The Benefit of Virtual Outpatient Rehabilitative Care: a Pilot Study

Abstract

<h3>Research Objectives</h3> 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. <h3>Design</h3> Nonrandomized, noncontrolled pilot with 16-week follow-up. <h3>Setting</h3> Ambulatory Care at the VA Boston Healthcare System. <h3>Participants</h3> Community-dwelling Veterans, aged 50 years and older. <h3>Interventions</h3> 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. <h3>Main Outcome Measures</h3> 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. <h3>Results</h3> 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. <h3>Conclusions</h3> 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. <h3>Author(s) Disclosures</h3> VA RR&D Merit Award #5I01RX003095-03