Walking Exercise Sustainability Through Telehealth for Veterans With Lower-Limb Amputation
Overview
- Phase
- Not Applicable
- Intervention
- Exercise self-management
- Conditions
- Lower-Limb Amputation
- Sponsor
- VA Office of Research and Development
- Enrollment
- 95
- Locations
- 2
- Primary Endpoint
- Average Daily Step Count
- Status
- Active, not recruiting
- Last Updated
- 8 days ago
Overview
Brief Summary
Despite recent advances in physical rehabilitation, Veterans with lower-limb amputation have poor long-term outcomes, including severely limited functional capacity and high levels of disability. Such poor outcomes are compounded by a lack of exercise participation over time, even with use of lower-limb prostheses. There is a clear need to advance current rehabilitation strategies to better promote sustained exercise following lower-limb amputation. To address this need, the study will determine the potential of a walking exercise self-management program to achieve sustained exercise participation. The 18-month intervention is focused on helping Veterans reduce habitual sedentary behavior through a remote exercise behavior-change intervention that includes multiple clinical disciplines, individualized exercise self-management training, and peer support. This innovative approach shifts the conventional rehabilitation paradigm to specifically target life-long exercise sustainability and remove an underlying cause of disability for Veterans with lower-limb amputation.
Detailed Description
Veterans living with lower-limb amputation have poor physical health outcomes, multiple chronic comorbidities, high medical service utilization, and high levels of disability. Self-reported disability for people living with lower limb amputation is greater than 95% of the general population. One way to reduce disability for Veterans with lower-limb amputation is for them to participate in life-long sustained walking exercise. Regular exercise improves functional independence and mental well-being, and reduces adverse effects of common comorbidities associated with lower-limb amputation, such as diabetes and peripheral artery disease. However, most Veterans with lower-limb amputation do not regularly exercise. Only 50% of people with lower limb amputation achieve levels of walking activity that support participation in their local community, creating a critical need to improve physical exercise participation after lower-limb amputation. Evidence suggests that clinician-supported exercise in a person's home living environment that includes evidence-based promotion of patient self-management has promise for interrupting the cycle of elevated sedentary behavior and poor health outcomes. Therefore, the primary aim of this randomized controlled superiority trial is to determine if a telerehabilitation walking exercise self-management program produces clinically meaningful walking exercise sustainability compared to attention-control education. This novel, low-cost intervention includes a novel combination of piloted behavior-change methods and clinical resources, including VA multidisciplinary telehealth sessions, individual exercise self-management training, and VA peer-group sessions. In addition, the intervention is integrated within an established VA Regional Amputation Center, using established VA clinical telerehabilitation and technology. Exercise and physical activity will be monitored as a continuous daily outcome, with secondary outcomes assessed at a baseline test and then after 6 and 18 months of intervention participation. The primary outcome will be accelerometer-assessed daily walking step count monitored continuously each day across the 18-month study period. Secondary outcomes are designed to assess the potential to assess how to best translate the walking exercise intervention into conventional VA amputation rehabilitation. These secondary outcomes include measures of intervention reach, intervention efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation with a home-based exercise model of life-long exercise support from clinicians and peers. The trial results will advance rehabilitation knowledge and provide the necessary evidence for larger clinical translation of self-management intervention to sustain walking exercise for Veterans living with lower-limb amputation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Unilateral or bilateral lower-limb amputation (transmetatarsal to him disarticulation, traumatic or non-traumatic etiology)
- •Ability to walk two minutes without seated rest using prosthesis and assistive device if needed
- •Living without assistance for basic activities of daily living
Exclusion Criteria
- •Congenital or cancer-related amputation
- •Unstable heart condition including:
- •unstable angina
- •uncontrolled cardiac dysrhythmia
- •acute myocarditis
- •acute pericarditis
- •Acute systemic infection
- •Mild cognitive impairment
- •Active cancer treatment
- •Discretion of PI to exclude patients who are determined to be unsafe and/or inappropriate to participate
Arms & Interventions
Exercise self-management
The EXP intervention will integrate conventional telehealth care with exercise self-management training and include structured 1:1 sessions (six) with an interventionist, peer group sessions (six), real-time step count feedback throughout the 18 months using a wrist-worn Fitbit with an LED interface, and tailored messaging with text messages designed using six key behavior-change techniques promoting exercise self-management.
Intervention: Exercise self-management
Attention control
The CTL intervention will incorporate the annual multidisciplinary team telehealth sessions, 12 attention-control telehealth sessions (six individual, six peer-group), and general health education text message prompts to match the timing and duration of the EXP group.
Intervention: Attention control
Outcomes
Primary Outcomes
Average Daily Step Count
Time Frame: Through study completion: Baseline to 18 months
Average daily step count will be measured and recorded continuously for the 18-month study period, using a waist-mounted tri-axial accelerometer.
Secondary Outcomes
- Patient-Reported Measurement Information System - Ability to Participate in Social Roles and Activities - Short Form 8A(Through study completion: Baseline to 18 months)
- 2-Minute Step Test(Through study completion: Baseline to 18 months)
- Prosthetic Limb Users Survey of Mobility Computer Adaptive Test (PLUS-M CAT)(Through study completion: Baseline to 18 months)
- Self-Efficacy for Exercise Scale(Through study completion: Baseline to 18 months)
- Comprehensive Lower Limb Amputee Socket Survey (CLASS)(Through study completion: Baseline to 18 months)
- 30-Second Chair Rise Test(Through study completion: Baseline to 18 months)
- World Health Organization Disability Assessment Scale 2.0(Through study completion: Baseline to 18 months)