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：接触 COVID-19 和社会经济因素的影响

• 批准号: 10731368
• 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/10731368
• 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.

尽管 2019 年冠状病毒病 (COVID-19) 在世界范围内广泛流行， 采取多种战略努力和预防措施来阻止其传播。合并症，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。 退伍军人这些病症的患病率很高，并且出现并发症和贫困的风险增加 恢复。退伍军人康复策略的制定和成功实施 COVID-19 后应该成为临床研究的高度优先事项。 COVID-19 对人类的长期影响 心肺和身体功能不确定；此外，针对障碍的康复策略 必须在社交距离的限制下可行。关于恢复后的相关知识差距 还需要解决患有肺部和心脏代谢疾病的患者的生理轨迹 制定有效的运动康复策略。 本次运动试验的目的是调查家庭远程运动康复的效果 对这些结果进行评估，并评估世界卫生组织的五项国际分类 确定用于 COVID-19 幸存者研究的功能、残疾和健康 (ICF) 组成部分。我们的中央 假设是带有团体成分的家庭锻炼（COVID Tele-EX）可以改善心肺功能 COVID-19 后退伍军人的身体机能。研究设计包括一个调查小组，该小组的成员包括： VA 康复合作的跟踪记录，并将允许探索与以下方面相关的医疗保健差异 COVID-19，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 及周边地区的退伍军人 社区门诊 (CBOC) 将在家参加为期 12 周的运动干预 其中包括 VA Video Connect (VVC) 中的虚拟团体锻炼课程。之前和之后的程序 干预措施包括心肺运动测试、肺功能测试、身体功能测试和 针对运动自我效能感的问卷调查。我们对退伍军人心肺和身体功能的研究 从 COVID-19 中康复将提供有关“长期 COVID”或急性后遗症的重要且新颖的信息 SARS-Co-V-2 感染。 该试验的结果将为在全国范围内实施远程家庭团体锻炼计划提供证据 退伍军人事务部中心可以超越 COVID-19 大流行，并对改善和创造具有重要影响 退伍军人康复护理的新标准。