Expanding Exercise Programming for Veterans Through Telehealth

通过远程医疗扩大退伍军人的锻炼计划

• 批准号: 10537533
• 负责人: LAUREN M ABBATE
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537533
• 关键词: Address; Adherence; Administrator; Adult; Ambulatory Care Facilities; Cardiac; Caring; Characteristics; Chronic; Chronic Disease; Chronic lung disease; Communities; Data; Data Collection; Degenerative polyarthritis; Development; Ensure; Environment; Equipment; Evidence based intervention; Exercise; Feedback; Focus Groups; Future; Guidelines; Health; Health Technology; Healthcare; High Prevalence; Home; Human Resources; Improve Access; Individual; Instruction; Integrated Health Care Systems; Internet; Intervention; Interview; Lower Extremity; Maintenance; Mentorship; Methodology; Methods; Modeling; Monitor; Participant; Phase; Physical Function; Physical activity; Population; Practical Robust Implementation and Sustainability Model; Provider; Public Health; Qualitative Methods; Quality of life; Randomized; Recommendation; Research; Research Personnel; Resources; Site; Social support; Surveys; Technology; Text Messaging; Training; Translating; Veterans; Veterans Health Administration; Work; acceptability and feasibility; care delivery; career; contextual factors; design; dissemination science; effectiveness testing; evidence base; exercise intervention; exercise program; exercise training; experience; flexibility; formative assessment; health care availability; implementation evaluation; implementation science; implementation trial; improved; innovation; instructor; multidisciplinary; pilot trial; prevent; program dissemination; programs; pulmonary rehabilitation; remote delivery; response; skills; stakeholder perspectives; telehealth; therapy development; trial design

Background: Exercise is an evidence-based intervention for the management of chronic conditions, yet the majority of Veterans are inactive. Group telehealth (GT) delivered exercise can potentially improve access to and participation in exercise. GT exercise sessions may increase exercise participation by providing social support, but a better understanding of the feasibility and acceptability of this format is needed. Telehealth delivered exercise programs should be designed with initiation and maintenance phases, but there is not consensus regarding the strategies for delivering exercise maintenance interventions. Skills for exercise initiation and maintenance differ, and interventions that focus on one or the other are not likely to result in sustained exercise participation. Significance/Impact: As the Veterans Health Administration is the largest integrated health care system in the US, implementing successful exercise programs could have a profound impact of public health. National priorities including telehealth and access to care as well as management of chronic conditions will be addressed by the development of this GT exercise initiation and maintenance intervention. Innovation: GT exercise combines the benefits of group exercise sessions, such as social support, and telehealth technology. There have been no studies comparing GT exercise booster sessions plus text messaging to text messaging alone to support exercise maintenance. These two strategies will be used as a multi-faceted approach to improving exercise maintenance. Specific Aims: Aim 1: Adapt evidenced-based exercise components for a group telehealth (GT) exercise intervention, guided by stakeholder input. Using qualitative methods, I will explore the perspectives of stakeholders through focus groups and interviews. Intervention development will include an iterative approach and formative evaluation. Aim 2: Conduct a randomized pilot trial to assess the feasibility and acceptability of the GT exercise initiation and maintenance program. I will use lower extremity osteoarthritis (OA) as a model to conduct this work because: 1) lower extremity osteoarthritis (OA) is a prevalent condition among Veterans, 2) exercise is a first line recommendation for the management of lower extremity OA, and 3) I have previous experience in OA. Veterans with lower extremity OA (n=50) will be randomized to the intervention. I will assess feasibility (i.e. referral, retention, data collection) and acceptability (i.e. number of sessions attended, number of text message responses, participant and provider feedback). Aim 3: Determine contextual factors related to successful implementation and sustainability of telehealth- delivered exercise programs within VA. Gerofit, an existing telehealth-delivered VA exercise program implemented at multiple sites, will be used as a model. An explanatory sequential mixed methods design will be used to describe site characteristics and simultaneously explore the perspectives of the site personnel, using survey and interview data. Methodology: The Practical Robust Implementation and Sustainability Model (PRISM), a conceptual framework for translating health interventions into practice, will be used with Dissemination and Implementation Science methods. Specifically, qualitative methods will be used to obtain stakeholder perspectives to design a GT delivered exercise program. A randomized pilot trial design will be used to pilot the GT exercise intervention to evaluate feasibility and acceptability. Mixed methods will be used to identify contextual factors related to successful implementation and sustainment. Next Steps/Implementation: This formative work will be used in a future larger, single site trial to test the effectiveness and evaluate the implementation of the GT exercise initiation and maintenance intervention.

背景：运动是治疗慢性病的一种循证干预措施，但 大多数退伍军人都不活跃。团体远程医疗 (GT) 提供的锻炼可能会改善获得服务的机会 和参与锻炼。 GT 锻炼课程可以通过提供社交活动来增加锻炼参与度 支持，但需要更好地了解这种格式的可行性和可接受性。远程医疗 交付的锻炼计划应设计有启动和维持阶段，但没有 关于提供运动维持干预措施的策略达成共识。锻炼技巧 启动和维持是不同的，专注于其中之一的干预措施不太可能导致 持续的运动参与。 意义/影响：由于退伍军人健康管理局是美国最大的综合医疗保健系统 在美国，实施成功的锻炼计划可能会对公众健康产生深远的影响。国家的 包括远程医疗和获得护理以及慢性病管理在内的优先事项将 通过开发 GT 练习启动和维持干预来解决这个问题。 创新：GT 锻炼结合了团体锻炼课程的好处，例如社会支持和 远程医疗技术。还没有研究比较 GT 运动强化课程和文字 短信仅以短信方式支持演练维护。这两种策略将被用作 多方面的方法来改善运动维持。 具体目标： 目标 1：采用循证运动组成部分进行团体远程医疗 (GT) 运动干预、指导 通过利益相关者的投入。使用定性方法，我将通过重点探讨利益相关者的观点 小组和访谈。干预措施的制定将包括迭代方法和形成性评估。 目标 2：进行随机试点试验，评估开始 GT 运动的可行性和可接受性 和维护计划。我将使用下肢骨关节炎（OA）作为模型来进行这项工作 因为：1) 下肢骨关节炎 (OA) 是退伍军人中的一种常见病，2) 锻炼是首要任务 治疗下肢 OA 的线路推荐，以及 3) 我以前有 OA 的经验。 患有下肢骨关节炎的退伍军人 (n=50) 将被随机分配接受干预。我将评估可行性（即 推荐、保留、数据收集）和可接受性（即参加的会议数量、短信数量 反应、参与者和提供者的反馈）。 目标 3：确定与远程医疗的成功实施和可持续性相关的背景因素 在 VA 内提供锻炼计划。 Gerofit，现有的远程医疗提供的 VA 锻炼计划 在多个站点实施，将用作模型。解释性顺序混合方法设计将 用于描述站点特征并同时探索站点人员的观点， 使用调查和访谈数据。 方法论：实用稳健实施和可持续性模型 (PRISM)，一个概念性的模型 将健康干预措施转化为实践的框架，将与传播和实施一起使用 科学方法。具体来说，定性方法将用于获取利益相关者的观点来设计 GT 发布了锻炼计划。 GT 演习将采用随机试点设计进行试点 干预以评估可行性和可接受性。将使用混合方法来识别背景因素 关系到成功的实施和维持。 后续步骤/实施：这项形成性工作将用于未来更大规模的单站点试验，以测试 有效性并评估 GT 运动启动和维持干预的实施情况。