Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation

接受下肢截肢的退伍军人身体健康状况不佳，患有多种慢性合并症， 医疗服务利用率高，残疾程度高。生活在较低水平的人的自我报告残疾 截肢人数占总人口的95%以上。减少退伍军人残疾的一种方法是 截肢是为了让他们参与终生持续的步行锻炼。定期锻炼 提高功能独立性和精神健康，减少常见疾病的不良影响 与下肢截肢相关的并发症，如糖尿病和外周动脉疾病。 然而，大多数下肢截肢的退伍军人并不经常锻炼。只有50%的人患有较低- 截肢达到步行活动的水平，支持他们在当地社区的参与，创造了 肢体截肢后提高体育锻炼参与度的迫切需要。有证据表明 临床医生支持的个人家庭生活环境中的锻炼，包括基于证据的促进 患者自我管理有望中断久坐行为增加和健康状况不佳的循环 结果。因此，这项随机对照优势试验的主要目的是确定一个 远程康复步行锻炼自我管理计划产生有临床意义的步行锻炼 可持续发展与注意力控制教育相比。这一新颖的、低成本的干预措施包括一部小说 试验性行为改变方法和临床资源的结合，包括VA多学科 远程保健会议、个人运动自我管理培训和退伍军人健康整体同伴小组会议。 此外，干预还整合在已建立的退伍军人管理局区域截肢中心内，使用 建立了退伍军人临床远程康复技术。运动和体力活动将作为一项 连续的每日结果，次级结果在基线测试中评估，然后在6和18之后进行评估 几个月的干预参与。主要结果将是加速计评估的每日步行步数 在18个月的研究期间，每天连续监测计数。次要结果是设计的 评估如何最好地将步行运动干预转化为常规VA的可能性 截肢康复。这些次要结果包括干预范围、干预措施 有效性、临床采用的可能性、临床实施的潜力以及参与者的能力 保持长期的锻炼行为。这项研究中使用的独特康复范式解决了 家庭锻炼模式下下肢截肢后慢性久坐生活方式的问题 来自临床医生和同行的终身运动支持。试验结果将促进康复知识和 为更大规模的临床转化自我管理干预提供必要的证据以维持 腿部截肢退伍军人的步行锻炼。

Veterans living with lower-limb amputation have poor physical health outcomes, multiple chronic comorbidities, high medical service utilization, and high levels of disability. Self-reported disability for people living with lower- limb amputation is greater than 95% of the general population. One way to reduce disability for Veterans with lower-limb amputation is for them to participate in life-long sustained walking exercise. Regular exercise improves functional independence and mental well-being, and reduces adverse effects of common comorbidities associated with lower-limb amputation, such as diabetes and peripheral artery disease. However, most Veterans with lower-limb amputation do not regularly exercise. Only 50% of people with lower- limb amputation achieve levels of walking activity that support participation in their local community, creating a critical need to improve physical exercise participation after lower-limb amputation. Evidence suggests that clinician-supported exercise in a person’s home living environment that includes evidence-based promotion of patient self-management has promise for interrupting the cycle of elevated sedentary behavior and poor health outcomes. Therefore, the primary aim of this randomized controlled superiority trial is to determine if a telerehabilitation walking exercise self-management program produces clinically meaningful walking exercise sustainability compared to attention-control education. This novel, low-cost intervention includes a novel combination of piloted behavior-change methods and clinical resources, including VA multidisciplinary telehealth sessions, individual exercise self-management training, and VA Whole Health peer-group sessions. In addition, the intervention is integrated within an established VA Regional Amputation Center, using established VA clinical telerehabilitation and technology. Exercise and physical activity will be monitored as a continuous daily outcome, with secondary outcomes assessed at a baseline test and then after 6 and 18 months of intervention participation. The primary outcome will be accelerometer-assessed daily walking step count monitored continuously each day across the 18-month study period. Secondary outcomes are designed to assess the potential to assess how to best translate the walking exercise intervention into conventional VA amputation rehabilitation. These secondary outcomes include measures of intervention reach, intervention efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation with a home-based exercise model of life-long exercise support from clinicians and peers. The trial results will advance rehabilitation knowledge and provide the necessary evidence for larger clinical translation of self-management intervention to sustain walking exercise for Veterans living with lower-limb amputation.