Telehealth to Improve Functional Status and Quality of Life in Veterans with PAD

本研究旨在增加退伍军人获得有监督的运动疗法的机会，并扩大其在 改善患有PAD的退伍军人的功能状态、生活质量和心血管风险状况。要完成 为了实现这些目标，我们将使用退伍军人管理局远程医疗服务部署远程可访问的监督运动培训 规划和评估基于远程健康的干预是否可以改善步行能力、生活质量、 并最终导致患有PAD的退伍军人的心脏风险。目前这项提议的动力来自以下几个方面： 1)超过50%的退伍军人生活在农村社区；2)患有PAD的退伍军人年龄较大(平均年龄为70岁 年)，进一步增加了他们功能衰退的风险；3)严重缺乏使用设施的机会- 为患有PAD的退伍军人提供有监督的运动训练。 本方案的培训目标如下：1)获得实践研究性学习 作为主要调查员的管理经验；2)培养可扩展干预所需的技能 开发和实施；以及3)提高利益相关者的参与技能。通过填写 根据目标，申请者将接受关于发展、实施、 以及传播一种新提出的照顾地方和国家收养的退伍军人模式。中环 这项拟议研究的假设是基于远程健康的干预可以改善身体功能， 与健康相关的生活质量，并降低患有PAD的退伍军人的冠状动脉疾病风险。二 预期的试点研究将完成我们的初步步骤，包括以下内容： 目的1.为患有PAD的退伍军人开发一种远程健康促进的运动干预 作为一种以退伍军人为中心的新护理模式。我们将评估其可行性、可接受性和 实施远程健康促进的监督锻炼计划。使用前瞻性的试点前研究 设计，患有PAD的退伍军人(n=54)将参加为期12周，每周3天的自我有氧训练计划 选定的位置。计划了6名患者的9个锻炼队列。参与度、满意度、技术方面的数据 错误和遵从性将被收集。步行能力、生活质量和PAD风险因素指标 还将评估基线和干预完成情况(3个月)。 目标2.将退伍军人的偏好纳入远程医疗的开发中--促进 有监督的锻炼计划。我们将收集和评估患者、提供者和利益相关者的反馈 每个锻炼队列。这些数据将被用于积极修改干预措施，以提高可行性， 可接受性，以及未来广泛实施的潜在可扩展性。 目的3.评估以下人群功能损害和生活质量的长期模式 患有PAD的退伍军人没有接受有监督的运动训练。我们将进行一次前瞻性的 纵向研究与上述先导研究同时进行。采用前瞻性队列研究设计， 我们将测量整体体能的自然进程及其对PAD风险因素和质量的影响 在没有监督运动疗法的情况下，100名患有PAD的退伍军人的生活质量。这一群体将不包括 参加目标1和目标2的退伍军人。关于步行能力、功能状态、步行感知的数据 能力、生活质量、PAD危险因素和心血管风险将在基线和12个月时收集。 通过这项提案收集的试点数据将指导以退伍军人为中心的新模式的发展 关爱。远程保健被退伍军人事务部强调为研究优先事项 服务研究和发展处，以改善服务不足人群获得护理的机会。 此外，这项工作是[随后在年第3年申请功勋奖]的基础 建议侧重于多站点实施试验和结果，评估覆盖范围、采用率、保真度和 可持续性。]

The present study aims to increase Veteran access to supervised exercise therapy and expand its role in improving functional status, quality of life, and cardiovascular risk profile of Veterans with PAD. To accomplish these goals, we will use the VA Telehealth service to deploy a remotely accessible supervised exercise training program and evaluate whether a telehealth-based intervention can improve walking performance, quality of life, and ultimately cardiac risk in Veterans with PAD. The impetus for the current proposal stems from the following: 1) over 50% of VA-enrolled Veterans live in rural communities; 2) Veterans with PAD are older (mean age, 70 years), further increasing their risk for functional decline; and 3) there is a significant lack of access to facility- based supervised exercise training for Veterans with PAD. The training goals of the present proposal are the following: 1) To obtain practical research study management experience as primary investigator; 2) To develop skills required for scalable intervention development and implementation; and 3) To improve stakeholder engagement skills. By completing the following aims, the applicant will undergo invaluable training in regard to the development, implementation, and dissemination of a newly proposed Veteran model of care for local and national adoption. The central hypothesis of this proposed research is that a telehealth-based intervention can improve physical function, health-related quality of life, and reduce coronary artery disease risk among Veterans with PAD. Two prospective pilot studies will accomplish our initial steps and include the following: Aim 1. To develop a telehealth-facilitated exercise intervention for Veterans with PAD that serves as a Veteran centric new model of care. We will evaluate the feasibility, acceptability, and implementation of a telehealth-facilitated supervised exercise program. Using a prospective pre-post pilot study design, Veterans with PAD (n=54) will be enrolled in a 12-week, 3 day a week, aerobic training program in a self- selected location. Nine exercise cohorts of 6 patients are planned. Data on participation, satisfaction, technical errors, and adherence will be collected. Walking performance, quality of life, and PAD risk factor metrics at baseline and completion of intervention (3 months) will also be evaluated. Aim 2. To integrate Veteran preferences into the development of a telehealth-facilitated supervised exercise program. We will collect and evaluate patient, provider, and stakeholder feedback with each exercise cohort. These data will be used to actively modify the intervention to improve feasibility, acceptability, and potential scalability for future broad based implementation. Aim 3. To assess the long term patterns of functional impairment and quality of life among Veterans with PAD not undergoing supervised exercise training. We will conduct a prospective longitudinal study contemporaneous to the pilot study described above. Using a prospective cohort study design, we will measure the natural course of overall physical performance and its impact on PAD risk factors and quality of life of Veterans with PAD (n=100) in the absence of supervised exercise therapy. This cohort will not include Veterans participating in Aims 1 and 2. Data on walking performance, functional status, perception of walking ability, quality of life, PAD risk factors, and cardiovascular risk will be collected at baseline and 12 months. The pilot data collected through this proposal will guide the development of a novel Veteran centric model of care. Telehealth is highlighted as a research priority by the VA Office of Research and Development/Health Services Research and Development Service to improve access to care for underserved populations. Furthermore, this work serves as a foundation for a [subsequent Merit Award application during year 3 of the proposal focusing on a multi-site implementation trial and outcomes assessing reach, adoption, fidelity, and sustainability.]