Modification and Pilot Testing of The Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) Intervention

NIH RePORTER · VA · IK2 · · view on reporter.nih.gov ↗

Abstract

Research: The current standard of care for physical rehabilitation of Veterans hospitalized for heart failure (HF) is inadequate for 3 reasons: 1) When prescribed, Veterans may fail to engage in physical rehabilitation due to feeling overwhelmed by their overall high treatment workload, 2) Home physical therapy is often under- dosed and therefore fails to achieve clinical impact, and 3) Cardiac rehabilitation (CR) is rarely prescribed. When it is utilized, its focus on moderate intensity aerobic exercise is inappropriate for severely debilitated Veterans hospitalized for HF. I am the Principal Investigator of an NIA-funded pilot study (R03AG064371) (BAMS-HF [Balance, Aerobic capacity, Mobility and Strength in HF] study), which provides older Veterans recently hospitalized for HF with a novel, rigorous 1:1 physical therapist-led home-based rehabilitation intervention that is designed to address #2 and #3 above. Although Veterans who complete the study are enthusiastic about it, they do desire contact with other BAMS-HF Veterans and [report low motivation as a significant barrier to participation.] These insights and challenges from the BAMS-HF study led to the current proposal of the Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) intervention. Based on the preliminary results of the BAMS-HF pilot study and existing literature, COACH-HF will take a 2-pronged approach to physical rehabilitation in Veterans recently hospitalized for HF: 1) Capacity Coaching from a Peer Support Specialist (a Veteran with HF), and 2) Physical therapist-led rigorous, in-home strength, balance and mobility exercise protocol that will occur 3 days/week for a maximum of 12 weeks, and monthly group exercise sessions with the physical therapist and other COACH-HF Veterans until 6 months. [Modification of the proposed COACH-HF intervention] and pilot testing will occur over the following 2 Aims: [Aim 1: Garner stakeholder feedback on the structure and delivery of the COACH-HF intervention using [12] focus groups (FGs) among 3 stakeholder categories: Veterans recently hospitalized for HF, Veterans’ caregivers, and healthcare providers. Differing perspectives from the FGs will be addressed with a small decision-making group of investigators and stakeholders. Using nominal group technique (NGT), the decision- making group will brainstorm and rank ideas for addressing key areas of disagreement. The intervention design will be modified by the PI based on the FG and NGT results. All FGs participants will be invited to give feedback on the final intervention design prior to moving forward to pilot testing (i.e. member-checking).] [Aim 2: Determine whether Capacity Coaching increases adherence to the rehabilitation intervention by randomizing 25 Veterans ≥ 55 years recently hospitalized for HF 1:1 to Capacity Coaching + Rehabilitation intervention (CC+Rehab) vs. Rehabilitation only (Rehab Only). Assess the feasibility and acceptability of rehabili...

Key facts

NIH application ID
10539371
Project number
1IK2RX003978-01A1
Recipient
VA EASTERN COLORADO HEALTH CARE SYSTEM
Principal Investigator
Kelsey M Flint
Activity code
IK2
Funding institute
VA
Fiscal year
2023
Award amount
Award type
1
Project period
2023-02-01 → 2028-01-31