接受康复治疗人群的自我管理计划 My Therapy 的结果：一项阶梯式楔形集群随机临床试验。

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial.

机构信息

Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia.

出版信息

Ann Phys Rehabil Med. 2024 Nov;67(8):101867. doi: 10.1016/j.rehab.2024.101867. Epub 2024 Aug 21.

DOI:10.1016/j.rehab.2024.101867

PMID:39173328

Abstract

BACKGROUND

Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays.

OBJECTIVES

To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation.

METHODS

This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge.

RESULTS

2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13).

CONCLUSIONS

My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.

摘要

背景

自我管理计划可以增加康复住院患者规定治疗性运动和活动的时间，这与更好的功能结果和更短的住院时间有关。

目的

确定在接受物理康复治疗的患者中，实施自我管理计划（“我的治疗”）相对于常规护理是否能提高功能独立性。

方法

这是一项阶梯式楔形、集群随机试验，在澳大利亚维多利亚州的 4 家医院的 9 个集群（普通康复病房）中进行，历时 54 周（9 个 6 周的周期，2021 年 4 月至 2022 年 4 月）。我们纳入了所有在参与病房接受康复治疗的成年人（≥18 岁）。干预措施包括常规护理加“我的治疗”，其中包括从监督课程中选择的一组练习和活动，这些练习和活动可以在没有监督或协助的情况下安全进行。主要结局是功能独立性测量（FIM™）中达到最小临床重要差异（MCID）的参与者比例，以及从入院到出院时总 FIM™评分的变化。

结果

共招募了 2550 名参与者（62%为女性）（对照组：n=1458，干预组：n=1092），平均（SD）年龄为 77（13）岁，37%为骨科诊断。在干预条件下，与对照条件下每天 4（SD 14）分钟相比，参与者报告每天进行 29（SD 21）分钟的自我导向治疗。在 FIM™中达到 MCID 的可能性方面，对照条件和干预条件之间没有差异（调整后的优势比 0.93，95%CI 0.65 至 1.31），FIM™评分的变化也没有差异（调整后的平均差异：-0.27 单位，95%CI-2.67 至 2.13）。