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

患有多种合并症或医学复杂性的老年退伍军人是最脆弱的人群之一， 患者人群。退伍军人健康管理局（VHA）受益者的这一比例很大，而且还在不断增长。 更有可能生活在农村地区，经历社会孤立和孤独，身体不活跃。 因此，医学上复杂的老年退伍军人在功能进行性下降， 生活，以及频繁的护理需求。虽然VHA已经建立了门诊计划，以解决康复 这些方案往往服务于特定疾病人群（如心脏病、中风）。而且这些 计划往往不能满足医疗复杂的老年退伍军人的需要，因为他们通常1）要求在- 2）生理康复强度不足，3）缺乏自我管理 维护功能的方法。远程医疗平台为重新设计康复模式提供了解决方案 护理医学复杂的老年退伍军人，并可以帮助克服准入障碍（农村， 交通），同时还整合技术，以加强生物行为干预，并提供社会 支持.针对医学上复杂的老年退伍军人的新型，可扩展的远程康复方法迫切需要 需要1）使用渐进式高强度康复来解决生理损伤，2）增加 缺乏身体活动与生物行为干预，促进自我管理，和3）减少社会 孤独和孤独通过社会支持。因此，我们提出了一个试点，双臂随机试验，使用 交叉研究设计，以确定12周的可行性，可接受性和安全性（AIM 1） 多功能远程康复计划我们还将衡量退伍军人的临床结果，以探索 对该计划的初步反应，并确定结果的变异性估计（AIM 2） 进行更大规模的调查本研究将招募50名医学上复杂的老年退伍军人，他们被指定为 “高需求，高风险”使用老年医学和扩展护理数据和分析中心提供的定义。 退伍军人将被随机分配到第1组或第2组（每组25名受试者）;第1组将接受 12周的干预，组2将接受由1小时教育课程组成的注意力控制 每2周交付一次（共6次）。然后，第2组将在完成12- 周将在基线（干预前）、6周（干预中点）、12周 (end干预）和24周。实现拟议的目标将确立可行性和初步的 一种新颖的，多成分的远程康复计划，批判性地解决了众多的反应， 相互关联的复杂性是目前传统康复服务不足的老年退伍军人所独有的 范例这项工作将直接转化为其他医疗复杂和服务不足的人群，他们将 受益于创新的远程康复护理方法。研究结果将立即产生临床影响 因为它们将指导安全有效的远程康复计划的实施， 康复医学复杂的老年退伍军人。

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.