Feasibility of Group Telerehabilitation for Older Adults: A Quality Improvement Project

Authors

  • Emily M. Hudson Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN USA
  • Stephanie P. Bazal Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Michelle R. Rauzi Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  • Hillari S. N. Olson Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Melissa J. Ludescher Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Christine Interrante Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Molly Lahn Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Estee Berg Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
  • Howard A. Fink Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN USA; Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA;
  • Jennifer P. Wisdom Wisdom Consulting, New York, New York, NY, USA
  • Allison M. Gustavson Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN USA; Rehabilitation & Engineering Center for Optimizing Veteran Engagement & Reintegration, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA https://orcid.org/0000-0002-6401-1230

DOI:

https://doi.org/10.5195/ijt.2024.6651

Keywords:

Fit for Life, Group rehabilitation, Physical therapy, Telerehabilitation, Veterans

Abstract

A growing body of evidence suggests group rehabilitation may empower patients to achieve functional goals by leveraging social connectivity. From previous work, we adapted an in-person group for older Veterans to a telerehabilitation group called Fit for Life. The current quality improvement project aimed to evaluate the feasibility of implementing Fit for Life. Eligible Veterans lived in the community and were at risk for falls or hospitalization per functional performance measures. We used convergent parallel mixed methods approach in the evaluation. Eighteen Veterans ≥55 years old (all male, mean 77 years, 39% rural) received a referral to Fit for Life, two did not participate. We analyzed and integrated adaptations posed by clinicians and Veterans in real-time to enhance access to and participation in Fit for Life. Future work will explore clinical effectiveness, tools to identify patients most likely to benefit, and care delivery structures that integrate telerehabilitation groups for older Veterans.

  

References

Baehr, L. A., Kaimal, G., Bruneau, M. J., & Finley, M. (2023). Development and feasibility of a group tele-exercise program for individuals with spinal cord injury. Journal of Neurologic Physical Therapy, 47(4), 200. https://doi.org/10.1097/NPT.0000000000000449

Beebe, J. R. (2014). Rapid qualitative inquiry: A field guide to team-based assessment (Second edition). Rowman & Littlefield.

Bohannon, R. W. (2006). Reference values for the five-repetition sit-to-stand test: A descriptive meta-analysis of data from elders. Perceptual and Motor Skills, 103(1), 215–222. https://doi.org/10.2466/pms.103.1.215-222

Bohannon, R. W., Shove, M. E., Barreca, S. R., Masters, L. M., & Sigouin, C. S. (2007). Five-repetition sit-to-stand test performance by community-dwelling adults: A preliminary investigation of times, determinants, and relationship with self-reported physical performance. Isokinetics and Exercise Science, 15(2), 77–81. https://doi.org/10.3233/IES-2007-0253

Borg, G. (1998). Borg’s perceived exertion and pain scales (pp. viii, 104). Human Kinetics.

Boulos, M. E., Colella, B., Meusel, L.-A., Sharma, B., Peter, M. K., Worthington, T., & Green, R. E. A. (2024). Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: Integrating clinical care and research. Disability and Rehabilitation, 46(4), 750–762. https://doi.org/10.1080/09638288.2023.2177357

Cowper-Ripley, D. C., Jia, H., Wang, X., Freytes, I. M., Hale-Gallardo, J., Castaneda, G., Findley, K., & Romero, S. (2019). Trends in VA telerehabilitation patients and encounters over time and by rurality. Federal Practitioner, 36(3), 122–128.

Darkins, A., Cruise, C., Armstrong, M., Peters, J., & Finn, M. (2008). Enhancing access of combat-wounded veterans to specialist rehabilitation services: The VA Polytrauma Telehealth Network. Archives of Physical Medicine and Rehabilitation, 89(1), 182–187. https://doi.org/10.1016/j.apmr.2007.07.027

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A., & Barry, M. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361–1367. https://doi.org/10.1007/s11606-012-2077-6

Gill, S., Hely, R., Page, R. S., Hely, A., Harrison, B., & Landers, S. (2022). Thirty second chair stand test: Test-retest reliability, agreement and minimum detectable change in people with early-stage knee osteoarthritis. Physiotherapy Research International: The Journal for Researchers and Clinicians in Physical Therapy, 27(3), e1957. https://doi.org/10.1002/pri.1957

Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Frontiers in Public Health, 7, 64. https://doi.org/10.3389/fpubh.2019.00064

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327. https://doi.org/10.2105/ajph.89.9.1322

Guralnik, J., Bandeen-Roche, K., Bhasin, S. a. R., Eremenco, S., Landi, F., Muscedere, J., Perera, S., Reginster, J.-Y., Woodhouse, L., & Vellas, B. (2020). Clinically meaningful change for physical performance: Perspectives of the ICSFR task force. The Journal of Frailty & Aging, 9(1), 9–13. https://doi.org/10.14283/jfa.2019.33

Gustavson, A. M., Rauzi, M. R., Lahn, M. J., Olson, H. S. N., Ludescher, M., Bazal, S., Roddy, E., Interrante, C., Berg, E., Wisdom, J. P., & Fink, H. A. (2021). Practice considerations for adapting in-person groups to telerehabilitation. International Journal of Telerehabilitation, 13(1), 1–13. https://doi.org/10.5195/IJT.2021.6374

Halcomb, E. J., & Davidson, P. M. (2006). Is verbatim transcription of interview data always necessary? Applied Nursing Research, 19(1), 38–42. https://doi.org/10.1016/j.apnr.2005.06.001

Hale-Gallardo, J. L., Kreider, C. M., Jia, H., Castaneda, G., Freytes, I. M., Ripley, D. C. C., Ahonle, Z. J., Findley, K., & Romero, S. (2020). Telerehabilitation for rural veterans: A qualitative assessment of barriers and facilitators to implementation. Journal of Multidisciplinary Healthcare, 13, 559–570. https://doi.org/10.2147/JMDH.S247267

Hatzakis, M., Haselkorn, J., Williams, R., Turner, A., & Nichol, P. (2003). Telemedicine and the delivery of health services to veterans with multiple sclerosis. Journal of Rehabilitation Research and Development, 40(3), 265–282.

Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687

Jesus, T. S., Stern, B. Z., Struhar, J., Deutsch, A., & Heinemann, A. W. (2023). The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clinical Rehabilitation, 37(2), 261–276. https://doi.org/10.1177/02692155221126690

Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport, 70(2), 113–119. https://doi.org/10.1080/02701367.1999.10608028

Kreider, C. M., Hale-Gallardo, J., Kramer, J. C., Mburu, S., Slamka, M. R., Findley, K. E., Myers, K. J., & Romero, S. (2022). Providers’ shift to telerehabilitation at the U.S. Veterans Health Administration during COVID-19: Practical applications. Frontiers in Public Health, 10. https://doi.org/10.3389/FPUBH.2022.831762

Kwan, B. M., McGinnes, H. L., Ory, M. G., Estabrooks, P. A., Waxmonsky, J. A., & Glasgow, R. E. (2019). RE-AIM in the real world: Use of the RE-AIM framework for program planning and evaluation in clinical and community settings. Frontiers in Public Health, 7, 345. https://doi.org/10.3389/fpubh.2019.00345

Meyer, D. Z., & Avery, L. M. (2009). Excel as a qualitative data analysis tool. Field Methods, 21(1), 91–112. https://doi.org/10.1177/1525822X08323985

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986–992. https://doi.org/10.1136/bmjqs-2015-004411

Page, P. (2014). Beyond statistical significance: Clinical interpretation of rehabilitation research literature. International Journal of Sports Physical Therapy, 9(5), 726–736

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 38(2), Article 2. https://doi.org/10.1007/S10488-010-0319-7

Rauzi, M. R., Abbate, L. M., Lum, H. D., Cook, P. F., & Stevens-Lapsley, J. E. (2023). Multicomponent telerehabilitation programme for older veterans with multimorbidity: A programme evaluation. BMJ Military Health, e002535. https://doi.org/10.1136/MILITARY-2023-002535

Rauzi, M. R., Mealer, M. L., Abbate, L. M., Stevens-Lapsley, J. E., & Nearing, K. A. (2023). Older veterans’ experiences of a multicomponent telehealth program: Qualitative program evaluation study. JMIR Formative Research, 7(1), e46081. https://doi.org/10.2196/46081

Rossiter-Fornoff, J. E., Wolf, S. L., Wolfson, L. I., & Buchner, D. M. (1995). A cross-sectional validation study of the FICSIT common data base static balance measures. frailty and injuries: Cooperative studies of intervention techniques. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50(6), M291-297. https://doi.org/10.1093/gerona/50a.6.m291

Scholten, J., Poorman, C., Culver, L., & Webster, J. B. (2019). Department of Veterans Affairs Polytrauma Telerehabilitation: Twenty-first century care. Physical Medicine and Rehabilitation Clinics of North America, 30(1), 207–215. https://doi.org/10.1016/j.pmr.2018.08.003

Schoonenboom, J., & Johnson, R. B. (2017). How to construct a mixed methods research design. Kolner Zeitschrift Fur Soziologie Und Sozialpsychologie, 69(Suppl 2), 107–131. https://doi.org/10.1007/s11577-017-0454-1

Singh, D. R., Sah, R. K., Simkhada, B., & Darwin, Z. (2023). Potentials and challenges of using co-design in health services research in low- and middle-income countries. Global Health Research and Policy, 8(1), 5. https://doi.org/10.1186/s41256-023-00290-6

Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: A report of a patient specific measure. Physiotherapy Canada, 47(4), 258–263. https://doi.org/10.3138/ptc.47.4.258

Woodward, M., Dixon-Woods, M., Randall, W., Walker, C., Hughes, C., Blackwell, S., Dewick, L., Bahl, R., Draycott, T., Winter, C., Ansari, A., Powell, A., Willars, J., Brown, I. A. F., Olsson, A., Richards, N., Leeding, J., Hinton, L., Burt, J., … Scheer, J. W. van der. (2023). How to co-design a prototype of a clinical practice tool: A framework with practical guidance and a case study. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2023-016196

Yalom, I. D., & Leszcz, M. (2020). The theory and practice of group psychotherapy (6th edition). Basic Books.

Zanini, A., Crisafulli, E., D’Andria, M., Gregorini, C., Cherubino, F., Zampogna, E., Azzola, A., Spanevello, A., Schiavone, N., & Chetta, A. (2019). Minimum clinically important difference in 30-s sit-to-stand test after pulmonary rehabilitation in subjects with COPD. Respiratory Care, 64(10), 1261–1269. https://doi.org/10.4187/respcare.06694

Downloads

Published

2025-01-15

How to Cite

Hudson, E. M., Bazal, S. P., Rauzi, M. R., Olson, H. S. N., Ludescher, M. J., Interrante, C., Lahn, M., Berg, E., Fink, H. A., Wisdom, J. P., & Gustavson, A. M. (2025). Feasibility of Group Telerehabilitation for Older Adults: A Quality Improvement Project. International Journal of Telerehabilitation, 16(2). https://doi.org/10.5195/ijt.2024.6651

Issue

Vol. 16 No. 2 (2024)

Section

Clinical Reports

License

Copyright (c) 2025 Emily M. Hudson, Stephanie P. Bazal, Michelle R. Rauzi, Hillari S. N. Olson, Melissa J. Ludescher, Christine Interrante, Molly Lahn, Estee Berg, Howard A. Fink, Jennifer P. Wisdom, Allison M. Gustavson

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Revised 7/16/2018. Revision Description: Removed outdated link. 

Funding data

Most read articles by the same author(s)