Impact of 3 Months of Supervised Exercise on Function by Arthritis Status.

Background: Exercise is an established intervention for the management of arthritis, but it is unclear whether general exercise programs, such as Gerofit clinical exercise program for older veterans, are effective for arthritis.

Methods: This secondary data analysis of previously collected Gerofit data evaluated the effect 3 months of participation had on physical function by self-reported arthritis status (ie, no arthritis, any arthritis, lower body arthritis, or both upper and lower body arthritis). Veterans aged ≥ 65 years from 5 sites were included.

Optimizing osteoarthritis care through clinical and community partnership: Results of an exploratory trial.

Background/purpose: To conduct an exploratory trial of a clinic-community care model (OA CARE) for managing osteoarthritis (OA).

Design: Participants (n ​= ​60) with symptomatic knee or hip OA and overweight/obesity were randomized to OA CARE or a usual care control group (UC). Participants in the OA CARE group received a 12-month medical membership to a local YMCA, which included a 12-week weight loss program and access to exercise programming, as well as referrals to rehabilitation, nutrition, sleep-related and psychological services.

Non-Pharmacological Pain Management for Osteoarthritis: Review Update.

Purpose Of Review: To summarize the state of research and recent studies on non-pharmacological therapies for osteoarthritis (OA).

Recent Findings: High intensity interval training is an exercise-based intervention with some new, promising findings for people with OA. Among mind-body therapies, Tai Chi has the strongest evidence base to date.

Exploration of heterogeneity of treatment effects across exercise-based interventions for knee osteoarthritis.

Objective: Variability exists in the degree of improvement patients experience following exercise-based interventions (EBIs) for knee osteoarthritis (KOA), but understanding of this heterogeneity is limited. Using a machine learning approach, this study leveraged data from two randomized controlled trials (RCTs) to identify patient characteristics contributing to differential treatment effects.

Design: The RCTs enrolled n ​= ​621 patients and evaluated three EBIs (group-based physical therapy (PT), individual PT, and a Stepped Exercise Program) and an education control group.

Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids: A Randomized Clinical Trial.

Importance: Guidelines recommend dose reduction or discontinuation of long-term opioid therapy when harm outweighs benefit, but strategies to help patients do so are limited.

Objective: To test optionally switching to buprenorphine as a strategy for improving pain and reducing opioids among patients prescribed high-dose, full agonist long-term opioid therapy.

Design, Setting, And Participants: In this pragmatic, multisite, 12-month randomized clinical trial with masked outcome assessment, patients treated at Veterans Affairs primary care clinics were recruited from October 2017 to March 2021, with follow-up completed June 2022.

Development and Delivery of Enhanced Implementation Support to Disseminate a National Caregiver Skills Training Program.

Background And Objectives: As the population ages there is an increasing need for caregiver training programs, but little is known about how to deliver implementation support for diverse sites in large-scale implementation efforts. External group-based implementation facilitation may be one promising approach. This study's objective is to detail the development and delivery of a pragmatic implementation facilitation approach to support the national rollout of caregiver training, Caregivers FIRST, at over 140 Veterans Health Administration (VHA) sites.

Cohort Profile: Baseline Characteristics of Veterans from Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) - an Embedded Pragmatic, Cluster Randomized Trial in the United States.

Purpose: AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics.

Participants: To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort).

Physical activity and symmetry following total knee arthroplasty: Results of a pilot randomized trial.

Objective: This pilot trial examined a Physical Activity and Symmetry (PAS) intervention focused on common deficits of physical inactivity and joint loading asymmetry following total knee arthroplasty (TKA).

Design: Participants (n ​= ​60) were enrolled during routine physical therapy (PT) following TKA and randomized to the PAS intervention or an attention (ATT) control group. The PAS intervention included physical activity counseling and balance exercise to address joint loading symmetry; content was delivered during 2 sessions at the end of routine PT plus supplemental sessions 4-weeks and 8-weeks following PT.

Older Veterans' perspectives on participation in a clinical exercise program: A qualitative study of the VA Gerofit exercise program.

Objectives: We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals.

Methods: Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change.

Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial.

Importance: Although mindfulness-based interventions (MBIs) are evidence-based treatments for chronic pain and comorbid conditions, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors.

Objective: To examine group and self-paced, scalable, telehealth MBIs, for veterans with chronic pain, compared to usual care.

Design, Setting, And Participants: This was a randomized clinical trial of veterans with moderate to severe chronic pain, recruited from 3 Veterans Affairs facilities from November 2020 to May 2022.

Relationships Between Applied Mindfulness Practice, Chronic Pain, and Pain-Related Functioning in Veterans.

Mindfulness-based interventions (MBIs) have been shown to improve chronic pain and associated conditions like depression, anxiety, and sleep disorders. However, there is limited research on how veterans with chronic pain apply mindfulness skills to manage pain in daily life. This cross-sectional study examined the association between applied mindfulness practice, pain, and several pain-related conditions among 1,737 veterans with chronic pain prior to enrollment in a trial of 2 MBIs.

Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling.

Objective: To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers.

Data Sources And Study Setting: We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site-reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022.

Site-initiated adaptations in the implementation of an evidence-based inpatient walking program.

Background: There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States.

Email recruitment for chronic pain clinical trials: results from the LAMP trial.

Background: Recruitment for clinical trials and large-scale studies is challenging, especially for patients with complex conditions like chronic pain. Email recruitment has the potential to increase efficiency, to reduce costs, and to improve access for underrepresented patient populations. The objective of this study was to examine the effectiveness, efficiency, and equitability of email versus postal mail recruitment for the Learning to Apply Mindfulness to Pain (LAMP) study, a three-site clinical trial of mindfulness-based interventions for chronic pain.