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| ID | Type | Description | Link |
|---|---|---|---|
| I01HX003877 | U.S. NIH Grant/Contract | View source |
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Walking speed is a powerful predictor of mortality and adverse health consequences (e.g. fall or hospitalization) in older adults. Knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Furthermore, walking speed is a modifiable risk factor such that early recognition of physical function decline allows for appropriate and timely intervention prior to the occurrence of adverse health events. Therefore, this proposal seeks to implement routine measures of walking speed into VHA primary care as a 'vital sign' to routinely monitor Veteran physical function and help guide provider referrals.
Background: Walking speed is a vital sign that can predict mortality and adverse health outcomes in older adults. However, it is not routinely assessed in outpatient primary care clinics, potentially leading to missed opportunities for timely intervention and rehabilitative care. Current literature identifies walking speed as a sensitive measure of overall health and functional status, with a walking speed of <0.6 m/s indicating increased risk of adverse events and reduced independence. Consequently, knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Importantly, walking speed is also a modifiable risk factor and is sensitive to change in multiple populations with varying medical conditions, making it an ideal measure for longitudinal monitoring of physical function. The investigators' preliminary work implementing walking speed measurement into outpatient geriatric clinical care, along with recent literature, demonstrates that routine walking speed assessments are feasible, quick, and safe.
Significance: Current VHA standard of care within primary care clinics relies on subjective information to evaluate a Veteran's physical function, which can be unreliable and inaccurate. Implementation of walking speed will introduce an objective measure that can accurately assess how a Veteran's physical function changes over time, thus helping providers identify whether referrals to rehabilitation services are needed.
Innovation and Impact: This proposal is innovative as it will be one of the first studies to assess the implementation and effect of walking speed across multiple primary care clinics. Additionally, examination of contextual factors influencing the implementation and effect of walking speed is innovative and will lead to adaptations that facilitate future widespread implementation.
Methodology: Pragmatic hybrid type 2 effectiveness-implementation study using a stepped-wedge cluster randomized trial design to evaluate and improve walking speed implementation and assess its effectiveness across VHA PACT clinics.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual Care | Active Comparator | Usual care will continue in clinical practice with this phase occurring before FASTER implementation. |
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| FASTER | Experimental | The FASTER intervention includes measurement, recording, and use of walking speed measurement to help guide care in older Veterans. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Usual Care | Other | During the Usual Care phase, participating clinics will continue with usual care with the addition that walking speed will be measured and recorded. Veterans and providers will be blinded to walking speed measurement so as to not influence care. |
| Measure | Description | Time Frame |
|---|---|---|
| Walking Speed | Time to complete 4-meter walk at usual speed converted to meters per second. Higher speed indicates better function. | Change in walking speed before exposure and change in walking speed after exposure to FASTER intervention (up to 12 months). |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse Events (Injurious Falls) | Falls that result in a medical visit | Start of usual care to end of implementation (anticipated 24 months). |
| Adverse Events (Emergency Department Visits and Hospitalizations) |
| Measure | Description | Time Frame |
|---|---|---|
| RE-AIM Component: Reach | Proportion of visits with a walking speed measured out of all in-person primary care visits (Veterans ≥65 years of age) | Start of usual care to end of implementation (anticipated 24 months). |
| RE-AIM Component: Adoption (Providers) |
Inclusion Criteria:
Site Inclusion Criteria:
VHA Personnel Inclusion Criteria:
Veteran Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jennifer E Stevens-Lapsley, PhD | Contact | (303) 949-9304 | Jennifer.Stevens-Lapsley@va.gov | |
| Joyce A Middleton | Contact | (303) 908-8935 | joyce.middleton@va.gov |
| Name | Affiliation | Role |
|---|---|---|
| Jennifer E. Stevens-Lapsley, PhD | Rocky Mountain Regional VA Medical Center, Aurora, CO | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rocky Mountain Regional VA Medical Center, Aurora, CO | Aurora | Colorado | 80045-7211 | United States |
The research team intends to share study data that may be requested from other research investigators in a data-sharing agreement provided at the study end. Data prepared for distribution under a data-sharing agreement will be further redacted to ensure privacy of study participant identity yet allow analyses to occur by other investigators. The data-sharing agreement will include requirements to protect participants' privacy and data confidentiality. All participants will be de-identified using a coded participant ID to maintain confidentiality and will not be individually identifiable by name.
The data will be available starting 6 months after primary study publication.
Data will be made available upon reasonable written request to the study team. The PI, Dr. Jennifer Stevens-Lapsley will review requests.
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| ID | Term |
|---|---|
| D051346 | Mobility Limitation |
| ID | Term |
|---|---|
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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The FASTER intervention includes three stages. First, the Veteran is instructed to walk over a 6-meter course (4-meter timed course with 1-meter acceleration and deceleration zones) with an emphasis on walking at their usual pace. While the Veteran walks this course, a stopwatch is used to measure walking speed. Second, the walking speed is input into the medical record along with any assistive device used during measurement. Third, providers use the walking speed information to help guide care and potential referrals.
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Those analyzing the quantitative data will be blinded to study phase.
| FASTER | Other | During the FASTER phase, walking speed will be measured during clinic visits, recorded in the medical record, and used by providers to guide care. An Action Toolkit will be provided with resources for providers to support informed care decisions based on Veterans' walking speeds. |
|
Emergency department visits and hospitalizations
| Start of usual care to end of implementation (anticipated 24 months). |
Proportion of providers that state they will use walking speed information
| Start of implementation. |
| RE-AIM Component: Adoption (Assessors) | Proportion of assessors that state they will measure walking speed | Start of usual care. |
| RE-AIM Component: Adoption (Clinics) | Proportion of clinics that state they will implement walking speed | Start of usual care. |
| RE-AIM Component: Implementation (Walking Speed Measurement) | Proportion of completed walking speed measurement elements out of all elements | Start of usual care to end of implementation (anticipated 24 months). |
| RE-AIM Component: Implementation (Walking Speed Initiative Elements) | Proportion of completed walking speed initiative elements out of all intervention elements | Start of usual care to end of implementation (anticipated 24 months). |
| RE-AIM Component: Implementation (Walking Speed Measurement Total Time) | Time to complete walking speed measurement and documentation | Start of usual care to end of implementation (anticipated 24 months). |
| RE-AIM Component: Implementation (Walking Speed Measurement Relative Time) | Time to complete walking speed measurement relative to total rooming procedures | Start of usual care to end of implementation (anticipated 24 months). |
| RE-AIM Component: Maintenance (Walking Speed Measurement) | Proportion of completed walking speed measurement elements out of all elements | Up to 6 months after Implementation phase. |
| RE-AIM Component: Maintenance (Walking Speed Initiative Elements) | Proportion of completed walking speed initiative elements out of all intervention elements | Up to 6 months after Implementation phase. |
| Referrals (Physical Therapy/Gerofit) | Change in VHA referrals to physical therapy/Gerofit | Start of usual care to end of implementation (anticipated 24 months). |
| Referrals (Follow-Through) | Proportion of referrals that result in follow-through | Start of usual care to end of implementation (anticipated 24 months). |
| Referrals (Recommendations) | Count of recommendations for community exercise programs, home exercise, physical activity promotion | Start of usual care to end of implementation (anticipated 24 months). |
| Adaptations | Number and type of adaptations at each VHA primary care clinical site | Start of usual care to end of implementation (anticipated 24 months). |