Implementation of Routine Walking Speed Measurements in Older Veterans

Aging, Fall Risk, Mobility Limitation

Screening, Preventative Care, Implementation Science, RE-AIM, PRISM

Walking speed is a powerful predictor of mortality and adverse health consequences (e.g. fall or hospitalization) in older adults. Knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Furthermore, walking speed is a modifiable risk factor such that early recognition of physical function decline allows for appropriate and timely intervention prior to the occurrence of adverse health events. Therefore, this proposal seeks to implement routine measures of walking speed into VHA primary care as a 'vital sign' to routinely monitor Veteran physical function and help guide provider referrals.

Background: Walking speed is a vital sign that can predict mortality and adverse health outcomes in older adults. However, it is not routinely assessed in outpatient primary care clinics, potentially leading to missed opportunities for timely intervention and rehabilitative care. Current literature identifies walking speed as a sensitive measure of overall health and functional status, with a walking speed of \<0.6 m/s indicating increased risk of adverse events and reduced independence. Consequently, knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Importantly, walking speed is also a modifiable risk factor and is sensitive to change in multiple populations with varying medical conditions, making it an ideal measure for longitudinal monitoring of physical function. The investigators' preliminary work implementing walking speed measurement into outpatient geriatric clinical care, along with recent literature, demonstrates that routine walking speed assessments are feasible, quick, and safe. Significance: Current VHA standard of care within primary care clinics relies on subjective information to evaluate a Veteran's physical function, which can be unreliable and inaccurate. Implementation of walking speed will introduce an objective measure that can accurately assess how a Veteran's physical function changes over time, thus helping providers identify whether referrals to rehabilitation services are needed. Innovation and Impact: This proposal is innovative as it will be one of the first studies to assess the implementation and effect of walking speed across multiple primary care clinics. Additionally, examination of contextual factors influencing the implementation and effect of walking speed is innovative and will lead to adaptations that facilitate future widespread implementation. Methodology: Pragmatic hybrid type 2 effectiveness-implementation study using a stepped-wedge cluster randomized trial design to evaluate and improve walking speed implementation and assess its effectiveness across VHA PACT clinics.

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