Multicomponent Telerehabilitation to Engage Veterans in Effective Self-Management of ComplexHealth Conditions
Project Number1I01RX005012-01
Contact PI/Project LeaderSTEVENS-LAPSLEY, JENNIFER E.
Awardee OrganizationVA EASTERN COLORADO HEALTH CARE SYSTEM
Description
Abstract Text
Older Veterans with medical 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) on an episodic basis. 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 activity
with biobehavioral interventions which promote self-management, and 3) reduce social isolation and loneliness
via social support. Our proposed MultiComponent TeleRehabilitation (MCTR) program addresses current
healthcare deficiencies by using a multicomponent approach that includes both high-intensity rehabilitation
interventions and self-management interventions that are not part of traditional physical therapy interventions.
Therefore, we propose a two-arm, parallel randomized trial using a crossover study design to determine the
effectiveness (AIM 1) of a 12-week multicomponent telerehabilitation program to improve physical function. We
will also measure Veterans’ clinical outcomes to evaluate the effectiveness of the MCTR program to improve
physical activity, health self-management, and self-reported health (AIM 2). Lastly, we will explore the effects
of the MCTR program on safety events such as emergency room visits, hospitalizations, falls, and other
adverse events (AIM 3). Participants (n=126) will be randomized to MCTR or Control group using computer-
generated random blocks, stratified by sex. The MCTR group will participate in the 12-week program
consisting of 1) progressive, high-intensity rehabilitation, 2) self-management interventions, 3) social support,
and 4) technology supports. The 12-week program is split into two phases: the Active Phase (weeks 1-6) and
the Transition Phase (weeks 7-12). The Control group will participate in education and health status update
sessions in parallel to the MCTR 12-week program. Following the program, participants in the MCTR group will
complete a 12-week Sustainability Phase and the Control group will complete a 12-week no-intervention
phase. Outcomes will be collected at baseline, 6 weeks, 12 weeks (primary endpoint), and 24 weeks.
Achievement of the proposed aims will provide evidence to expand high quality telerehabilitation services for
medically complex older Veterans with multiple factors contributing to poor health (e.g., social isolation,
loneliness, physical inactivity, poor self-management). Importantly, results will guide the advancement of
rehabilitation practices, moving away from a traditionally narrow, episodic, diagnosis-focused approach to a
model emphasizing whole health self-management and sustained healthy living. Study findings will have
immediate clinical impact as they will be directly translatable to other medically complex and underserved
populations who will benefit from innovative telerehabilitation care approaches.
Public Health Relevance Statement
Medically complex older Veterans are at greater risk for progressive declines in physical function, lower quality
of life, and increasing care needs. Additionally, older Veterans experience social isolation and loneliness, and
have low levels of physical activity. While the Veterans Health Administration has established programs to
address rehabilitation needs, these programs tend to be diagnosis-focused, lack self-management
approaches, include low-intensity rehabilitation, and typically require in-person attendance. A MultiComponent
TeleRehabilitation (MCTR) program that includes high-intensity rehabilitation and self-management
interventions, social support, and telehealth and technology supports may be more effective in improving and
sustaining physical function for older Veterans with complex health conditions. Therefore, this project is
designed to determine whether the MCTR program improves strength and physical function more effectively
than traditional interventions.
NIH Spending Category
No NIH Spending Category available.
Project Terms
2 arm randomized control trialAccelerationAchievementAddressAdverse eventCardiacCaringCessation of lifeChronicClinicalClinical TrialsComplexControl GroupsCross-Over StudiesDiagnosisDiseaseDoseEducational StatusEmergency department visitEnrollmentEventExerciseGeographyGoalsHealthHealth BenefitHealth StatusHealthcareHealthcare SystemsHomeHospitalizationImpairmentInterventionLonelinessMeasuresMedicalModelingMotivationOutcomeParticipantPatient Self-ReportPersonsPhasePhase TransitionPhysical FunctionPhysical activityPhysical therapyPhysiologicalPopulationPsyche structurePublishingQuality of lifeRandomizedRehabilitation therapyReportingResearchResearch DesignRiskRuralSafetySelf ManagementServicesSocial isolationSocial supportStep TestsStrokeTechnologyTestingTherapeutic InterventionTransportationUnderserved PopulationUpdateVeteransVeterans Health Administrationactigraphyacute symptomadverse outcomearmbehavior changebeneficiarybiobehaviorbiopsychosocialcomparison controlcomputer generateddesigneffectiveness evaluationexercise intensityexperiencefallsfunctional declinehealth care availabilityimprovedinnovationmultiple chronic conditionsnoveloutpatient programspatient populationphysical inactivityprematurepreservationprimary endpointprimary outcomeprogramsrandomized trialrehabilitation managementrehabilitation strategyrural arearuralitysatisfactionservice deliverysexskillssocialstandard caretelehealthtelerehabilitationtheoriesurban areawhole health
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