Medically complex older Veterans are at greater risk for progressive declines in physical function, lower quality of life, and increasing care needs. Additionally, older Veterans experience social isolation and loneliness, and have low levels of physical activity. While the Veterans Health Administration has established programs to address rehabilitation needs, these programs tend to be diagnosis-focused, lack self-management approaches, include low-intensity rehabilitation, and typically require in-person attendance. A MultiComponent TeleRehabilitation (MCTR) program that includes high-intensity rehabilitation and self-management interventions, social support, and telehealth and technology supports may be more effective in improving and sustaining physical function for older Veterans with complex health conditions. Therefore, this project is designed to determine whether the MCTR program improves strength and physical function more effectively than traditional interventions.
60 years of age and older
Multiple chronic conditions (Functional Comorbidity Index > or = 3)
Impaired physical function (< or = 8 repetitions on 30 second sit to stand test)
Life expectancy < 12 months
Acute or progressive neurological disorder (e.g. amyotrophic lateral sclerosis, recent stroke)
Moderate to severe dementia (<11 on telephone Montreal Cognitive Assessment(T-MoCA))
Medical conditions precluding safe participation in high-intensity rehabilitation (e.g. unstable angina)
Parallel
Motivational Interviewing Techniques
BehavioralMotivational Interviewing Techniques including but not limited to open-ended questions, reflection, affirmations, and summary will be used to build participant rapport, support behavior change (physical activity), and facilitate program engagement.
Physical Therapy Interventions
Other interventionStrengthening, balance, functional activities, stretching, breathing, aerobic endurance exercise.
Education
Other interventionEducation on general health topics which may include the following: basic nutrition, stress reduction, sleep hygiene, etc.
Health Status Updates
Other interventionHealth Status Updates will be completed by a trained assessor. The assessor will ask about adverse events, general health topics, medication changes, and changes in social circumstances.
Physical Therapy Consult
Other interventionParticipants in the control condition will be offered a physical therapy consult at the end of their 24 week study involvement.
2 Minute Step Test
This is a functional performance test for aerobic endurance. It requires participants to march in place for 2 minutes (alternating legs), and the score is the number of repetitions completed on the right leg. Scores are continuous, and higher scores indicate better aerobic endurance.
Arm Curl Test
This is a functional performance test for upper body strength and is performed on each arm (one arm at a time). It requires the participant to perform as many arm curls (biceps curls) as possible in 30 seconds. Males use a 8 pound weight and females use a 5 pound weight. Scores are continuous, and higher scores indicate greater arm strength (better outcome)
30 Second Sit To Stand
The test uses a standard height chair and requires the participant to stand up and sit down as many times as possible in 30 seconds. More repetitions indicate better lower extremity strength.
Physical Activity
Physical activity will be measured via accelerometry and will include an averaged daily step count.
Exercise readiness to change
Four-item survey collected via interview format, and it is used to categorize participants into stages of change according to the Transtheoretical Model, possible stages include: (pre-contemplating, contemplation, preparation, action, and maintenance).
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