Modification and Pilot Testing of The Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) Intervention

心力衰竭住院后能力训练和锻炼（COACH-HF）干预措施的修改和试点测试

• 批准号: 10539371
• 负责人: Kelsey M Flint
• 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: 2023-02-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10539371
• 关键词: Address; Adherence; Aerobic; Aerobic Exercise; Age; Appointment; Area; Award; Behavior Therapy; Cardiac rehabilitation; Cardiovascular system; Caregivers; Categories; Chronic Disease; Clinical; Clinical Research; Clinical Trials Design; Colorado; Decision Making; Dose; Elderly; Enrollment; Environment; Equilibrium; Exercise; Feedback; Feeling; Focus Groups; Foundations; Funding; Genetic Transcription; Goals; Health; Health Personnel; Health behavior change; Heart failure; Home; Hospitalization; Intervention; Interview; Knowledge; Literature; Measures; Medical; Medical center; Methods; Modification; Motivation; Outcome; Participant; Patients; Pharmaceutical Preparations; Physical Function; Physical Rehabilitation; Physical therapy; Pilot Projects; Principal Investigator; Protocols documentation; Qualitative Research; Randomized; Rehabilitation therapy; Reporting; Research; Research Personnel; Resources; Specialist; Structure; Surveys; Techniques; Testing; Training; Universities; Veterans; Workload; Writing; acceptability and feasibility; arm; career; career development; comorbidity; coping; design; efficacy testing; experience; functional independence; improved; innovation; insight; interest; lens; member; novel; novel strategies; peer support; physical therapist; pilot test; post intervention; programs; rehabilitative care; skeletal muscle weakness; skills; standard of care; stressor; tertiary care; therapy design; treatment arm

Research: The current standard of care for physical rehabilitation of Veterans hospitalized for heart failure (HF) is inadequate for 3 reasons: 1) When prescribed, Veterans may fail to engage in physical rehabilitation due to feeling overwhelmed by their overall high treatment workload, 2) Home physical therapy is often under- dosed and therefore fails to achieve clinical impact, and 3) Cardiac rehabilitation (CR) is rarely prescribed. When it is utilized, its focus on moderate intensity aerobic exercise is inappropriate for severely debilitated Veterans hospitalized for HF. I am the Principal Investigator of an NIA-funded pilot study (R03AG064371) (BAMS-HF [Balance, Aerobic capacity, Mobility and Strength in HF] study), which provides older Veterans recently hospitalized for HF with a novel, rigorous 1:1 physical therapist-led home-based rehabilitation intervention that is designed to address #2 and #3 above. Although Veterans who complete the study are enthusiastic about it, they do desire contact with other BAMS-HF Veterans and [report low motivation as a significant barrier to participation.] These insights and challenges from the BAMS-HF study led to the current proposal of the Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) intervention. Based on the preliminary results of the BAMS-HF pilot study and existing literature, COACH-HF will take a 2-pronged approach to physical rehabilitation in Veterans recently hospitalized for HF: 1) Capacity Coaching from a Peer Support Specialist (a Veteran with HF), and 2) Physical therapist-led rigorous, in-home strength, balance and mobility exercise protocol that will occur 3 days/week for a maximum of 12 weeks, and monthly group exercise sessions with the physical therapist and other COACH-HF Veterans until 6 months. [Modification of the proposed COACH-HF intervention] and pilot testing will occur over the following 2 Aims: [Aim 1: Garner stakeholder feedback on the structure and delivery of the COACH-HF intervention using [12] focus groups (FGs) among 3 stakeholder categories: Veterans recently hospitalized for HF, Veterans’ caregivers, and healthcare providers. Differing perspectives from the FGs will be addressed with a small decision-making group of investigators and stakeholders. Using nominal group technique (NGT), the decision- making group will brainstorm and rank ideas for addressing key areas of disagreement. The intervention design will be modified by the PI based on the FG and NGT results. All FGs participants will be invited to give feedback on the final intervention design prior to moving forward to pilot testing (i.e. member-checking).] [Aim 2: Determine whether Capacity Coaching increases adherence to the rehabilitation intervention by randomizing 25 Veterans ≥ 55 years recently hospitalized for HF 1:1 to Capacity Coaching + Rehabilitation intervention (CC+Rehab) vs. Rehabilitation only (Rehab Only). Assess the feasibility and acceptability of rehabilitation intervention (both arms) and Capacity Coaching (CC+Rehab arm).] Candidate: I am an advanced HF trained cardiologist with an interest in physical rehabilitation for Veterans hospitalized for HF. I am co-director of the clinical CR and HF programs at the Rocky Mountain Regional (RMR) VAMC. My career goal is to become an independent VA rehabilitation researcher specializing in physical rehabilitation of Veterans hospitalized for HF. This award will help me develop the skills in qualitative research, stakeholder engagement and clinical trial design for behavioral interventions that are necessary to achieve my career goals. The next step is to write a Merit Review application that proposes testing the efficacy of the COACH-HF intervention. Environment: This research will be conducted at the Rocky Mountain Regional VA Medical Center (RMR VAMC). The RMR VAMC is a tertiary care center that is affiliated with the University of Colorado Anschutz Medical Campus. The proposed study will leverage the existing resources and culture of supporting clinical research within the RMR VAMC, Cariology Division and the Seattle-Denver Center of Innovation.

研究：目前因心力衰竭住院的退伍军人身体康复护理标准 (HF) 不充分的原因有 3 个：1) 当处方时，退伍军人可能无法进行身体康复 由于整体高治疗工作量让他们感到不知所措，2) 家庭物理治疗常常不足- 管理，因此未能达到临床效果，并且 3) 很少进行心脏康复 (CR)。 使用时，其重点是中等强度的有氧运动，不适合严重虚弱的人 因心力衰竭住院的退伍军人 我是 NIA 资助的试点研究 (R03AG064371) 的首席研究员。 （BAMS-HF [HF 中的平衡、有氧能力、灵活性和力量] 研究），为老年退伍军人提供 最近因心力衰竭住院，接受了由物理治疗师主导的新颖、严格的 1:1 家庭康复治疗 旨在解决上述问题 2 和 3 的干预措施，尽管完成研究的退伍军人是。 他们对此充满热情，确实希望与其他 BAMS-HF 退伍军人接触，并且[报告作为一个积极性较低的人 [参与的重大障碍。] BAMS-HF 研究的这些见解和挑战导致了当前的 心力衰竭住院后能力辅导和锻炼（COACH-HF）提案 基于 BAMS-HF 试点研究的初步结果和现有文献，COACH-HF 将为最近因心力衰竭住院的退伍军人采取双管齐下的身体康复方法：1) 能力 来自同伴支持专家（患有心力衰竭的退伍军人）的指导，以及 2) 由物理治疗师主导的严格的家庭指导 每周 3 天进行力量、平衡和灵活性锻炼方案，最多持续 12 周，以及 每月与物理治疗师和其他 COACH-HF 退伍军人一起进行集体锻炼，直至 6 个月。 [对拟议的 COACH-HF 干预措施的修改]和试点测试将针对以下 2 个目标进行： [目标 1：使用 [12] 收集利益相关者对 COACH-HF 干预措施的结构和实施的反馈 3 个利益相关者类别中的焦点小组 (FG)：最近因心力衰竭住院的退伍军人、退伍军人的 护理人员和医疗保健提供者的不同观点将通过小型会议得到解决。 由研究者和利益相关者组成的决策小组使用名义小组技术（NGT），做出决策 制定小组将集思广益，并对解决关键分歧领域的想法进行排序。 PI 将根据 FG 和 NGT 结果修改设计。所有 FG 参与者将被邀请提供。 在进行试点测试（即会员检查）之前对最终干预设计的反馈。] [目标 2：确定能力辅导是否可以通过以下方式提高对康复干预的依从性： 将最近因心衰住院的 25 名 ≥ 55 岁退伍军人随机分为 1:1 进行能力辅导 + 康复 干预（CC+康复）与仅康复（仅康复）评估可行性和可接受性。 康复干预（双臂）和能力辅导（CC+康复臂）。] 候选人：我是一名经过高级心力衰竭培训的心脏病专家，对退伍军人的身体康复感兴趣 我因心力衰竭住院。我是落基山地区临床 CR 和心力衰竭项目的联合主任。 (RMR) VAMC 我的职业目标是成为一名独立的 VA 康复研究员。 因心力衰竭住院的退伍军人的身体康复该奖项将帮助我发展定性技能。 行为干预的研究、利益相关者参与和临床试验设计是必要的 下一步是编写一份绩效评估申请，建议测试功效。 COACH-HF 干预的结果。 环境：这项研究将在落基山地区退伍军人医疗中心 (RMR RMR VAMC 是隶属于科罗拉多大学安舒茨分校的三级护理中心。 医学园区。拟议的研究将利用支持临床的现有资源和文化。 RMR VAMC、龋齿科和西雅图-丹佛创新中心的研究。