REhabilitation Promoting Prevention And Improved Resilience (REPPAIR)

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To optimize the function and independence of Veterans, it is critical to develop proactive treatments that ameliorate and prevent disability and the resulting loss of quality of life and high cost health care associated with the progression of chronic disease. 1 Ideally, these preventative treatments should be designed to target Veterans at greatest risk and be personalized to their needs. This is critical for the VA since the mean age of Veterans is 64 years and Veterans manifest greater impairment and functional limitations than their age- matched civilian counterparts. 2,3 Aspects of personalization include a focus on impairments linked to not only physical but cognitive function; and acknowledging that critical steps to preventative care include a focus on behavior change of the patient. 1 Treatments promoting long term success commonly emphasize these approaches. Rehabilitative care can play a leading role in this model of secondary preventative care. 4 Preventative rehabilitative care is known as prehabilitation. 5 This term traditionally refers to preventative pre- surgical care and less frequently focuses on prevention and amelioration of disability among Veterans with chronic disease. However, there is a tremendous unmet need to develop prehabilitative care treatments that maximize the functional capacity of aging veterans and thereby extend quality of life as well as prevent disability and excessive health care utilization. The Prehabilitation Center (PreHC) REAP will prioritize the development of Prehabilitative Care strategies optimizing functioning among Veterans at risk for functional decline and disability. Through the leadership of three organizational cores and the combination of qualifying studies and pilot studies, the PreHC will develop a single data repository supporting three programmatic research aims: 1) It will test the efficacy of novel therapeutic approaches on three important prehabilitative outcomes (i.e., 3M’s): cognitive function (Mind); physical function (Mobility) and successful behavioral change (Motivation); 2) It will identify biologic subtypes and phenotypes that mediate treatment response; 3) It will confirm and validate these relationships using the large data resource derived from our collective studies and through linkage with data from VA national databases. Our center will advance VA clinical research and prehabilitative care by providing core resources and training for investigators of all levels. Under the leadership of the Project Director (Dr. Bean), three operational cores will be created: 1) a Leadership, Capacity and Advancement Core that will include the administrative leadership of the REAP and oversee all training and education activities sponsored by PreHC, including administration of the pilot grant program for trainees and junior faculty; 2) a Scientific Discovery Core that will provide state of the art assessment of neurocognitive function (mind), physical function (mobility) and measures of behavior change (motivation); and 3) a Data Management Core supporting the collection, monitoring, management and transfer of complex data, the development of single data repository resulting from the qualifying and pilot studies and biostatistical support assisting with study design and analysis. An internal steering committee will help oversee day to day operations and programmatic success and an external advisory board of content experts will help guide the achievement of the short- and long-term goals. We will use this resulting information to develop more personalized Prehabilitative treatment approaches that will be tested for better meeting the personalized needs of Veterans. Additionally, the resulting data repository will be an available resource for VA-based RR&D researchers that will develop and grow with advancement of PreHC. In sum, over the next five years, the PreHC will evolve into a national resource center that will conduct cutting-edge research in prehabilitative care. The knowledge gained from this research will fill gaps in our current therapeutics to advance and maintain the long-term health of aging Veterans.