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

有多种合并症或医学复杂性的老年退伍军人是最脆弱的 患者群体。退伍军人健康管理局(VHA)受益者的这一巨大且不断增长的比例 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面临着更大的风险，即功能进行性下降、生活质量下降 生活，以及频繁的护理需求。虽然VHA已经建立了门诊计划来解决康复问题 根据需要，这些方案往往服务于特定疾病的人群(例如心脏病、中风)。此外，这些 计划往往不能满足医学上复杂的老年退伍军人的需求，因为他们通常1)需要- 2)康复的生理强度不足，3)缺乏自我管理 保存功能的方法。远程医疗平台为重新设计康复模式提供了解决方案 为医学上复杂的老年退伍军人提供护理，并可帮助克服无障碍(乡村、 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颖、可扩展的远程康复方法迫在眉睫 需要1)使用渐进的高强度康复来解决生理损伤，2)增加 通过促进自我管理的生物行为干预来减少身体活动，以及3)减少社交 通过社会支持获得孤立和孤独。因此，我们提出了一项试点双臂随机试验，使用 交叉研究设计以确定为期12周的可行性、可接受性和安全性(AIM 1) 多组分远程康复计划。我们还将测量退伍军人的临床结果，以探索 对方案的初步反应，并确定准备中的结果的可变性估计(目标2) 进行更大规模的调查。这项研究将招募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”使用老年医学和长期护理数据与分析中心提供的定义。 退伍军人将被随机分到第一组或第二组(每组25人)；第一组将获得 为期12周的干预，第二组将接受由1小时教育课程组成的注意力控制 每2周分娩一次(共6次)。然后，第2组将在12个月结束时交叉进入干预- 几周。结果将在基线(干预前)、6周(干预中点)、12周进行评估 (干预结束)和24周。拟议目标的实现将确立可行性和初步 一种新的、多组件远程康复计划的响应，该计划关键地解决了 传统康复服务不足的老年退伍军人所特有的相互关联的复杂性 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 因为他们将指导实施安全有效的远程康复计划，作为面对面康复计划的替代方案 医学上复杂的老年退伍军人的康复。

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.