Expanding Exercise Programming for Veterans Through Telehealth

通过远程医疗扩大退伍军人的锻炼计划

• 批准号: 10537533
• 负责人: LAUREN M ABBATE
• 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: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537533
• 关键词: Address; Adherence; Administrator; Adult; Ambulatory Care Facilities; Cardiac; Caring; Characteristics; Chronic; Chronic Disease; Chronic lung disease; Communities; Data; Data Collection; Degenerative polyarthritis; Development; Ensure; Environment; Equipment; Evidence based intervention; Exercise; Feedback; Focus Groups; Future; Guidelines; Health; Health Technology; Healthcare; High Prevalence; Home; Human Resources; Improve Access; Individual; Instruction; Integrated Health Care Systems; Internet; Intervention; Interview; Lower Extremity; Maintenance; Mentorship; Methodology; Methods; Modeling; Monitor; Participant; Phase; Physical Function; Physical activity; Population; Practical Robust Implementation and Sustainability Model; Provider; Public Health; Qualitative Methods; Quality of life; Randomized; Recommendation; Research; Research Personnel; Resources; Site; Social support; Surveys; Technology; Text Messaging; Training; Translating; Veterans; Veterans Health Administration; Work; acceptability and feasibility; care delivery; career; contextual factors; design; dissemination science; effectiveness testing; evidence base; exercise intervention; exercise program; exercise training; experience; flexibility; formative assessment; health care availability; implementation evaluation; implementation science; implementation trial; improved; innovation; instructor; multidisciplinary; pilot trial; prevent; program dissemination; programs; pulmonary rehabilitation; remote delivery; response; skills; stakeholder perspectives; telehealth; therapy development; trial design

Background: Exercise is an evidence-based intervention for the management of chronic conditions, yet the majority of Veterans are inactive. Group telehealth (GT) delivered exercise can potentially improve access to and participation in exercise. GT exercise sessions may increase exercise participation by providing social support, but a better understanding of the feasibility and acceptability of this format is needed. Telehealth delivered exercise programs should be designed with initiation and maintenance phases, but there is not consensus regarding the strategies for delivering exercise maintenance interventions. Skills for exercise initiation and maintenance differ, and interventions that focus on one or the other are not likely to result in sustained exercise participation. Significance/Impact: As the Veterans Health Administration is the largest integrated health care system in the US, implementing successful exercise programs could have a profound impact of public health. National priorities including telehealth and access to care as well as management of chronic conditions will be addressed by the development of this GT exercise initiation and maintenance intervention. Innovation: GT exercise combines the benefits of group exercise sessions, such as social support, and telehealth technology. There have been no studies comparing GT exercise booster sessions plus text messaging to text messaging alone to support exercise maintenance. These two strategies will be used as a multi-faceted approach to improving exercise maintenance. Specific Aims: Aim 1: Adapt evidenced-based exercise components for a group telehealth (GT) exercise intervention, guided by stakeholder input. Using qualitative methods, I will explore the perspectives of stakeholders through focus groups and interviews. Intervention development will include an iterative approach and formative evaluation. Aim 2: Conduct a randomized pilot trial to assess the feasibility and acceptability of the GT exercise initiation and maintenance program. I will use lower extremity osteoarthritis (OA) as a model to conduct this work because: 1) lower extremity osteoarthritis (OA) is a prevalent condition among Veterans, 2) exercise is a first line recommendation for the management of lower extremity OA, and 3) I have previous experience in OA. Veterans with lower extremity OA (n=50) will be randomized to the intervention. I will assess feasibility (i.e. referral, retention, data collection) and acceptability (i.e. number of sessions attended, number of text message responses, participant and provider feedback). Aim 3: Determine contextual factors related to successful implementation and sustainability of telehealth- delivered exercise programs within VA. Gerofit, an existing telehealth-delivered VA exercise program implemented at multiple sites, will be used as a model. An explanatory sequential mixed methods design will be used to describe site characteristics and simultaneously explore the perspectives of the site personnel, using survey and interview data. Methodology: The Practical Robust Implementation and Sustainability Model (PRISM), a conceptual framework for translating health interventions into practice, will be used with Dissemination and Implementation Science methods. Specifically, qualitative methods will be used to obtain stakeholder perspectives to design a GT delivered exercise program. A randomized pilot trial design will be used to pilot the GT exercise intervention to evaluate feasibility and acceptability. Mixed methods will be used to identify contextual factors related to successful implementation and sustainment. Next Steps/Implementation: This formative work will be used in a future larger, single site trial to test the effectiveness and evaluate the implementation of the GT exercise initiation and maintenance intervention.

背景：锻炼是一种基于证据的干预措施，用于管理慢性病，但 大多数退伍军人是不活跃的。小组远程医疗（GT）进行的锻炼可能会改善对 并参与运动。 GT运动会议可能会通过提供社会来增加运动的参与 支持，但需要更好地理解这种格式的可行性和可接受性。远程医疗 交付的锻炼计划应通过启动和维护阶段设计，但没有 关于提供锻炼干预措施的策略的共识。锻炼技能 启动和维护的不同，而专注于一个或另一个的干预措施不太可能导致 持续的运动参与。 意义/影响：由于退伍军人卫生管理局是最大的综合卫生保健系统 美国，实施成功的锻炼计划可能会对公共卫生产生深远的影响。国家的 包括远程医疗和获得护理以及慢性病管理在内的优先事项将是 通过开发GT锻炼开始和维护干预来解决。 创新：GT练习结合了小组练习的好处，例如社会支持和 远程医疗技术。没有研究比较GT练习助推器会议和文本 单独发送文本消息的消息传递以支持锻炼维护。这两种策略将用作 改进运动维护的多方面方法。 具体目的： 目的1：适应小组远程医疗（GT）运动干预的基于证据的锻炼组件，指导 由利益相关者输入。使用定性方法，我将通过重点探讨利益相关者的观点 小组和访谈。干预开发将包括迭代方法和形成性评估。 目标2：进行随机试验试验以评估GT运动启动的可行性和可接受性 和维护计划。我将使用下肢骨关节炎（OA）作为进行这项工作的模型 因为：1）下肢骨关节炎（OA）是退伍军人的普遍状况，2）运动是第一个 对下肢OA管理的行建议，以及3）我以前在OA方面经验。 下肢OA（n = 50）的退伍军人将被随机分配给干预措施。我将评估可行性（即 推荐，保留，数据收集）和可接受性（即参加会议的数量，短信数量 回应，参与者和提供者的反馈）。 目标3：确定与远程医疗成功实施和可持续性有关的上下文因素 - 在VA内提供了锻炼计划。 GEROFIT，现有的远程医疗服务VA锻炼计划 在多个站点实现，将用作模型。解释性的顺序混合方法设计将 用于描述站点特征并同时探索现场人员的观点， 使用调查和访谈数据。 方法论：实践强大的实施和可持续性模型（PRISM），这是一种概念 将健康干预措施转化为实践的框架将用于传播和实施 科学方法。具体而言，定性方法将用于获得利益相关者的观点来设计 GT交付的锻炼计划。随机试验试验设计将用于试行GT练习 干预以评估可行性和可接受性。混合方法将用于识别上下文因素 与成功的实施和维持有关。 下一步/实施：这项形成性工作将在未来的较大的单个站点试验中使用，以测试 有效性并评估GT运动开始和维护干预的实施。