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

远程医疗可改善患有 PAD 的退伍军人的功能状态和生活质量

• 批准号: 10388198
• 负责人: Jorge Antonio Antonio Gutierrez
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10388198
• 关键词: Adherence; Adoption; Aerobic; Age; Award; Cardiac; Caring; Cholesterol; Coronary Arteriosclerosis; Data; Development; Disease model; Enrollment; Event; Exercise; Exercise Therapy; Feedback; Foundations; Future; Goals; Health Services Accessibility; Health Services Research; High Prevalence; Home; Improve Access; Intervention; Leg; Life Style; Location; Longitudinal prospective study; Measures; Medical; Mission; Modeling; Myocardial Ischemia; Pain; Pain in lower limb; Patients; Pattern; Perception; Performance; Peripheral arterial disease; Physical Function; Physical Performance; Physical activity; Pilot Projects; Practice Guidelines; Premature Mortality; Prospective cohort study; Provider; Quality of life; Research; Research Design; Research Personnel; Research Priority; Risk; Risk Factors; Role; Rural Community; Services; Site; Supervision; Training; Training Programs; Travel; Underserved Population; Vascular blood supply; Veterans; Walking; Work; base; cardiovascular risk factor; claudication; cohort; common symptom; disorder risk; exercise intervention; exercise program; exercise rehabilitation; exercise training; experience; functional decline; functional disability; functional status; health related quality of life; heart disease risk; implementation outcomes; implementation trial; improved; novel; preference; programs; prospective; research and development; research study; satisfaction; sedentary lifestyle; skills; stem; telehealth; therapy development; walking speed

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.]

本研究旨在增加退伍军人获得监督运动疗法，并扩大其在 改善PAD退伍军人的功能状态、生活质量和心血管风险状况。完成 为了实现这些目标，我们将利用退伍军人事务部的远程医疗服务来部署一种远程可访问的监督运动训练 规划和评估基于远程医疗的干预是否可以改善行走能力、生活质量 最终导致患PAD的退伍军人的心脏病风险。本提案的推动力来自以下方面： 1)超过50%的VA登记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 年龄），进一步增加了他们的功能下降的风险;和3）有一个显着缺乏获得设施- 为患有PAD的退伍军人提供基于监督的运动训练。 本方案的培养目标是：1）获得实践性的研究性学习 作为主要研究者的管理经验; 2）发展可扩展干预所需的技能 制定和实施;以及3）提高利益相关者参与的技能。通过完成 根据目标，申请人将接受关于开发，实施， 并传播新提出的退伍军人护理模式，供地方和国家采用。中央 这项拟议研究的假设是，基于远程保健的干预可以改善身体功能， 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。两 未来的试点研究将完成我们的初步步骤，包括以下内容： 目标1.为患有PAD的退伍军人开发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的护理模式。我们将评估其可行性、可接受性和 实施远程保健促进监督锻炼方案。使用前瞻性的前后试点研究 设计，PAD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9个运动队列，每组6名患者。关于参与、满意度、技术 错误和遵守将被收集。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）。 目标二。将退伍军人的偏好纳入远程医疗促进的发展 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， 每一个练习队列。这些数据将用于积极修改干预措施，以提高可行性， 可接受性和未来广泛实施的潜在可扩展性。 目标3。评估功能障碍和生活质量的长期模式， 患有PAD的退伍军人没有接受监督下的运动训练。我们将进行前瞻性的 纵向研究与上述试点研究同时进行。采用前瞻性队列研究设计， 我们将测量整体身体表现的自然过程及其对PAD风险因素和质量的影响 在没有监督运动治疗的情况下，患有PAD的退伍军人（n=100）的生活。该队列将不包括 参加目标1和2的退伍军人。行走性能、功能状态、行走感知的数据 将在基线和12个月时收集能力、生活质量、PAD风险因素和心血管风险。 通过该提案收集的试点数据将指导开发一种新的以退伍军人为中心的模型 照顾。远程医疗是由研究和发展/健康VA办公室强调的研究重点 服务研究和发展服务，以改善服务不足的人口获得护理的机会。 此外，这项工作是[随后的优异奖申请]的基础， 建议重点放在多站点实施试验和结果评估范围，采用，保真度， 可持续性]。