REACH Pilot Study (Rehabilitation Enhancing Aging Through Connected Health)
Condition: Mobility Limitation
MeSH terms: Mobility Limitation
Study type: Interventional

Summary: 
      Rehabilitation Enhancing Aging through Connected Health, REACH, is designed to evaluate the
      benefits of a novel rehabilitative care program on physical function utilizing mobile health
      technology to deliver patient centered care more efficiently and health care utilization
      after one year of follow up.
    

Detailed description: 
      Rehabilitation Enhancing Aging through Connected Health, REACH, is designed to evaluate the
      benefits of a novel rehabilitative care program on physical function utilizing mobile health
      technology to deliver patient centered care more efficiently and health care utilization
      after one year of follow up. Study staff will recruit 76 community dwelling older adult
      primary care patients. The same procedures that were approved by the IRB for the Boston RISE
      cohort study will be used for REACH recruitment, screening and enrollment of potential
      participants. This process will be centered at Spaulding Cambridge Outpatient Clinic (SCOC).
      Potential participants will be contacted and a brief phone screen will be conducted. Eligible
      and interested participants will be scheduled for the consent/screen visit. If the
      participant consents, the study staff will administer three tests to determine final
      eligibility for study involvement. These include: Mini Mental Status Exam, the Short Physical
      Performance Battery (SPPB) and the Long Distance Corridor Walk.

      Qualified participants will complete all baseline and 1-year assessments at SCOC. The
      assessments include: the Late Life Function and Disability Index (LLFDI), Hopkins Verbal
      Learning Test, Trail Making, Digit Symbol Substitution Test, Katz Comorbidity, depression
      (PHQ-9), Activities Specific Balance Scale, Barriers Specific Self-Efficacy Scale, Computer
      Attitude Scale, McGill Pain Map, Brief Pain Inventory, Figure 8 walk test, grip strength
      testing, single leg press strength and speed testing, ankle/knee ROM, the trunk extensor
      endurance test and stair climb power test.

      The exercise/technology training with a licensed physical therapist will consist of 8-10
      (with the possibility of up to 16 sessions) clinic or home visits interspersed over a 9-month
      period and will take place after baseline at one of two locations per choice of participant:
      SCOC or BU Center for Neurorehabilitation. During the clinic/home visits, the assigned
      exercises are video recorded using the Wellpepper clinician version housed on an iPad mini.
      During and after the in-person visits, the PTs will remotely monitor exercise adherence,
      provide feedback, progress the exercise program and answer participants' questions using the
      chat feature of the exercise app. PT support will be tapered over the course of this 9-month
      period as the participants become more successful at integrating exercise into their lives
      using the provided technology. Over the final 3 months of the study, participants will
      continue to perform exercises independently with reduced PT involvement. PT support will be
      available through the chat feature if participants have questions or concerns.

      Participants will be contacted at quarterly intervals and asked to self-report recent falls,
      hospitalizations, ER visits and PT (outside of their participation in this study). At 6
      months the LLFDI will be administered over the phone. In addition, the PT will perform these
      performance based assessments during a clinic visit: SPPB, ankle/knee ROM, trunk extensor
      endurance test and the stair climb power test.

      Collaborators at Brandeis University will access CMS claims data for all participants during
      the year of participation and for an additional six months after study participation ends to
      evaluate health care utilization and health care costs after 1-year of follow up.
    

Intervention name(s): Exercise Intervention
Intervention type(s): Behavioral
Intervention description(s): Investigators are proposing an innovative rehabilitative care program for older primary care patients at risk for mobility decline. The program targets newly identified risk factors for mobility decline and utilizes mobile health technology to deliver patient centered care more efficiently. Study participants will receive exercise instruction with a licensed physical therapist for an average of 8-10 training sessions, with the possibility of up to 16 sessions. some at home and some in the clinic. The exercise training sessions will focus on improving mobility, balance and ability to get up from a chair with the use of an exercise application (Wellpepper) being used on a study issued iPad.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: health care utilization; health care costs