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：当前护理标准的身体康复，老兵住院 （HF）出于三个原因而不足：1）当规定时，退伍军人可能无法进行身体康复 由于他们的整体高治疗工作量感到不知所措，2）家庭物理疗法常常不足 剂量，因此无法实现临床影响，3）很少开处方心脏康复（CR）。 当使用时，其专注于中等强度有氧运动不适合严重衰弱 退伍军人住院的HF。我是NIA资助的试点研究（R03AG064371）的主要研究员 （BAMS-HF [平衡，有氧运动能力，移动性和HF中的力量]研究），该研究提供了老年退伍军人 最近为HF住院的小说，严格的1：1物理治疗师主导的家庭康复 旨在解决上述2和＃3的干预措施。尽管完成研究的退伍军人是 对此充满热情，他们确实希望与其他BAMS-HF退伍军人进行联系，并[报告动力低下 参与的重大障碍。] BAMS-HF研究的这些见解和挑战导致了当前 住院后能力教练和运动的提议（教练HF） 干涉。根据BAMS-HF试点研究和现有文献的初步结果，教练-HF 将采取2条派别的身体康复方法，最近因HF住院而住院：1） 由同伴支持专家（拥有HF的退伍军人）和2）物理治疗师领导的严格，在家的教练 强度，平衡和流动性锻炼方案将每周3天进行12周，并且 每月与物理治疗师和其他教练HF退伍军人进行的小组练习，直到6个月。 [拟议的教练-HF干预的修改]和试点测试将在以下2个目标中进行： [AIM 1：GARNER利益相关者使用[12]的教练-HF干预的结构和交付的反馈 焦点小组（FGS）在3个利益相关者类别中：退伍军人最近住院的HF，退伍军人 护理人员和医疗保健提供者。将视角与FGS区分开来 调查人员和利益相关者的决策小组。使用名义组技术（NGT），决策 - 组成小组将集思广益并对解决分歧的关键领域进行思想。干预 根据FG和NGT结果，PI将修改设计。所有FGS参与者都将被邀请给 在进行试点测试之前（即成员检查）之前，有关最终干预设计的反馈。] [AIM 2：确定能力教练是否通过通过 随机将25名退伍军人≥55岁，最近因HF 1：1住院到容量教练 +康复 干预（CC+康复）与康复（仅康复）。评估可行性和可接受性 康复干预（武器）和能力教练（CC+康复臂）。] 候选人：我是一名高级HF训练有素的心脏病专家，对退伍军人的身体康复很有趣 住院HF。我是落基山地区临床CR和HF计划的联合主任 （RMR）VAMC。我的职业目标是成为专门从事的独立VA康复研究人员 退伍军人的身体康复。该奖项将帮助我发展定性的技能 研究，利益相关者的参与和临床试验设计，用于行为干预措施 实现我的职业目标。下一步是编写一份优点审查申请，该应用程序提议测试效率 教练-HF干预。 环境：这项研究将在落基山地区VA医疗中心（RMR）进行 VAMC）。 RMR VAMC是科罗拉多大学Anschutz大学的三级护理中心 医疗校园。拟议的研究将利用支持临床的现有资源和文化 RMR VAMC，Cariology Division和Seattle-Denver Innovation中心的研究。