ABSTRACT
Research Objectives To examine the feasibility of the Live Long Walk Strong (LLWS) rehabilitation program delivered via telehealth. Secondary objectives are to examine the preliminary efficacy of LLWS on mobility and exercise self-efficacy. Design Nonrandomized, noncontrolled pilot with 16-week follow-up. Setting Ambulatory Care at the VA Boston Healthcare System. Participants Community-dwelling Veterans, aged 50 years and older. Interventions An evidence-based outpatient rehabilitation program was adapted as a telehealth program during year one of the COVID-19 pandemic. It included 10 sessions with a physical therapist over 8 weeks via VA Video Connect. LLWS uniquely addresses impairments linked to mobility decline and behavior change strategies targeting exercise adoption. Main Outcome Measures The primary outcome was feasibility measured by recruitment and retention, number and type of technology problems, and completion of program components. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) outpatient mobility measure and the Self-Efficacy for Exercise (SEE) scale. Results After contacting 178 primary care patients with self-reported mobility limitations, 21 enrolled in the study (12%). Seven never initiated the study due to intercurrent medical issues (n=5) and delayed disclosure of participation in another exercise study (n=2). Participants averaged 2 technology interruptions. Over 99% of the technology issues were resolved by the PT and fell into 2 broad categories of connectivity and ease of use. Attendance rate was 98% across all intervention visits. We examined the change in self-reported mobility and self-efficacy from baseline through follow-up using linear mixed models with a fixed effect of time. The AM-PAC scores improved from baseline by average of 4.1 points (p = 0.019) at 2 weeks follow-up and remained (4.2 points, p= 0.014) at 16 weeks follow-up. This improvement in mobility surpassed clinically meaningful levels. The change in self-efficacy (0.9 points) was not statistically significant. Conclusions The telehealth LLWS program appears feasible and capable to produce both short and long term improvements in physical functioning. Its benefits need to be tested in studies scaled to better evaluate efficacy and effectiveness. Author(s) Disclosures
ABSTRACT
To determine the reliability of three physical performance tests performed via a telehealth visit (30-second arm curls test, 30-second chair stand test, 2-minute step test) among community-dwelling older Veterans. Cross sectional study. Virtual. Veterans (mean age 75) who enrolled in Gerofit, virtual group exercise program. N/A. Participants were tested by two different assessors at one time point. The Interclass Correlation Coefficient (ICC) with 95% confidence intervals (CIs) and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, and depression). Assessments were conducted among 55 participants. The ICC was above 0.98 for all three tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among Veterans. Thus, they are reliable for evaluating physical performance in older Veterans in virtual settings. The authors declare no conflict of interest.
ABSTRACT
OBJECTIVE: To determine the reliability of 3 physical performance tests performed via a telehealth visit (30-s arm curls test, 30-s chair stand test, 2-min step test) among community-dwelling older veterans. DESIGN: Cross sectional study. SETTING: Virtual. PARTICIPANTS: Veterans (N=55; mean age 75y) who enrolled in Gerofit, a virtual group exercise program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were tested by 2 different assessors at 1 time point. The intraclass correlation coefficient (ICC) with 95% confidence intervals and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, depression). RESULTS: Assessments were conducted among 55 participants. The ICC was above 0.98 for all 3 tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. CONCLUSIONS: The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among veterans. Thus, they are reliable for evaluating physical performance in older veterans in virtual settings.
ABSTRACT
Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.