REACH Pilot Study (Rehabilitation Enhancing Aging Through Connected Health)

Rehabilitation Enhancing Aging through Connected Health, REACH, is designed to evaluate the
benefits of a novel rehabilitative care program on physical function utilizing mobile health
technology to deliver patient centered care more efficiently and health care utilization
after one year of follow up. Study staff will recruit 76 community dwelling older adult
primary care patients. The same procedures that were approved by the IRB for the Boston RISE
cohort study will be used for REACH recruitment, screening and enrollment of potential
participants. This process will be centered at Spaulding Cambridge Outpatient Clinic (SCOC).
Potential participants will be contacted and a brief phone screen will be conducted.
Eligible and interested participants will be scheduled for the consent/screen visit. If the
participant consents, the study staff will administer three tests to determine final
eligibility for study involvement. These include: Mini Mental Status Exam, the Short
Physical Performance Battery (SPPB) and the Long Distance Corridor Walk.

Qualified participants will complete all baseline and 1-year assessments at SCOC. The
assessments include: the Late Life Function and Disability Index (LLFDI), Hopkins Verbal
Learning Test, Trail Making, Digit Symbol Substitution Test, Katz Comorbidity, depression
(PHQ-9), Activities Specific Balance Scale, Barriers Specific Self-Efficacy Scale, Computer
Attitude Scale, McGill Pain Map, Brief Pain Inventory, Figure 8 walk test, grip strength
testing, single leg press strength and speed testing, ankle/knee ROM, the trunk extensor
endurance test and stair climb power test.

The exercise/technology training with a licensed physical therapist will consist of 8-10
(with the possibility of up to 16 sessions) clinic or home visits interspersed over a
9-month period and will take place after baseline at one of two locations per choice of
participant: SCOC or BU Center for Neurorehabilitation. During the clinic/home visits, the
assigned exercises are video recorded using the Wellpepper clinician version housed on an
iPad mini. During and after the in-person visits, the PTs will remotely monitor exercise
adherence, provide feedback, progress the exercise program and answer participants'
questions using the chat feature of the exercise app. PT support will be tapered over the
course of this 9-month period as the participants become more successful at integrating
exercise into their lives using the provided technology. Over the final 3 months of the
study, participants will continue to perform exercises independently with reduced PT
involvement. PT support will be available through the chat feature if participants have
questions or concerns.

Participants will be contacted at quarterly intervals and asked to self-report recent falls,
hospitalizations, ER visits and PT (outside of their participation in this study). At 6
months the LLFDI will be administered over the phone. In addition, the PT will perform these
performance based assessments during a clinic visit: SPPB, ankle/knee ROM, trunk extensor
endurance test and the stair climb power test.

Collaborators at Brandeis University will access CMS claims data for all participants during
the year of participation and for an additional six months after study participation ends to
evaluate health care utilization and health care costs after 1-year of follow up.

Inclusion Criteria:

1. Ages 65-95 years

2. Able to understand and communicate in English

3. Difficulty or task modification with walking ½ mile (6 blocks) or climbing one flight
of stairs

4. Ability to continuously walk 400 m in less than 15 minutes without stopping for more
than a minute at a time, sitting, leaning, or the help of another person

5. Lives in a zip code within 10 mile radius of Spaulding Cambridge Facility

6. Baseline Short Physical Performance Battery (SPPB) scores from 3-12 with <20% of SPPB
scores in the 11-12 range

Exclusion Criteria:

1. Presence of a terminal disease (e.g. receiving hospice services, metastatic cancer)

2. Major surgery or Myocardial Infarction in the last 6 months

3. Planned major surgery (e.g. joint replacement)

4. Planned move from the Boston area within 1.5 years

5. Mini-mental state exam (MMSE) score <20

6. Major medical problems interfering with safe and successful testing (examples may
include: history hip replacement with recurrent dislocation, uncontrolled
hypertension, use of supplemental oxygen)