Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol.

BACKGROUND: Alcohol use is a significant risk factor for disability and death in U.S. adults, and approximately one out of every six Veterans seen in primary care (PC) report unhealthy alcohol use. Unhealthy alcohol use is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA pioneered implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. To improve alcohol-related care, this study will conduct a pilot study to assess whether a multi-faceted evidence-based implementation strategy-practice facilitation-has the potential to improve PC-based alcohol-related care at a single VA clinic. METHODS: We will first recruit and conduct qualitative interviews with Veterans with unhealthy alcohol use (n = 20-25) and PC stakeholders (N = 10-15) to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the multifaceted practice facilitation intervention. Qualitative interviews, analysis, and refinement of the intervention will be guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups with a small sample of PC providers and staff (n = 5-7) will be used to further refine the practice facilitation intervention and assess its acceptability and feasibility. The refined practice facilitation intervention will then be offered in the PC clinic to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes based on the RE-AIM framework. DISCUSSION: This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. If successful, this pilot may generate an intervention with far-reaching effects on adverse outcomes experienced by Veterans with unhealthy alcohol use, including increased access to care and suicide prevention. Trial registration Clinicaltrials.gov identifier: NCT04565899; Date of registration: 9/25/2020.

Feasibility, acceptability, and preliminary efficacy of a handcycling high-intensity interval training program for individuals with spinal cord injury.

STUDY DESIGN: Pilot nonrandomized clinical trial. OBJECTIVES: To examine the feasibility, acceptability, and preliminary efficacy of performing handcycling high-intensity interval training (HIIT) for 6 weeks in wheelchair users with spinal cord injury. SETTING: Participant's home. METHODS: Participants completed pre- and postgraded exercise stress tests, exercise surveys and 6 weeks of handcycling HIIT. The HIIT program consisted of two weekly, 25 min supervised at-home sessions (2-3 min warm-up, then ten intervals of cycling with a ratio of 1 min work at 90% peak power output (PPO) to 1 min recovery at 0-20% PPO, then 2-3 min cool down). Real-time power output and heart rate were recorded via sensors and a bike computer. The sensor data were analyzed to evaluate training efficacy. RESULTS: Seven of the ten enrolled participants (70%) completed the study. All but one completed the required 12 sessions. The participants met at least 1 of the HIIT target intensity criteria in 76 out of 89 total sessions (85.4%) performed. Participants expressed a high level of enjoyment on the Physical Activity Enjoyment Scale, mean (SD) = 114.8 (11.3), and satisfaction with the overall experience. Five of the seven participants (71%) who completed the study felt an increase in endurance, function, and health. Objective physiological changes showed mixed results. CONCLUSIONS: Six weeks of handcycling HIIT appears to be safe, feasible and acceptable. A longer HIIT work interval may be needed to elicit significant physiological responses. Future investigation of the feasibility and efficacy of differing HIIT parameters is needed.