Engaging Medically Complex Veterans in Tele-Rehabilitation Using a Biobehavioral Approach: A Pilot Study of Feasibly and Acceptability

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Older Veterans with multiple comorbidities or medically complexities represent one of the most vulnerable patient populations. This large and growing proportion of Veterans Health Administration (VHA) beneficiaries are more likely to live in rural areas, experience social isolation and loneliness, and be physically inactive. Thus, medically complex older Veterans are at greater risk for progressive declines in function, lower quality of life, and frequent care needs. While the VHA has established outpatient programs to address rehabilitation needs, these programs tend to serve disease-specific populations (e.g. cardiac, stroke). Moreover, these programs often do not meet the needs of medically complex older Veterans, as they typically 1) require in- person attendance, 2) under-dose the physiologic intensity of rehabilitation, and 3) lack self-management approaches for preservation of function. Telehealth platforms offer a solution to redesign rehabilitation models of care for medically complex older Veterans and can aid in overcoming access barriers (rurality, transportation), while also integrating technologies to augment biobehavioral interventions and provide social support. Novel, scalable telerehabilitation approaches targeting medically complex older Veterans are urgently needed to 1) address physiologic impairments using progressive, high-intensity rehabilitation, 2) increase physical inactivity with biobehavioral interventions which promote self-management, and 3) reduce social isolation and loneliness via social support. Therefore, we propose a pilot, two-arm randomized trial using a crossover study design to determine the feasibility, acceptability, and safety (AIM 1) of a 12-week multicomponent telerehabilitation program. We will also measure Veterans’ clinical outcomes to explore the preliminary response to the program and to determine variability estimates for outcomes (AIM 2) in preparation for a larger investigation. This study will enroll 50 medically complex older Veterans who are designated as “high-need, high-risk” using a definition provided by the Geriatrics & Extended Care Data & Analysis Center. Veterans will be randomized to GROUP1 or GROUP2 (25 participants in each group); GROUP1 will receive the 12-week intervention, and GROUP2 will receive attention control consisting of 1-hour education sessions delivered every 2 weeks (6 total). GROUP2 will then crossover to the intervention at the completion of 12- weeks. Outcomes will be assessed at baseline (pre-intervention), 6 weeks (intervention mid-point), 12 weeks (end of intervention), and 24 weeks. Achievement of the proposed aims will establish feasibility and preliminary response of a novel, multicomponent telerehabilitation program that critically addresses the multitude of interrelated complexities unique to older Veterans who are currently underserved by traditional rehabilitation paradigms. This work will directly translate to other medically complex and underserved populations who will benefit from innovative telerehabilitation care approaches. Study findings will have immediate clinical impact as they will guide implementation of safe and effective telerehabilitation programs as alternatives to in-person rehabilitation for medically complex older Veterans.