Abstract

Background: Stroke is the leading cause of long-term disability, characterized by complex impairments that require ongoing, multidisciplinary care to improve function and promote disease self-management. Many Veterans with stroke will receive a period of formal post-acute rehabilitation after a stroke. Rehabilitation services improve function and facilitate community reintegration, but the degree of functional impairment that remains at discharge from post-acute rehabilitation is poorly understood. Functional status at discharge from post-acute rehabilitation is associated with long-term morbidity, hospital readmissions, and quality of life. In order to design a system that enables Veterans with stroke to achieve their full recovery potential, it is critical to characterize the degree of residual functional impairment Veterans experience at the end of post-acute rehabilitation and how this may vary by Veteran subpopulations. Understanding this will help identify Veterans who may be most likely to benefit from further programs to improve function, health, and promote disease self- management. At the individual level, regular physical activity post-stroke can improve function, prevent further decline, and is an essential component of disease self-management. Scalable interventions to improve physical activity for older Veterans after stroke are not well-defined or well-studied in VA. Significance/Impact: This project addresses the complex, chronic care needs of Veterans after stroke at the system and individual level. It addresses the HSR&D priority areas of complex chronic disease management; disability, function, long-term care and aging; and access to care/ rural health in addition to the ORD-wide priorities to increase the substantial real world impact of VA research and putting VA data to work for Veterans. Project findings will yield actionable insights at the system and individual level to help ensure the VA is providing high quality stroke care for older Veterans. Innovation: This is the first national, contemporary evaluation of post-stroke function at the conclusion of post- acute rehabilitation for older Veterans (≥65 years of age) that includes care provided in the community and VA. This proposal uses data from a standardized, identical functional assessment across post-acute settings (inpatient rehabilitation, skilled nursing, home health) to quantify function. This will provide a comprehensive understanding of the amount of functional impairment Veterans have at such a critical period in the recovery process and how this varies by Veteran subpopulations. At the individual level, this proposal addresses the lack of scalable interventions that leverage behavioral science and remote technologies to help increase physical activity in this older, often medically complex population. Remote designs extend the reach of novel physical activity programs to Veteran populations, such as rurally residing Veterans, who are often excluded from physical activity programs due to distance or transportation barriers. Specific Aims: The specific aims are (1) Characterize residual functional impairment among Veterans ≥ 65 years and examine differences by individual and system characteristics. (2) Identify barriers and facilitators contributing to physical activity in older Veterans after stroke. (3) Examine the feasibility and acceptability of a tailored, remote behavioral intervention to increase physical activity for Veterans post-stroke. Methodology: This proposal includes a retrospective, quantitative evaluation of functional impairment among older Veterans with stroke (Aim 1); a qualitative analysis of the capabilities, opportunities, and motivators of physical activity (Aim 2); and pilot testing of a tailored, behavioral economic intervention for increasing physical activity (Aim 3). Next Steps/Implementation: This research program will improve our understanding of current stroke care while building the foundation to intervene effectively at the delivery system and individual levels to improve functional outcomes in older Veterans post-stroke.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/10999831


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