Team VA Video Connect (VVC) to optimize mobility and physical activity in post-hospital discharge older veterans: baseline assessment

Abstract

Background Telehealth is increasingly used for rehabilitation and exercise but few studies include older adult participants with comorbidities and impairment, particularly cognitive. Using Veterans Administration Video Connect (VVC), the aim of the present study is to present the screening, recruitment, baseline assessment, and initial telehealth utilization of post-hospital discharge Veterans in a VVC home-telehealth based program to enhance mobility and physical activity. Methods Older adult Veterans (n = 45, mean age 73), recently discharged from the hospital with physical therapy goals, were VVC-assessed in self-report and performance-based measures, using test adaptations as necessary, by a clinical pharmacy specialist and social worker team. Results Basic and instrumental ADL disabilities were common as were low mobility (Short Portable Performance Battery) and physical activity levels (measured by actigraphy). Half had Montreal Cognitive Assessment (MoCA) scores in the mild cognitive impairment range (< 24). Over 2/3 of the participants used VA-supplied tablets. While half of the Veterans were fully successful in VVC, 1/3 of these and an additional group with at least one failed connection requested in-person visits for assistance. One-quarter had no VVC success and sought help for tablet troubleshooting, and half of these eventually “gave up” trying to connect; difficulty with using the computer and physical impairment (particularly dexterity) were described prominently in this group. On the other hand, Veterans with at least mild cognitive impairment (based on MoCA scores) were present in all connectivity groups and most of these used caregiver support to facilitate VVC. Conclusions Disabled older post-hospital discharged Veterans with physical therapy goals can be VVC-assessed and enrolled into a mobility/physical activity intervention. A substantial proportion required technical support, including in-person support for many. Yet, VVC seems feasible in those with mild cognitive impairment, assuming the presence of an able caregiver. Modifications of assessment tools were needed for the VVC interface, and while appearing feasible, will require further study. Trial registration ClinicalTrials.gov NCT 04045054 05/08/2019.

Implementation of a Multicomponent Otago-Based Virtual Fall Reduction, Education, and Exercise Program (MOVing FREEly) in Older Veterans

“…Performance tests were conducted over video platform with PT providing guidance and demonstration as needed. Other performance tests are more difficult to conduct over a virtual modality and were omitted [18,29]. Pre-class, post class and three-month post program questionnaires completed independently by participants captured changes in self-report of gait, balance or lower extremity impairments (adapted from CDC STEADI "Stay Independent" assessment), concern for falling (e.g., falls efficacy scale-international (FES-I) short form and self-report concern for falling) and demographic information [30][31][32].…”

“…Telemedicine is an accepted way to provide and receive care in VHA, and in many cases is a preferred modality due to transportation and other logistical challenges that rural veterans face [15][16][17]. Though there has been some success in converting other Veterans Affairs (VA) mobility and exercise programs to virtual platforms, a virtual fall prevention group program has yet to be piloted in VHA [18,19]. The goal of this project was to evaluate the feasibility and acceptance of a novel VHA multicomponent and interdisciplinary virtual fall prevention program, developed to increase awareness of fall risk factors, improve strength and balance, and promote risk-reducing behaviors.…”