Engaging Medically Complex Veterans in Tele-Rehabilitation Using a Biobehavioral Approach: A Pilot Study of Feasibly and Acceptability

使用生物行为方法让医学复杂的退伍军人参与远程康复：可行性和可接受性的试点研究

• 批准号: 10447060
• 负责人: Jennifer E. Stevens-Lapsley
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447060
• 关键词: Accelerometer; Achievement; Address; Adherence; Adverse event; Cardiac; Caring; Clinical; Communities; Complex; Cross-Over Studies; Crossover Design; Data; Disease; Dose; Education; Elderly; Enrollment; Exercise; Feedback; Gait speed; Geriatrics; Health Promotion; Health Services Accessibility; Home; Home environment; Hour; Impairment; Intervention; Investigation; Lead; Life; Loneliness; Long-Term Care; Measures; Medical; Methods; Modeling; Motivation; Nature; Outcome; Participant; Patient Self-Report; Patients; Persons; Physical Function; Physical activity; Physiological; Pilot Projects; Population; Preparation; Probability; Protocols documentation; Provider; Quality of life; Randomized; Rehabilitation therapy; Research; Research Design; Residual state; Resources; Risk; Role; Rural; Safety; Sample Size; Sampling; Self Management; Site; Social isolation; Social support; Stroke; Structure; Techniques; Technology; Testing; Training; Translating; Transportation; Underserved Population; Veterans; Veterans Health Administration; Vulnerable Populations; Work; acceptability and feasibility; acute care; adverse event monitoring; arm; attentional control; behavior change; beneficiary; biobehavior; care costs; comorbidity; design; effectiveness trial; evidence base; exercise prescription; experience; functional decline; high risk; improved; improved outcome; innovation; novel; novel strategies; outpatient programs; patient population; physical inactivity; preservation; prevent; programs; randomized trial; rehabilitation paradigm; rehabilitation service; resistance exercise; response; rural area; rurality; safety assessment; sedentary lifestyle; telehealth; telerehabilitation; theories; trend; virtual delivery; virtual group

Older Veterans with multiple comorbidities or medically complexities represent one of the most vulnerable patient populations. This large and growing proportion of Veterans Health Administration (VHA) beneficiaries are more likely to live in rural areas, experience social isolation and loneliness, and be physically inactive. Thus, medically complex older Veterans are at greater risk for progressive declines in function, lower quality of life, and frequent care needs. While the VHA has established outpatient programs to address rehabilitation needs, these programs tend to serve disease-specific populations (e.g. cardiac, stroke). Moreover, these programs often do not meet the needs of medically complex older Veterans, as they typically 1) require in- person attendance, 2) under-dose the physiologic intensity of rehabilitation, and 3) lack self-management approaches for preservation of function. Telehealth platforms offer a solution to redesign rehabilitation models of care for medically complex older Veterans and can aid in overcoming access barriers (rurality, transportation), while also integrating technologies to augment biobehavioral interventions and provide social support. Novel, scalable telerehabilitation approaches targeting medically complex older Veterans are urgently needed to 1) address physiologic impairments using progressive, high-intensity rehabilitation, 2) increase physical inactivity with biobehavioral interventions which promote self-management, and 3) reduce social isolation and loneliness via social support. Therefore, we propose a pilot, two-arm randomized trial using a crossover study design to determine the feasibility, acceptability, and safety (AIM 1) of a 12-week multicomponent telerehabilitation program. We will also measure Veterans’ clinical outcomes to explore the preliminary response to the program and to determine variability estimates for outcomes (AIM 2) in preparation for a larger investigation. This study will enroll 50 medically complex older Veterans who are designated as “high-need, high-risk” using a definition provided by the Geriatrics & Extended Care Data & Analysis Center. Veterans will be randomized to GROUP1 or GROUP2 (25 participants in each group); GROUP1 will receive the 12-week intervention, and GROUP2 will receive attention control consisting of 1-hour education sessions delivered every 2 weeks (6 total). GROUP2 will then crossover to the intervention at the completion of 12- weeks. Outcomes will be assessed at baseline (pre-intervention), 6 weeks (intervention mid-point), 12 weeks (end of intervention), and 24 weeks. Achievement of the proposed aims will establish feasibility and preliminary response of a novel, multicomponent telerehabilitation program that critically addresses the multitude of interrelated complexities unique to older Veterans who are currently underserved by traditional rehabilitation paradigms. This work will directly translate to other medically complex and underserved populations who will benefit from innovative telerehabilitation care approaches. Study findings will have immediate clinical impact as they will guide implementation of safe and effective telerehabilitation programs as alternatives to in-person rehabilitation for medically complex older Veterans.

患有多种合并症或医疗复杂性的老年退伍军人是最脆弱的群体之一 退伍军人健康管理局 (VHA) 受益人的比例庞大且不断增长。 更有可能生活在农村地区，经历社会孤立和孤独，并且缺乏身体活动。 因此，医学复杂的老年退伍军人面临着功能逐渐衰退、生活质量较低的更大风险。 生活和频繁的护理需求，而 VHA 已建立门诊计划来解决康复问题。 根据需求，这些计划往往服务于特定疾病人群（例如心脏病、中风）。 计划通常不能满足医疗复杂的老年退伍军人的需求，因为他们通常需要 人员出勤率，2）康复生理强度不足，3）缺乏自我管理 远程医疗平台提供了重新设计康复模型的解决方案。 为医疗状况复杂的老年退伍军人提供护理服务，并可以帮助克服准入障碍（农村、 交通），同时还整合技术以增强生物行为干预措施并提供社会服务 迫切需要针对医疗复杂的老年退伍军人提供新颖、可扩展的远程康复方法。 需要 1) 通过渐进式高强度康复来解决生理损伤，2) 增加 通过促进自我管理的生物行为干预措施减少身体活动，以及3）减少社交 因此，我们提出了一项试验性的双组随机试验。 交叉研究设计，以确定 12 周的可行性、可接受性和安全性 (AIM 1) 我们还将测量退伍军人的临床结果，以探索 对计划的初步响应并确定准备中结果的可变性估计（AIM 2） 这项研究将招募 50 名身体状况复杂的老年退伍军人，他们被指定为 使用老年病学和延伸护理数据与分析中心提供的定义，“高需求、高风险”。 退伍军人将被随机分配到 GROUP1 或 GROUP2（每组 25 名参与者）； 为期 12 周的干预，GROUP2 将接受由 1 小时教育课程组成的注意力控制 每 2 周进行一次（总共 6 次），然后第 2 组将在 12 周完成后交叉进行干预。 将在基线（干预前）、6 周（干预中点）、12 周时评估结果。 （干预结束），24 周后将确定可行性和初步目标的实现。 一种新颖的、多组成部分的远程康复计划的反应，该计划批判性地解决了众多问题 目前传统康复服务不足的老年退伍军人所特有的相互关联的复杂性 这项工作将直接转化为其他医疗复杂且服务不足的人群。 受益于创新的远程康复护理方法 研究结果将产生直接的临床影响。 因为它们将指导安全有效的远程康复计划的实施，作为面对面康复的替代方案 为病情复杂的老年退伍军人提供康复服务。