Physical activity behavior change for older veterans after dysvascular amputation

Abstract

Objective Determine the feasibility of using a physical-activity behavior-change (PABC) intervention for increasing physical activity and reducing disability in Veterans 1–5 years following dysvascular lower-limb amputation (LLA). Design Cross-over, feasibility trial Setting VA Geriatric Research Education and Clinical Center and Veterans Homes Participants 32 Veterans with dysvascular LLA (1–5 years after major LLA) Intervention The home-based study, using telerehabilitation technology, is intended to reduce participant burden by removing transportation and time barriers. Participants will be randomized into two participation periods of three months (Months 1–3 and 4–6). PABC intervention will occur Months 1–3 for GROUP1 and Months 4–6 for GROUP2. During PABC Intervention, participants engage in weekly video interaction with a physical therapist, who uses a collaborative approach to develop self-monitoring, barrier identification, problem solving and action planning skills to improve physical activity. GROUP2 will participate in a no physical activity intervention, attention control in Months 1–3. GROUP1 will have a no contact, intervention “wash-out” period in Months 4–6. Main Outcome Measures Feasibility will be determined using measures of 1) participant retention, 2) dose goal attainment, 3) participant acceptability, 4) safety, and 5) initial effect size. Effect size will be based on accelerometer-based physical activity and self-report disability using the Late-Life Function and Disability Index. Conclusions This study focuses on a prevalent and understudied population with low physical activity and high levels of disability due to dysvascular LLA. The results of this study will guide future development of targeted rehabilitation research to improve long term physical activity and disability outcomes.

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

“…Chronic disease self‐management interventions largely seek to enhance self‐efficacy and motivation for positive health behaviors (eg, physical activity, medication adherence) by developing psychosocial skills known to positively influence health outcomes . Psychosocial skills commonly addressed by chronic disease self‐management interventions include self‐monitoring, education, barrier/facilitator identification, problem solving, and action planning, among others . Practicing these psychosocial skills with the guidance of a clinician provides an opportunity to collaboratively discuss patient‐identified issues that prevent participation in positive health behaviors like walking.…”

“…75 Psychosocial skills commonly addressed by chronic disease self-management interventions include self-monitoring, education, barrier/facilitator identification, problem solving, and action planning, among others. 75,76 Practicing these psychosocial skills with the guidance of a clinician provides an opportunity to collaboratively discuss patient-identified issues that prevent participation in positive health behaviors like walking. For example, a patient with dysvascular LLA may discuss how icy weather, poor socket fit, or fatigue negatively affect physical activity, and the clinician can guide the patient through the problem-solving process for strategies to minimize or remove such barriers.…”

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

“…Details of the clinical trial methods have been previously published. 20 The study protocol was approved by the Colorado Multiple Institutional Review Board and Rocky Mountain Veterans Affairs Review Board and written informed consent obtained from all participants. Participants U.S. military veterans with nontraumatic LLA were recruited for trial participation.…”

“…GROUP2 participated in a telehealth attention control period for 12 weeks, crossing over to the telehealth biobehavioral intervention for the final 12 weeks. Details of the clinical trial methods have been previously published . The study protocol was approved by the Colorado Multiple Institutional Review Board and Rocky Mountain Veterans Affairs Review Board and written informed consent obtained from all participants.…”

“…Details of the behavior-change intervention are previously published. 20 The weekly video-based interactions (12 sessions,~30 minutes each) included systematic biobehavioral intervention that consisted of participant education (~5 minutes), self-monitoring (~3 minutes), tailored feedback (~3 minutes), barrier and facilitator identification (~5 minutes), promotion of problem solving (~5 minutes), action planning (~5 minutes), and encouragement (~2 minutes). Finally, participants reported on fall occurrence, research activity difficulties, their residual limb issues, healthcare visits, and health issues (~2 minutes).…”