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：运动是一种以证据为基础的慢性疾病管理干预措施， 大多数退伍军人不活跃。小组远程医疗（GT）提供的练习可能会改善获得 和参与锻炼。GT锻炼课程可以通过提供社交活动来增加锻炼参与度。 这一模式的可行性和可接受性需要更好的理解。远程医疗 交付的锻炼计划应设计有启动和维持阶段，但没有 关于提供运动维持干预的策略的共识。运动技能 启动和维持是不同的，专注于其中一个的干预措施不太可能导致 持续参与锻炼。 意义/影响：由于退伍军人健康管理局是美国最大的综合医疗保健系统， 在美国，实施成功的锻炼计划可能会对公众健康产生深远的影响。国家 优先事项包括远程保健和获得护理以及慢性病的管理， 通过制定GT练习启动和维护干预措施来解决。 创新：GT运动结合了团体运动的好处，如社会支持， 远程保健技术。目前还没有研究比较GT运动助推器会议加文本 消息传递到单独的文本消息传递以支持锻炼维持。这两种策略将被用作 改善运动维持的多方面方法。 具体目标： 目标1：调整基于证据的运动成分，用于团体远程健康（GT）运动干预，指导 利益相关者的投入。使用定性的方法，我将通过焦点探讨利益相关者的观点 小组和面试。干预措施的制定将包括一种迭代方法和形成性评价。 目的2：进行一项随机试验，以评估GT运动开始的可行性和可接受性 和维护程序。我将使用下肢骨关节炎（OA）作为模型进行这项工作 因为：1）下肢骨关节炎（OA）是退伍军人中的一种普遍疾病，2）运动是第一个 下肢OA管理的一线建议，3）我以前有OA的经验。 患有下肢OA的退伍军人（n=50）将随机接受干预。我将评估可行性（即， 转介、保留、数据收集）和可接受性（即参加的会议次数、短信数量 参与者和提供者反馈）。 目标3：确定与远程保健的成功实施和可持续性有关的背景因素 在VA内提供锻炼计划。Gerofit，一个现有的远程医疗提供的VA锻炼计划 在多个地点实施，将被用作模型。解释性序贯混合方法设计将 用于描述现场特征，同时探索现场人员的观点， 使用调查和访谈数据。 方法论：实用的稳健实施和可持续性模型（PRISM），一个概念性的 将卫生干预措施转化为实践的框架，将与传播和实施 科学方法。具体而言，将使用定性方法来获取利益相关者的观点，以设计一个 GT提供了锻炼计划。将采用随机初步试验设计来初步开展GT练习 干预，以评估可行性和可接受性。将使用混合方法来确定背景因素 与成功实施和维持有关。 后续步骤/实施：这项形成性工作将用于未来更大规模的单中心试验，以测试 有效性和评估GT运动启动和维持干预的实施。