Rehabilitation in the Home Setting for Older Adults In the Early Period After Myocardial Infarction

Study Overview
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Brief Summary
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This pilot feasibility study will test whether a home-based cardiac rehabilitation intervention, using physical therapist visits combined with mobile health technology, will prevent decline in high-risk patients post acute myocardial infarction (AMI). Participants will be randomized to either an intervention arm (home-based physical therapy), or a control (usual care) arm. Prior to discharge, participants in the intervention arm will receive a 1-hour educational session by a research physical therapist that includes information on cardiac risk factor management, postoperative recovery, education on medication adherence, and a prescription for home exercise that is tailored to each patient's baseline abilities and limitations. Participants assigned to the control arm will receive a 30-minute counseling session on risk factor modification prior to discharge, in addition to usual care post-AMI.

Detailed Description
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All participants enrolled in this research study will receive the FDA-approved FitBit Flex, a wearable activity monitoring device which will objectively measure physical activity and sedentary behavior in the period post-hospital discharge. Daily activity monitoring will include: number of steps, distance traveled, calories burned, number of active minutes.

Official Title
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Rehabilitation in the Home Setting for Older Adults In the Early Period After Myocardial Infarction

Conditions
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Acute Myocardial Infarction (AMI)

Intervention / Treatment
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* Behavioral: Home-based physical therapy
* Behavioral: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of acute myocardial infarction (AMI). Exclusion Criteria: moderate to severe cognitive impairment; non-ambulatory severe heart failure (NYHA Class IV); decisional impairment as assessed by the University of California San Diego Brief Assessment of Capacity to Consent (UBACC) 22, if the RC questions capacity; very limited life expectancy (e.g. anticipated discharge to hospice) non-English/non-Spanish speaking.

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home-Based Physical Therapy<br> | Behavioral: Home-based physical therapy<br>* Participants will be visited by a physical therapist 3 times a week for approximately 1 hour each day, for a duration of 4 weeks. These visits will serve to encourage adherence to the intervention, reinforce activities recommended at discharge, monitor safety under direct supervision, and adjust the exercise prescription if/as needed (e.g. advance recommended activity level) if necessary. Patients will also be provided with a tablet computer device installed with software, Moving Analytics, that will reinforce the cardiac rehabilitation program through daily reminders and easily accessible visual activity plans. This program will be updated by the physical therapist during home visits as the program advances. Daily patient-reported health status (Your Activities of Daily Living) 26 will be ascertained on the same tablet device by participants three times per week using open source software designed.<br>|
| Active Comparator: Control-30-minute counseling session<br>Participants in the control arm will be provided with a 30-minute counseling session on risk factor modification prior to discharge. | Behavioral: Usual Care<br>* Participants in the control arm will be provided with a 30-minute counseling session on risk factor modification prior to discharge. Participants will be provided with a tablet computer device to complete patient-reported health status (Your Activities of Daily Living) 26 three times per week using open source software designed. Participants will be visited by the Research Coordinator or member of the study team at one month post-hospital discharge to perform a follow-up assessment that will include ADLs, IADLs, SF-12 PCS, frailty measures, and questions on healthcare utilization (hospital readmissions).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activities of Daily Living (ADL) Decline | Assessment of the functional dependence or independence in carrying out activities of daily living, including bathing, dressing, toileting, transferring, continence, and feeding. | 5 Weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decline in self-perceived physical health (measured by SF-12 PCS) | Health status measure that addresses both physical and mental health. | 5 Weeks | 
| Mean time spent in sedentary activity |  | 5 Weeks | 
| Mortality Rate |  | 5 Weeks | 
| Hospital readmission rate |  | 5 Weeks |