Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation

下肢截肢的退伍军人身体健康状况不佳，有多种慢性合并症， 医疗服务利用率高，残疾率高。生活在较低水平的人的自我报告残疾- 截肢率超过95%。减少退伍军人残疾的一种方法 下肢截肢是为了让他们参与终身持续的步行锻炼。经常锻炼 改善功能独立性和心理健康，并减少常见的不良影响 与下肢截肢相关的合并症，如糖尿病和外周动脉疾病。 然而，大多数下肢截肢的退伍军人不经常锻炼。只有50%的人- 截肢者的步行活动水平可以支持他们参与当地社区， 下肢截肢后迫切需要改善体育锻炼的参与。证据表明 在一个人的家庭生活环境中进行临床医生支持的锻炼，包括基于证据的促进 病人自我管理有望打破久坐行为和健康状况不佳的恶性循环 结果。因此，本随机对照优效性试验的主要目的是确定 远程康复步行锻炼自我管理程序产生临床意义的步行锻炼 可持续性与注意力控制教育相比。这种新颖的低成本干预包括一种新颖的 结合试点行为改变方法和临床资源，包括VA多学科 远程医疗会议，个人锻炼自我管理培训，和VA整体健康同龄人小组会议。 此外，干预措施被纳入一个既定的VA地区截肢中心，使用 建立了VA临床远程康复和技术。运动和体力活动将作为一项监测， 连续的每日结局，在基线检查时评估次要结局，然后在6和18岁后评估次要结局 参与干预的时间。主要结果将是加速度计评估的每日步行步数 在18个月的研究期间，每天连续监测计数。次要结局设计为 评估如何最好地将步行运动干预转化为传统VA的可能性 截肢康复这些次要结果包括干预范围、干预措施 有效性、临床采用的可能性、临床实施的潜力以及参与者 保持长期的运动习惯。本研究中使用的独特康复范式解决了 下肢截肢后长期久坐不动的生活方式的问题， 来自临床医生和同行的终身运动支持。试验结果将促进康复知识， 为自我管理干预的更大临床转化提供必要的证据， 步行锻炼的退伍军人生活与下肢截肢。

Veterans living with lower-limb amputation have poor physical health outcomes, multiple chronic comorbidities, high medical service utilization, and high levels of disability. Self-reported disability for people living with lower- limb amputation is greater than 95% of the general population. One way to reduce disability for Veterans with lower-limb amputation is for them to participate in life-long sustained walking exercise. Regular exercise improves functional independence and mental well-being, and reduces adverse effects of common comorbidities associated with lower-limb amputation, such as diabetes and peripheral artery disease. However, most Veterans with lower-limb amputation do not regularly exercise. Only 50% of people with lower- limb amputation achieve levels of walking activity that support participation in their local community, creating a critical need to improve physical exercise participation after lower-limb amputation. Evidence suggests that clinician-supported exercise in a person’s home living environment that includes evidence-based promotion of patient self-management has promise for interrupting the cycle of elevated sedentary behavior and poor health outcomes. Therefore, the primary aim of this randomized controlled superiority trial is to determine if a telerehabilitation walking exercise self-management program produces clinically meaningful walking exercise sustainability compared to attention-control education. This novel, low-cost intervention includes a novel combination of piloted behavior-change methods and clinical resources, including VA multidisciplinary telehealth sessions, individual exercise self-management training, and VA Whole Health peer-group sessions. In addition, the intervention is integrated within an established VA Regional Amputation Center, using established VA clinical telerehabilitation and technology. Exercise and physical activity will be monitored as a continuous daily outcome, with secondary outcomes assessed at a baseline test and then after 6 and 18 months of intervention participation. The primary outcome will be accelerometer-assessed daily walking step count monitored continuously each day across the 18-month study period. Secondary outcomes are designed to assess the potential to assess how to best translate the walking exercise intervention into conventional VA amputation rehabilitation. These secondary outcomes include measures of intervention reach, intervention efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation with a home-based exercise model of life-long exercise support from clinicians and peers. The trial results will advance rehabilitation knowledge and provide the necessary evidence for larger clinical translation of self-management intervention to sustain walking exercise for Veterans living with lower-limb amputation.