Multicomponent telerehabilitation program for Veterans with multimorbidity: A randomized controlled feasibility study

Abstract: Background: 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. Objective: To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity. Design: Randomized controlled cross-over feasibility study. Setting: Telehealth from Veterans Affairs Medical Center to participants' homes. Participants: 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. Intervention: 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. Main Outcome Measures: 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. Results: 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. Conclusions: 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.

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