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Objective: To examine retention and compliance to a novel physical therapy (PT) treatment among Veterans with and without executive function deficits (EFD+/EFD−). Design: This study was a preplanned secondary analysis of an ongoing randomized controlled trial. Setting: Outpatient PT at VA Boston Healthcare System. Participants: Seventy-two community-dwelling middle-aged and older Veterans (mean age, 72 years [range 51-91]; 87% male) with gait speed between 0.5 and 1.0 m/second were recruited from primary care practices. Interventions: Eight-week moderate-to-vigorous intensity PT program. Main outcome measure: Veterans’ baseline mobility, retention (dropouts), and treatment compliance and posttreatment exercise compliance to 8-week PT treatment were evaluated based on their baseline EFD status. Results: Of the 72 participants, 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility performance (Short Physical Performance Battery [SPPB], 7.7 vs 9.5, P.05). In multivariable logistic regression modeling, pain interference, depressive symptoms, mobility, and living alone but not EFD status were associated with dropping out. Among study completers, there was no evidence of significant differences in treatment compliance or posttreatment exercise compliance, measured by the number of attended sessions and the number of posttreatment exercise days by EFD status. Conclusion: EFD+ was associated with poor baseline mobility. Although the dropout rate was higher among Veterans with EFD+, we were unable to conclude whether EFD status impacts retention or compliance due to the small sample size. Further investigation is needed to determine whether EFD status may identify individuals who need additional support during and/or after rehabilitation treatment.

Objective: To evaluate the feasibility and preliminary efficacy of the transition of an outpatient center-based rehabilitation program for middle and older aged Veterans with mobility limitations to a tele-health platform. Design: Non-randomized non-controlled pilot study including 10 treatment sessions over 8 weeks and assessments at baseline, 8, 16, and 24 weeks. Setting: VA Boston Healthcare System ambulatory care between August 2020 and March 2021. Participants: Veterans aged 50 years and older (n=178) were contacted via letter to participate, and 21 enrolled in the study. Intervention: Participants had virtual intervention sessions with a physical therapist who addressed impairments linked to mobility decline and a coaching program promoting exercise adherence. Main Outcome Measures: Ambulatory Measure for Post-Acute Care (AM-PAC), Phone-FITT, and Self-Efficacy for Exercise (SEE) scale. Results: Completers (n=14, mean age 74.9 years, 86% men) averaged 9.8 out of 10 visits. Changes in the Ambulatory Measure for Post-Acute Care (AM-PAC) exceeded clinically meaningful change after 8 and 24 weeks of treatment, at 4.1 units and 4.3 units respectively. Statistically significant improvements from baseline in AM-PAC and Phone-FITT were observed after 8 weeks of treatment and at 24 weeks. No significant changes were observed in exercise self-efficacy. Conclusions: In this group of veterans, telerehab was feasible and demonstrated preliminary efficacy in both mobility and physical activity, thus justifying further investigation in a larger scale clinical trial.

Objective: To determine the reliability of 3 physical performance tests performed via a telehealth visit (30-s arm curls test, 30-s chair stand test, 2-min step test) among community-dwelling older veterans. Design: Cross sectional study. Setting: Virtual. Participants: Veterans (N=55; mean age 75y) who enrolled in Gerofit, a virtual group exercise program. Interventions: Not applicable. Main Outcome Measures: Participants were tested by 2 different assessors at 1 time point. The intraclass correlation coefficient (ICC) with 95% confidence intervals and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, depression). Results: Assessments were conducted among 55 participants. The ICC was above 0.98 for all 3 tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. Conclusions: The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among veterans. Thus, they are reliable for evaluating physical performance in older veterans in virtual settings.