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Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation

通过远程医疗为下肢截肢退伍军人提供步行锻炼的可持续性

基本信息

批准号：
10534859
负责人：
Cory L Christiansen
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-11-01 至 2026-10-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10534859
关键词：
Accelerometer Activities of Daily Living Acute Address Adopted Adoption Adverse effects Amputation Behavior Chronic Clinic Clinical Colorado Communities Continuity of Patient Care Data Diabetes Mellitus Discipline Education Effectiveness Enrollment Ensure Environment Exercise Focus Groups Future General Population Goals Health Healthcare Systems Home Individual Infrastructure Interruption Intervention Knowledge Life Limb Prosthesis Link Lower Extremity Maintenance Measures Medical Methods Modeling Monitor Outcome Participant Patient Self-Report Patients Peer Group Performance Peripheral arterial disease Persons Phase II Clinical Trials Physical Exercise Physical Function Physical Rehabilitation Physical activity Program Sustainability Prosthesis Provider Randomized Randomized Controlled Trials Reach Effectiveness Adoption Implementation and Maintenance Rehabilitation therapy Resources Self Efficacy Self Management Social support Step Tests Structure Techniques Technology Testing Time Training Training Support Translating Translations Treatment Efficacy Veterans Walking Well in self arm attentional control base behavior change clinical implementation clinical translation comorbidity design disability efficacy outcomes evidence base exercise intensity exercise intervention exercise rehabilitation functional independence implementation design improved innovation intervention cost limb amputation multidisciplinary novel novel strategies peer peer support physical conditioning population health primary outcome programs prosthesis wearer rehabilitation paradigm rehabilitation strategy remote monitoring rural area secondary outcome sedentary lifestyle self-management program service utilization social engagement telehealth telerehabilitation trend trial design underserved area wearable sensor technology

项目摘要

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.

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，