The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial.
Chinenye Okpara, George Ioannidis, Lehana Thabane, Jonathan Derrick Adachi, Alexander Rabinovich, Patricia Hewston, Justin Lee, Caitlin McArthur, Courtney Kennedy, Tricia Woo, Pauline Boulos, Raja Bobba, Mimi Wang, Samuel Thrall, Derelie Mangin, Sharon Marr, David Armstrong, Christopher Patterson, Steven Bray, Kerstin de Wit, Shyam Maharaj, Brian Misiaszek, Jessica Belgrave Sookhoo, Karen Thompson, Alexandra Papaioannou
Author Information
Chinenye Okpara: Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada. okparc1@mcmaster.ca. ORCID
George Ioannidis: Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Lehana Thabane: Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Jonathan Derrick Adachi: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Alexander Rabinovich: Department of Surgery, McMaster University, Hamilton, ON, Canada.
Patricia Hewston: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Justin Lee: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Caitlin McArthur: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Courtney Kennedy: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Tricia Woo: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Pauline Boulos: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Raja Bobba: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Mimi Wang: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Samuel Thrall: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Derelie Mangin: Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
Sharon Marr: Department of Medicine, University of Toronto, Hamilton, ON, Canada.
David Armstrong: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Christopher Patterson: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Steven Bray: Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
Kerstin de Wit: Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
Shyam Maharaj: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Brian Misiaszek: Department of Medicine, McMaster University, Hamilton, ON, Canada.
Jessica Belgrave Sookhoo: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Karen Thompson: Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Alexandra Papaioannou: Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
BACKGROUND: The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS: Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5��������STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS: The program enrolled 33% (n���=���72) of referrals to the study (n���=���220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION: The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.
