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

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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.]