Home-Based Exercise Tele-Rehabilitation in High-Risk Veterans: Impact of COVID-19 Exposure and Socioeconomic Factors

高风险退伍军人的家庭远程运动康复：COVID-19 暴露和社会经济因素的影响

• 批准号: 10538686
• 负责人: KRISANN K OURSLER
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538686
• 关键词: 2019-nCoV; Address; Adherence; Admission activity; Adult; Affect; Ambulatory Care Facilities; Area; Award; Baltimore; Black race; COVID-19; COVID-19 impact; COVID-19 mortality; COVID-19 pandemic; COVID-19 patient; COVID-19 survivors; Cardiopulmonary; Cardiovascular Diseases; Cessation of life; Chronic; Chronic Kidney Failure; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Classification; Clinical Research; Collaborations; Communicable Diseases; Communities; Coronavirus; Databases; Development; Diabetes Mellitus; Dyspnea; Epidemic; Ethnic Origin; Exercise; Exercise Physiology; Exercise Test; Fatigue; Future; Geographic Locations; Group Homes; Guidelines; HIV Infections; Hand Strength; Health; Healthcare; Healthcare Systems; High Prevalence; Hispanic; Home; Hospitalization; Hypertension; Impairment; Individual; Infection; Inflammatory; Inflammatory Response; Intervention; Knowledge; Long COVID; Lung; Maryland; Muscle Weakness; Not Hispanic or Latino; Organ; Outcome; Patients; Physical Function; Physical Performance; Physical activity; Physiological; Post-Acute Sequelae of SARS-CoV-2 Infection; Procedures; Pulmonary function tests; Questionnaires; Race; Recovery; Rehabilitation therapy; Research; Research Design; Research Priority; Risk; Risk Factors; Rural Community; SARS-CoV-2 exposure; SARS-CoV-2 negative; SARS-CoV-2 positive; Seasons; Self Efficacy; Social Distance; Socioeconomic Factors; Socioeconomic Status; Source; Step Tests; Support Groups; Symptoms; Syndrome; Testing; United States; Urban Community; Vaccines; Variant; Veterans; Veterans Health Administration; Viral; World Health Organization; cardiometabolism; cardiorespiratory fitness; clinical practice; comorbidity; coronavirus disease; disability; disability risk; ethnic disparity; exercise intensity; exercise intervention; exercise program; exercise rehabilitation; exercise training; fitness; functional decline; functional improvement; health care disparity; heart disease risk; high risk; hospitalization rates; human old age (65+); improved; international health organization; long term consequences of COVID-19; long-term sequelae; member; multiple chronic conditions; novel; pandemic disease; post-COVID-19; programs; pulmonary function; racial disparity; rehabilitation research; rehabilitation strategy; rehabilitative care; rurality; systemic inflammatory response; telerehabilitation; transmission process; ventilation; virtual group

The Coronavirus Disease 2019 (COVID-19) pandemic is widespread throughout the world despite multiple strategic efforts and precautions to impede its transmission. Comorbid conditions, especially hypertension, diabetes and chronic lung and cardiac disease are risk factors for hospitalization and death. Veterans have a high prevalence of these conditions and are at increased risk for complications and poor recovery. The development and successful implementation of rehabilitative strategies for Veterans during and post COVID-19 should be a high clinical research priority. The long-term impact of COVID-19 on cardiopulmonary and physical function is uncertain; and further, rehabilitation strategies to target impairments must be feasible within constraints of social distancing. Pertinent knowledge gaps regarding the post-recovery physiologic trajectory in patients with pulmonary and cardiometabolic conditions also need to be addressed to tailor effective exercise rehabilitation strategies. The objective of this exercise trial is to investigate the effect of a home-based exercise tele-rehabilitation on these outcomes and to evaluate five individual World Health Organization’s International Classification of Functioning, Disability and Health (ICF) components identified for research in COVID-19 survivors. Our central hypothesis is that home-based exercise with a group component (COVID Tele-EX) improves cardiopulmonary and physical function in Veterans post COVID-19. The study design includes an investigative team who have a track record of VA rehabilitation collaboration and will allow the exploration of healthcare disparities related to COVID-19, which are associated with functional decline and may affect sustainability of exercise rehabilitation strategies deployed under social distancing restrictions. Veterans from the Baltimore VAMC and surrounding Community Based Outpatient Clinics (CBOCs) will participate from home in the 12-week exercise intervention which will consist of virtual group exercise classes in VA Video Connect (VVC). Procedures before and after the intervention will include cardiopulmonary exercise test, pulmonary function test, physical function, and questionnaires targeted at exercise self-efficacy. Our study of cardiopulmonary and physical function in Veterans recovered from COVID-19 will provide critical and novel information on “Long COVID” or Post-Acute Sequelae of SARS-Co-V-2 infection. Findings from this trial will provide evidence to implement this tele-home group exercise program across VA centers that can extend beyond the COVID-19 pandemic and has vital implications for improving and creating a new standard of rehabilitative care for Veterans.

冠状病毒病2019年(新冠肺炎)大流行在世界各地蔓延，尽管 多重战略努力和预防措施，以阻止其传播。并存的条件，特别是 高血压、糖尿病以及慢性肺病和心脏病是住院和死亡的危险因素。 退伍军人这些疾病的患病率很高，并发症和贫穷的风险增加。 恢复。制定和成功实施退伍军人康复战略 后新冠肺炎应该是临床研究的高优先级。新冠肺炎对全球经济的长期影响 心肺和身体功能不确定；此外，针对损伤的康复策略 必须在社会距离的限制下可行。关于恢复后的相关知识差距 肺和心脏代谢性疾病患者的生理轨迹也需要解决 量身定制有效的运动康复策略。 这项运动试验的目的是调查家庭运动远程康复的效果。 关于这些结果，并评估世界卫生组织的五个单独的国际分类 确定对新冠肺炎幸存者进行研究的功能、残疾与健康组成部分。我们的中央 假说是家庭锻炼和团体锻炼(COVID Tele-ex)改善心肺功能 退伍军人的身体机能在新冠肺炎上发帖。研究设计包括一个调查小组，他们有一个 退伍军人康复协作的跟踪记录，并将允许探索与以下相关的医疗差异 新冠肺炎，它们与功能衰退有关，可能影响运动康复的可持续性 在社交距离限制下部署的策略。来自巴尔的摩VAMC和周边地区的退伍军人 社区门诊(CBOCs)将在家参加为期12周的运动干预 它将包括VA Video Connect(VVC)中的虚拟团体练习课程。手术前后的程序 干预措施包括心肺运动试验、肺功能测试、身体功能和 针对运动自我效能感的问卷调查。退伍军人心肺功能和身体机能的研究 从新冠肺炎恢复将提供关于“长期冠状病毒病”或急性后后遗症的关键和新信息 SARS-Co-V-2感染。 这项试验的结果将为在全国范围内实施远程家庭小组练习计划提供证据 退伍军人管理局中心可以延伸到新冠肺炎大流行之外，并对改善和创造 退伍军人康复护理的新标准。