Exploring Changes in Veterans’ Social Health Following a Multicomponent Telerehabilitation Program: An Embedded Convergent Mixed Methods Study

Research Objectives: To explore changes in secondary social health outcomes following a multicomponent telerehabilitation (MCTR) program focused on physical function and activity, and to identify whether such changes mediated physical activity outcomes.

Design: Embedded convergent mixed-methods.

Setting: Telerehabilitation from site (Veterans Health Administration) to participants’ homes.

Participants: Fifty military Veterans aged ≥60 years with ≥3 chronic medical conditions; 18 completed interviews.

Interventions: The 12-week MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education control group started the MCTR program after 12 weeks.

Main Outcome Measures: Surveys of loneliness, social disengagement, and participation were collected; physical activity was measured by survey and actigraphy. Semi-structured interviews focused on aspects of social health. Quantitative and qualitative data pertaining to the same constructs were compared for mixed-methods analysis.

Results: Mean (SD) age of participants was 62.9 (6.7) years. Most were male (64%), White (82%), and non-Hispanic (92%). Out of 46 participants with complete data, 4 (8.7%) became socially engaged, and 7 (15.2%) became socially disengaged. Loneliness and participation in social activities did not change. The number of participants who reported being physically active increased from 21 (42.5%) pre-program to 33 (66.0%) post program completion, but average daily step count did not change. Themes related to loneliness and social disengagement highlighted sources of social support inside and outside the program, participation in social activities, and influences of physical and mental health on social health.

Conclusions: Social health is under studied in physical therapy research. Results from this study help identify social health outcomes that are important to patients and propose potential mechanisms by which physical therapy interventions can support these outcomes. Given the discordant results of qualitative and quantitative findings, future research is warranted to elucidate the dynamic relationship between physical activity and social health.

Author(s) Disclosures: The authors have no conflicts of interest. This material is based upon work supported in part by facilities of the VA Eastern Colorado Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.