Osteoarthritis
Conditions
Keywords
telehealth, telerehabilitation, deconditioning, exercise
Brief summary
The purpose of this study is to develop a home exercise program for patients 60 years of age and over who are deconditioned following their discharge from the hospital, or recruited from GLA outpatient clinics. The program will be designed to monitor and improve patients' exercise behavior through the use of home technology, such as text messaging monitors.
Detailed description
The aim of this study is to develop and determine the feasibility of implementing a home exercise and functional status monitoring telerehabilitation program, known as TEL-REHAB, for older adults 60 years of age and over who are deconditioned following their discharge from the inpatient setting, or recruited from GLA outpatient clinics. Deconditioning is a modifiable risk factor for preventing institutionalization of frail elderly patients who would otherwise be able to live independently. Home exercise programs are an effective intervention to reduce the risk, but patient compliance with home exercise programs, and assessments of patients during home exercise programs, are barriers to achieving maximal benefits. Face-to-face visits with physical medicine professionals are an effective means to perform these functions, but are problematic because of professional time impacts and patient transportation problems. A TEL-REHAB program will empower these patients to take responsibility for their own health by providing ongoing communication with a healthcare provider. In this way, telerehabilitation may assist older adults to remain independent in their homes as long as possible.
Interventions
DEVICEHealth Buddy, Home telehealth technology
Exercise questions, educational messages, and clinical reminders have been programmed into the home telehealth technology and are administered daily via the Health Buddy(R) to evaluate the program's feasibility based on adherence rates, program completion rates, and safety.
OTHERTelephone counseling
Sponsors
US Department of Veterans Affairs
Study design
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* acute decline in functional status while hospitalized as reported by the patient * physically inactive outpatients (exercise less than 30 min/day, 3 d/wk) * ability to hear and communicate via telephone * ability to read a video or text monitor * ability to manually operate the technology * have a working telephone and power source * willingness to use the TEL-REHAB technology
Exclusion criteria
* does not speak English * poor cognition as determined by the Mini-Cog * non-ambulatory * had a stroke, myocardial infarction, hip fracture, or total hip or knee replacement within the prior 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Exercise Adherence | at monthly intervals, for 3-months | An 11-week exercise adherence rate was calculated by dividing the total number of days that the participant reported exercising by 77 days and multiplying by 100. This first calculation estimated the exercise adherence rate for the full intervention period regardless of participant dropout. Eleven weeks rather than 12 weeks was used in the denominator because subjects received their HB units some time during the first week of study enrollment and may have missed some days during this first week. |
| HB/Phone Adherence | Monthly over 3 months | An 11-week text messaging or phone adherence rate was calculated by dividing the number of response days via the HB or phone divided by 77 days and multiplied by 100. This first calculation estimated the text messaging or phone adherence rate for the full intervention period regardless of participant dropout. Eleven weeks rather than 12 weeks was used in the denominator because subjects received their HB units some time during the first week of study enrollment and may have missed some days during this first week. |
Countries
United States
Participant flow
Recruitment details
Subjects were recruited from both the inpatient and outpatient settings of a large urban academic VA hospital. Potential participants were recruited through referrals from physicians, case managers, and social workers, participant recruitment fairs, and flyers posted around the hospital.
Participants by arm
| Arm | Count |
|---|---|
| Health Buddy Outpatient Received Health Buddy, recruited from outpatient setting | 16 |
| Telephone Outpatient Received telephone counseling, recruited from outpatient setting | 15 |
| Health Buddy Inpatient Received Health Buddy, recruited from inpatient setting | 4 |
| Telephone Inpatient Received telephone counseling, recruited from inpatient setting | 3 |
| Total | 38 |
Baseline characteristics
| Characteristic | Telephone Outpatient | Health Buddy Inpatient | Health Buddy Outpatient | Telephone Inpatient | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 14 Participants | 4 Participants | 15 Participants | 3 Participants | 36 Participants |
| Age, Categorical Between 18 and 65 years | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 2 Participants |
| Age, Continuous | 65 years STANDARD_DEVIATION 6.1 | 78 years STANDARD_DEVIATION 4.7 | 69.9 years STANDARD_DEVIATION 7.9 | 76 years STANDARD_DEVIATION 7.5 | 72.2 years STANDARD_DEVIATION 6.6 |
| Region of Enrollment United States | 15 participants | 4 participants | 16 participants | 3 participants | 38 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 15 Participants | 4 Participants | 16 Participants | 3 Participants | 38 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 4 / 16 | 1 / 15 | 3 / 4 | 0 / 3 |
| serious Total, serious adverse events | 0 / 16 | 0 / 15 | 0 / 4 | 0 / 3 |
Outcome results
Primary
Exercise Adherence
An 11-week exercise adherence rate was calculated by dividing the total number of days that the participant reported exercising by 77 days and multiplying by 100. This first calculation estimated the exercise adherence rate for the full intervention period regardless of participant dropout. Eleven weeks rather than 12 weeks was used in the denominator because subjects received their HB units some time during the first week of study enrollment and may have missed some days during this first week.
Time frame: at monthly intervals, for 3-months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Health Buddy Outpatient | Exercise Adherence | 57.4 percentage of days adhered | Standard Deviation 24.9 |
| Telephone Outpatient | Exercise Adherence | 32.1 percentage of days adhered | Standard Deviation 22.7 |
| Health Buddy Inpatient | Exercise Adherence | 56.2 percentage of days adhered | Standard Deviation 15.6 |
| Telephone Inpatient | Exercise Adherence | 35.1 percentage of days adhered | Standard Deviation 20 |
Comparison: Statistical analyses included descriptive statistics to assess demographic and medical characteristics, safety, text messaging or phone adherence, exercise adherence, and patient satisfaction. T-tests were used to determine significant differences between the HB text messaging and telephone groups (with inpatients and outpatients combined within each group). All analyses were conducted using SPSS version 14.0 for Windows.p-value: <0.05t-test, 2 sided
Primary
HB/Phone Adherence
An 11-week text messaging or phone adherence rate was calculated by dividing the number of response days via the HB or phone divided by 77 days and multiplied by 100. This first calculation estimated the text messaging or phone adherence rate for the full intervention period regardless of participant dropout. Eleven weeks rather than 12 weeks was used in the denominator because subjects received their HB units some time during the first week of study enrollment and may have missed some days during this first week.
Time frame: Monthly over 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Health Buddy Outpatient | HB/Phone Adherence | 64.7 percentage of days adhered | Standard Deviation 29.7 |
| Telephone Outpatient | HB/Phone Adherence | 36.3 percentage of days adhered | Standard Deviation 24.2 |
| Health Buddy Inpatient | HB/Phone Adherence | 70.1 percentage of days adhered | Standard Deviation 26.3 |
| Telephone Inpatient | HB/Phone Adherence | 43.7 percentage of days adhered | Standard Deviation 25.8 |
Comparison: Statistical analyses included descriptive statistics to assess demographic and medical characteristics, safety, text messaging or phone adherence, exercise adherence, and patient satisfaction. T-tests were used to determine significant differences between the HB text messaging and telephone groups (with inpatients and outpatients combined within each group). All analyses were conducted using SPSS version 14.0 for Windows.p-value: <0.05t-test, 2 sided