Walking Exercise Sustainability through Telehealth for Veterans with Lower-Limb Amputation

Background

The VA Durability of Rehabilitation Interventions for Veterans (DRIVE) funding mechanism supports novel, multimodal rehabilitation approaches, including clinician-directed interventions and Veteran self-managed components, to improve long-term durability of rehabilitation outcomes. This trial funded by the DRIVE mechanism focuses on sustained walking exercise after lower-limb amputation. While conventional lower-limb amputation rehabilitation effectively improves functional capacity, healthy levels of walking are not sustained post-rehabilitation.

Objective

The "Walking Exercise Sustainability Training (WEST)" trial examines a Veteran home-based self-maintenance intervention after lower-limb loss. The WEST trial, designed by a transdisciplinary team of patients, physical therapists, occupational therapists, physicians, psychologists, nurses, and bioengineers, is a psychologically informed approach based on behavioral frameworks and patient-centered communication. Wearable sensors and peer support are used in a telehealth environment to deliver the intervention with the aim of sustaining walking exercise.

Methods

WEST is a randomized controlled superiority trial that tests an 18-month telehealth walking exercise self-management program. Veteran participants will complete six one-on-one intervention sessions, and six peer-support group sessions. The experimental arm will receive a self-management program focused on sustaining walking exercise and the control group will receive attention-control health education. Daily walking step count (primary outcome; actigraphy) will be continuously monitored during study participation. Secondary outcomes assess potential translation of the WEST intervention into conventional VA amputation care. IMPACT The unique rehabilitation paradigm in this trial addresses the problem of persistent sedentary lifestyles following lower-limb amputation through a telehealth self-management model. The novel transdisciplinary strategy will inform implementation potential, including a signal for clinical effectiveness.