisestandard of caresuccesstheoriestreatment as usualtrial design
Eunice Kennedy Shriver National Institute of Child Health and Human Development
$100,000
Year
Funding IC
FY Total Cost by IC
Sub Projects
No Sub Projects information available for 5R01AG072693-04
Publications
Publications are associated with projects, but cannot be identified with any particular year of the project or fiscal year of funding. This is due to the continuous and cumulative nature of knowledge generation across the life of a project and the sometimes long and variable publishing timeline. Similarly, for multi-component projects, publications are associated with the parent core project and not with individual sub-projects.
No Publications available for 5R01AG072693-04
Patents
No Patents information available for 5R01AG072693-04
Outcomes
The Project Outcomes shown here are displayed verbatim as submitted by the Principal Investigator (PI) for this award. Any opinions, findings, and conclusions or recommendations expressed are those of the PI and do not necessarily reflect the views of the National Institutes of Health. NIH has not endorsed the content below.
No Outcomes available for 5R01AG072693-04
Clinical Studies
No Clinical Studies information available for 5R01AG072693-04
News and More
Related News Releases
No news release information available for 5R01AG072693-04
History
No Historical information available for 5R01AG072693-04
Similar Projects
No Similar Projects information available for 5R01AG072693-04