Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation

通过远程医疗为下肢截肢退伍军人提供步行锻炼的可持续性

基本信息

批准号：
10534859
负责人：
Cory L Christiansen
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
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：
2022-11-01 至 2026-10-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10534859
关键词：
Accelerometer Activities of Daily Living Acute Address Adopted Adoption Adverse effects Amputation Behavior Chronic Clinic Clinical Colorado Communities Continuity of Patient Care Data Diabetes Mellitus Discipline Education Effectiveness Enrollment Ensure Environment Exercise Focus Groups Future General Population Goals Health Healthcare Systems Home Individual Infrastructure Interruption Intervention Knowledge Life Limb Prosthesis Link Lower Extremity Maintenance Measures Medical Methods Modeling Monitor Outcome Participant Patient Self-Report Patients Peer Group Performance Peripheral arterial disease Persons Phase II Clinical Trials Physical Exercise Physical Function Physical Rehabilitation Physical activity Program Sustainability Prosthesis Provider Randomized Randomized Controlled Trials Reach Effectiveness Adoption Implementation and Maintenance Rehabilitation therapy Resources Self Efficacy Self Management Social support Step Tests Structure Techniques Technology Testing Time Training Training Support Translating Translations Treatment Efficacy Veterans Walking Well in self arm attentional control base behavior change clinical implementation clinical translation comorbidity design disability efficacy outcomes evidence base exercise intensity exercise intervention exercise rehabilitation functional independence implementation design improved innovation intervention cost limb amputation multidisciplinary novel novel strategies peer peer support physical conditioning population health primary outcome programs prosthesis wearer rehabilitation paradigm rehabilitation strategy remote monitoring rural area secondary outcome sedentary lifestyle self-management program service utilization social engagement telehealth telerehabilitation trend trial design underserved area wearable sensor technology

项目摘要

Veterans living with lower-limb amputation have poor physical health outcomes, multiple chronic comorbidities, high medical service utilization, and high levels of disability. Self-reported disability for people living with lower- limb amputation is greater than 95% of the general population. One way to reduce disability for Veterans with lower-limb amputation is for them to participate in life-long sustained walking exercise. Regular exercise improves functional independence and mental well-being, and reduces adverse effects of common comorbidities associated with lower-limb amputation, such as diabetes and peripheral artery disease. However, most Veterans with lower-limb amputation do not regularly exercise. Only 50% of people with lower- limb amputation achieve levels of walking activity that support participation in their local community, creating a critical need to improve physical exercise participation after lower-limb amputation. Evidence suggests that clinician-supported exercise in a person’s home living environment that includes evidence-based promotion of patient self-management has promise for interrupting the cycle of elevated sedentary behavior and poor health outcomes. Therefore, the primary aim of this randomized controlled superiority trial is to determine if a telerehabilitation walking exercise self-management program produces clinically meaningful walking exercise sustainability compared to attention-control education. This novel, low-cost intervention includes a novel combination of piloted behavior-change methods and clinical resources, including VA multidisciplinary telehealth sessions, individual exercise self-management training, and VA Whole Health peer-group sessions. In addition, the intervention is integrated within an established VA Regional Amputation Center, using established VA clinical telerehabilitation and technology. Exercise and physical activity will be monitored as a continuous daily outcome, with secondary outcomes assessed at a baseline test and then after 6 and 18 months of intervention participation. The primary outcome will be accelerometer-assessed daily walking step count monitored continuously each day across the 18-month study period. Secondary outcomes are designed to assess the potential to assess how to best translate the walking exercise intervention into conventional VA amputation rehabilitation. These secondary outcomes include measures of intervention reach, intervention efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation with a home-based exercise model of life-long exercise support from clinicians and peers. The trial results will advance rehabilitation knowledge and provide the necessary evidence for larger clinical translation of self-management intervention to sustain walking exercise for Veterans living with lower-limb amputation.

生活截肢截肢的退伍军人的身体健康成果差，多种慢性合并症，高医疗服务利用率和高水平的残疾。自我报告的残疾肢体截肢大于一般人群的95％。减少退伍军人残疾的一种方法下限截肢是为了让他们参加终身持续的步行运动。定期运动改善功能独立性和心理健康，并减少共同的不利影响与下LIMB截肢相关的合并症，例如糖尿病和外周动脉疾病。但是，大多数具有较低截肢截肢的退伍军人不会定期运动。只有50％的人肢体截肢达到了支持参与当地社区的步行水平，创造了一个降低截肢后改善体育锻炼的迫切需要。有证据表明这一点在一个人的家庭生活环境中，临床支持的运动包括基于证据的促销患者自我管理有望中断久坐行为升高和健康状况不佳的周期结果。因此，这项随机对照优势试验的主要目的是确定是否a Telerehabilitation步行练习自我管理计划会产生临床意义的步行练习与注意力控制教育相比，可持续性。这部小说，低成本的干预包括一部小说试验行为改变方法和临床资源的结合，包括VA多学科远程医疗会议，个人运动自我管理培训和VA全健康同伴组。此外，使用干预措施集成在已建立的VA区域截肢中心中已建立的VA临床远离式居民和技术。运动和体育锻炼将被监测为连续的每日结局，在基线测试中评估了次级结果，然后在6和18之后进行评估几个月的干预参与。主要结果将是通过加速度计评估的每日步行步骤在整个18个月的研究期间，每天不断监控计数。次要结果是设计的评估评估如何最好地将步行运动干预转化为常规VA的潜力截肢康复。这些次要结果包括干预措施，干预功效，临床采用的可能性，临床实施潜力以及参与者的能力保持长期的运动行为。本研究中使用的独特康复范式解决了下limb截肢后长期久坐的生活方式的问题，其基于家庭的运动模型临床医生和同伴的终身运动支持。试验结果将提高康复知识和为自我管理干预措施进行更大的临床翻译提供了必要的证据，以维持居住在较低截肢的退伍军人的步行练习。