Rauzi Michelle R, Abbate Lauren M, Churchill Laura, Garbin Alexander J, Forster Jeri E, Christiansen Cory L, Stevens-Lapsley Jennifer E
Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA.
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.
PM R. 2025 May;17(5):548-562. doi: 10.1002/pmrj.13299. Epub 2025 Jan 8.
Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.
To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.
Randomized controlled cross-over feasibility study.
Telehealth from Veterans Affairs Medical Center to participants' homes.
Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.
The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.
The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.
Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.
The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.
患有多种疾病的老年退伍军人存在身体和社会方面的脆弱性，这使得他们接受和坚持物理康复服务变得复杂。因此，传统的物理康复项目不足以应对这一人群的异质性临床表现。
评估针对患有多种疾病的老年退伍军人的多组分远程康复（MCTR）项目的可行性和可接受性。
随机对照交叉可行性研究。
从退伍军人事务医疗中心到参与者家中的远程医疗。
50名美国退伍军人，年龄≥60岁（平均±标准差；69.2±6.7），患有≥3种合并症（6.0±1.9），且身体功能受损，被随机分为两组，每组人数相等。
MCTR项目包括高强度康复、指导、社会支持和技术。物理治疗师为每位参与者提供12次个人和20次小组远程康复课程。教育组的参与者在12周后开始MCTR项目。
主要结局是综合依从性（>75%的参与者参加≥80%的课程）。可接受性通过干预措施可接受性量表进行测量。次要结局包括安全性、参与者调查和身体功能。在基线、12周（主要时间点）和24周收集患者层面的结局。
50名参与者中，39人坚持参加了全部课程（0.78[95%置信区间：0.64-0.88]，p = 0.76），45人坚持参加个人课程（0.90[95%置信区间：0.78-0.97]，p = 0.01），48人将该项目评为可接受（0.96[95%置信区间：0.85-0.99]，p < 0.001）。35名参与者报告了78起安全事件，其中12起（15%）与方案有一定程度的相关性。在12周时，两组之间的大多数患者层面结局相似。
基于对个人课程的高依从性和高可接受性，MCTR项目是可行的。依从性结果与之前针对老年人的运动研究一致。大多数课程中的安全事件与潜在的医疗状况有关，与面对面物理康复安全事件一致。这些结果可为类似人群使用远程康复提供参考。
