Implementation of Routine Walking Speed Measurements in Older Veterans
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Usual Care, FASTER.
- Who it may be relevant to
- Registry conditions: Aging, Fall Risk, Mobility Limitation. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Walking Speed as a Vital Sign: Enhancing Function in Older Veterans
Overview
Walking speed is a powerful predictor of mortality and adverse health consequences (e.g. fall or hospitalization) in older adults. Knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Furthermore, walking speed is a modifiable risk factor such that early recognition of physical function decline allows for appropriate and timely intervention prior to the occurrence of adverse health events. Therefore, this proposal seeks to implement routine measures of walking speed into VHA primary care as a 'vital sign' to routinely monitor Veteran physical function and help guide provider referrals.
Detailed description
Background: Walking speed is a vital sign that can predict mortality and adverse health outcomes in older adults. However, it is not routinely assessed in outpatient primary care clinics, potentially leading to missed opportunities for timely intervention and rehabilitative care. Current literature identifies walking speed as a sensitive measure of overall health and functional status, with a walking speed of \<0.6 m/s indicating increased risk of adverse events and reduced independence. Consequently, knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Importantly, walking speed is also a modifiable risk factor and is sensitive to change in multiple populations with varying medical conditions, making it an ideal measure for longitudinal monitoring of physical function. The investigators' preliminary work implementing walking speed measurement into outpatient geriatric clinical care, along with recent literature, demonstrates that routine walking speed assessments are feasible, quick, and safe.
Significance: Current VHA standard of care within primary care clinics relies on subjective information to evaluate a Veteran's physical function, which can be unreliable and inaccurate. Implementation of walking speed will introduce an objective measure that can accurately assess how a Veteran's physical function changes over time, thus helping providers identify whether referrals to rehabilitation services are needed.
Innovation and Impact: This proposal is innovative as it will be one of the first studies to assess the implementation and effect of walking speed across multiple primary care clinics. Additionally, examination of contextual factors influencing the implementation and effect of walking speed is innovative and will lead to adaptations that facilitate future widespread implementation.
Methodology: Pragmatic hybrid type 2 effectiveness-implementation study using a stepped-wedge cluster randomized trial design to evaluate and improve walking speed implementation and assess its effectiveness across VHA PACT clinics.
Interventions
- Other Usual Care
During the Usual Care phase, participating clinics will continue with usual care with the addition that walking speed will be measured and recorded. Veterans and providers will be blinded to walking speed measurement so as to not influence care. - Other FASTER
During the FASTER phase, walking speed will be measured during clinic visits, recorded in the medical record, and used by providers to guide care. An Action Toolkit will be provided with resources for providers to support informed care decisions based on Veterans' walking speeds.
Primary outcome measures
- Walking Speed [Time frame: Change in walking speed before exposure and change in walking speed after exposure to FASTER intervention (up to 12 months).]
Secondary outcome measures (2)
- Adverse Events (Injurious Falls) [Time frame: Start of usual care to end of implementation (anticipated 24 months).]
- Adverse Events (Emergency Department Visits and Hospitalizations) [Time frame: Start of usual care to end of implementation (anticipated 24 months).]
Eligibility criteria
Inclusion criteria
Site Inclusion Criteria:
- VHA primary care clinics
VHA Personnel Inclusion Criteria:
- Providers working in a VHA primary care clinic where FASTER is implemented
- Nursing staff working in a VHA primary care clinic where FASTER is implemented
Veteran Inclusion Criteria:
- Veterans 60 years and older receiving care in a VHA primary care clinic where FASTER is implemented
Exclusion criteria
- None
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Crossover
- Masking
- Single blind
- Primary purpose
- Health services research
Study locations
United States · 1 center
- Rocky Mountain Regional VA Medical Center, Aurora, CO — Aurora
Identifiers
NCT: NCT07513805 · HSR6-009-24S · I01HX003877