Modification and Pilot Testing of The Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) Intervention

研究：目前的护理标准为物理康复的退伍军人住院的心脏衰竭 (HF)是不够的3个原因：1）当规定，退伍军人可能无法从事身体康复 由于感觉不堪重负，他们的整体高治疗工作量，2）家庭物理治疗往往是在- 给药，因此未能实现临床影响，和3）心脏康复（CR）很少规定。 当它被利用时，它的重点是中等强度的有氧运动，不适合严重虚弱的人。 因HF住院的退伍军人。我是NIA资助的初步研究（R03AG064371）的主要研究者 （BAMS-HF [HF中的平衡、有氧能力、移动性和力量]研究）， 最近因HF住院，接受了一种新的，严格的1：1物理治疗师主导的家庭康复治疗 这是一个旨在解决上述#2和#3问题的干预措施。虽然完成这项研究的退伍军人是 他们对此充满热情，他们确实希望与其他BAMS-HF退伍军人接触，[报告动机低， 参与的重大障碍]。BAMS-HF研究的这些见解和挑战导致了目前的 心力衰竭住院后能力训练与锻炼（COACH-HF）的建议 干预根据BAMS-HF初步研究的初步结果和现有文献，COACH-HF 对于最近因HF住院的退伍军人的身体康复，我将采取双管齐下的方法：1）容量 来自同伴支持专家（HF退伍军人）的指导，以及2）物理治疗师领导的严格的家庭 力量、平衡和活动性锻炼方案，每周3天，最长12周，以及 每月与物理治疗师和其他COACH-HF退伍军人一起进行小组锻炼，直到6个月。 [拟议COACH-HF干预的修改]和试点测试将在以下2个目标下进行： [Aim 1：利用[12]收集利益相关者对COACH-HF干预措施的结构和交付的反馈意见 3个利益相关者类别中的焦点小组（FG）：最近因HF住院的退伍军人， 护理人员和医疗保健提供者。不同的观点从FG将解决一个小的 调查人员和利益攸关方的决策小组。使用名义组技术（NGT），决策- 决策小组将集思广益，并对解决关键分歧领域的想法进行排名。干预 PI将根据FG和NGT结果修改设计。所有参加者将被邀请 在进行试点测试（即成员检查）之前，对最终干预设计的反馈。] [Aim 2：通过以下方式确定能力训练是否增加了对康复干预的依从性： 将25名近期因HF住院的≥ 55岁退伍军人以1：1的比例随机分配至能力训练+康复组 干预（CC+康复）与仅康复（仅康复）。评估以下项目的可行性和可接受性： 康复干预（两组）和能力训练（CC+康复组）。 候选人：我是一名受过高级HF培训的心脏病专家，对退伍军人的身体康复感兴趣 因HF住院。我是落基山脉地区临床CR和HF项目的联合主任 (RMR)VAMC。我的职业目标是成为一名独立的VA康复研究员， 因HF住院的退伍军人的身体康复。这个奖项将帮助我发展定性的技能， 研究，利益相关者参与和临床试验设计的行为干预是必要的， 实现我的职业目标。下一步是编写一个Merit Review应用程序，建议测试疗效 COACH-HF的干预。 环境：本研究将在落基山地区VA医疗中心（RMR）进行 VAMC）。RMR VAMC是一个三级护理中心，隶属于科罗拉多安舒茨大学 医学院。拟议的研究将利用现有的资源和文化，支持临床 在RMR VAMC，Cariology Division和Seattle-Denver创新中心进行研究。

Research: The current standard of care for physical rehabilitation of Veterans hospitalized for heart failure (HF) is inadequate for 3 reasons: 1) When prescribed, Veterans may fail to engage in physical rehabilitation due to feeling overwhelmed by their overall high treatment workload, 2) Home physical therapy is often under- dosed and therefore fails to achieve clinical impact, and 3) Cardiac rehabilitation (CR) is rarely prescribed. When it is utilized, its focus on moderate intensity aerobic exercise is inappropriate for severely debilitated Veterans hospitalized for HF. I am the Principal Investigator of an NIA-funded pilot study (R03AG064371) (BAMS-HF [Balance, Aerobic capacity, Mobility and Strength in HF] study), which provides older Veterans recently hospitalized for HF with a novel, rigorous 1:1 physical therapist-led home-based rehabilitation intervention that is designed to address #2 and #3 above. Although Veterans who complete the study are enthusiastic about it, they do desire contact with other BAMS-HF Veterans and [report low motivation as a significant barrier to participation.] These insights and challenges from the BAMS-HF study led to the current proposal of the Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) intervention. Based on the preliminary results of the BAMS-HF pilot study and existing literature, COACH-HF will take a 2-pronged approach to physical rehabilitation in Veterans recently hospitalized for HF: 1) Capacity Coaching from a Peer Support Specialist (a Veteran with HF), and 2) Physical therapist-led rigorous, in-home strength, balance and mobility exercise protocol that will occur 3 days/week for a maximum of 12 weeks, and monthly group exercise sessions with the physical therapist and other COACH-HF Veterans until 6 months. [Modification of the proposed COACH-HF intervention] and pilot testing will occur over the following 2 Aims: [Aim 1: Garner stakeholder feedback on the structure and delivery of the COACH-HF intervention using [12] focus groups (FGs) among 3 stakeholder categories: Veterans recently hospitalized for HF, Veterans’ caregivers, and healthcare providers. Differing perspectives from the FGs will be addressed with a small decision-making group of investigators and stakeholders. Using nominal group technique (NGT), the decision- making group will brainstorm and rank ideas for addressing key areas of disagreement. The intervention design will be modified by the PI based on the FG and NGT results. All FGs participants will be invited to give feedback on the final intervention design prior to moving forward to pilot testing (i.e. member-checking).] [Aim 2: Determine whether Capacity Coaching increases adherence to the rehabilitation intervention by randomizing 25 Veterans ≥ 55 years recently hospitalized for HF 1:1 to Capacity Coaching + Rehabilitation intervention (CC+Rehab) vs. Rehabilitation only (Rehab Only). Assess the feasibility and acceptability of rehabilitation intervention (both arms) and Capacity Coaching (CC+Rehab arm).] Candidate: I am an advanced HF trained cardiologist with an interest in physical rehabilitation for Veterans hospitalized for HF. I am co-director of the clinical CR and HF programs at the Rocky Mountain Regional (RMR) VAMC. My career goal is to become an independent VA rehabilitation researcher specializing in physical rehabilitation of Veterans hospitalized for HF. This award will help me develop the skills in qualitative research, stakeholder engagement and clinical trial design for behavioral interventions that are necessary to achieve my career goals. The next step is to write a Merit Review application that proposes testing the efficacy of the COACH-HF intervention. Environment: This research will be conducted at the Rocky Mountain Regional VA Medical Center (RMR VAMC). The RMR VAMC is a tertiary care center that is affiliated with the University of Colorado Anschutz Medical Campus. The proposed study will leverage the existing resources and culture of supporting clinical research within the RMR VAMC, Cariology Division and the Seattle-Denver Center of Innovation.