Using Integrated Care and Wearable Technology to Evaluate Outcomes of the Shields & Stripes Program for Veterans and First Responders

Study Overview This retrospective mixed-methods observational study evaluates the effectiveness of the Shields \& Stripes (S\&S) program, a 12-week integrated wellness model that combines occupational therapy (OT), mental health (MH) services, physical therapy (PT), and registered dietitian (RD) support. The program serves veterans and first responders who experience cumulative physical, cognitive, and emotional stress related to their service.

The study will retrospectively analyze quantitative and qualitative data from S\&S cohorts between 2024-2026 to assess changes in health, functioning, and quality of life.

Objectives

Evaluate changes in physical, psychological, and occupational functioning following participation in S\&S.

Explore relationships between biometric indicators (e.g., heart-rate variability, sleep, activity) and self-reported well-being.

Examine trends in nutrition and metabolic markers across cohorts.

Analyze participant and provider perspectives through qualitative interviews to better understand mechanisms of change and perceived program value.

Design and Methods

Design: Convergent mixed-methods retrospective observational study.

Quantitative Data: Includes biometric data (sleep, HRV, activity), self-report scales (GAD-7, PHQ-9, PCL-5, RAND-36, PSQI, ISI), and laboratory measures (cholesterol, glucose regulation, vitamin D, testosterone, thyroid, inflammatory markers, etc.).

Qualitative Data: Semi-structured interviews with consenting participants and providers conducted post-program (via teleconference).

Participants: Veterans and first responders aged 18-70 who have completed the S\&S program and program providers who have worked within the S\&S program.

Recruitment: No direct external recruitment will occur for this study. All participants will be drawn from existing Shields \& Stripes program cohorts and affiliated program providers, which utilize processes separate from this research.

Data Handling: All data will be de-identified prior to analysis; stored securely on encrypted, access-restricted cloud servers.

Primary Outcomes

Change in self-reported anxiety (GAD-7)

Change in depressive symptoms (PHQ-9)

Change in PTSD symptoms (PCL-5)

Change in sleep (PSQI and ISI)

Change in quality of life (RAND-36)

Change in sleep quality and recovery metrics (Oura Ring data)

Secondary Outcomes

Changes in nutritional and metabolic lab results (e.g., cholesterol, glucose, vitamin D, thyroid function).

Qualitative themes related to perceived program benefit, barriers, and provider perspectives.

Duration and Setting Data will be collected retrospectively from cohorts between 2024-2026. The study will take place remotely with data stored and analyzed by the research team.

Risk and Safeguards The study is minimal risk. No interventions or procedures are performed beyond standard program participation. Risks are limited to potential discomfort during interviews and minimal risk of confidentiality breach, mitigated through HIPAA-compliant data handling.

Expected Impact Results will inform how multidisciplinary programs combining OT, MH, PT, and RD services improve functional, psychological, and physiological outcomes among high-stress occupational populations. The study aims to contribute to the evidence base for integrated, holistic wellness approaches for veterans and first responders.

• Change in Heart Rate Variability (HRV) [Time frame: Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)]
• Change in Sleep Quality - Pittsburgh Sleep Quality Index (PSQI) [Time frame: Baseline (Week 0) to Post-Program (Week 12)]
• Change in Health-Related Quality of Life - RAND 36-Item Health Survey (RAND-36) [Time frame: Baseline (Week 0) to Post-Program (Week 12)]
• Change in Total Cholesterol [Time frame: Baseline (Week 0) to Post-Program (Week 12)]
• Qualitative Themes from Semi-Structured Interviews [Time frame: Post-Program (within 4 weeks of completion)]
• Change in Physical Function and Performance (PSFS) [Time frame: Baseline (Week 0) to Post-Program (Week 12)]
• Change in Sleep Duration [Time frame: Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)]
• Change in Sleep Efficiency [Time frame: Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)]
• Change in Resting Heart Rate [Time frame: Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)]
• Change in Physical Activity Level [Time frame: Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)]
• Change in Insomnia Severity - Insomnia Severity Index (ISI) [Time frame: Baseline (Week 0) to Post-Program (Week 12)]
• Change in HDL Cholesterol [Time frame: Baseline (Week 0) to Post-Program (Week 12)]