Serving Rural Veterans with Disabilities: A National Survey of Centers for Independent Living.

This study comprises a systematic national examination of how Centers for Independent Living can and do support Veteran consumers, especially those living in rural communities. This research provides contextualized understanding of rural Veteran needs for community-based services and resources available through Centers for Independent Living. A survey was administered to the leadership of 383 Centers for Independent Living throughout the United States, the majority of which have rural catchment areas and serve rural Veterans through both main and satellite offices. Descriptive univariate analysis was used to describe responses. Study respondents represented a total of 39 states, with 20% of respondents reporting that their consumers were 100% rural and only 3% entirely urban. Services and supports from Centers for Independent Living provided to rural Veterans most frequently included housing, transportation, and peer support. Approximately half of all Centers for Independent Living reported tracking the status of their Veteran consumers.

Rural and Urban Home Modification Program Users: A Comparative Study.

OBJECTIVE: To understand the sociodemographic, geographical, and clinical characteristics of rural veterans utilizing home modification (HM) healthcare services under the Home Improvement Structural Alterations (HISA) program, to compare these characteristics between rural and urban veteran users, to estimate the costs of HMs performed, and to present distance that users traveled to HISA-prescribing medical facilities within the Veterans Health Administration (VHA). BACKGROUND: Accessible housing is in short supply. HMs allow veterans with disabilities (VWDs) to remain living at home rather than enter institutional-type settings. HISA is associated with decreased inpatient hospitalization rates and increased use of preventative healthcare via outpatient clinic visits. Home accessibility provides psychological benefits improving social interactions and interaction with the physical environment. METHODS: This retrospective database study analyzes data from the National Prosthetics Patient Database and other medical datasets within the VHA. RESULTS: Results provide a profile of and comparison between rural and urban veteran users. HISA users are substantially older compared to younger VWDs. The frequency of bathroom, railing, and wooden ramp HMs differed significantly between rural and urban users (p values < .001). Rural users traveled more miles than urban users to reach a prescribing facility. CONCLUSIONS: Older adults and individuals with disabilities have unmet housing needs since accessible housing is in short supply. This HM healthcare service is helping to meet the housing accessibility needs of older veterans, VWDs, older adults, and people with disabilities, in general.

Predictors of County-Level Home Modification Use Across the US.

Background: Geospatial analyses illustrating where the Home Improvements and Structural Alterations program (HISA) have been prescribed suggest that home modification (HM) services under US Department of Veterans Affairs (VA) is not prescribed and used uniformly across the US. Methods: The objective of this study was to identify county characteristics associated with HISA use rates, such as county-level measures of clinical care and quality of care, variables related to physical environment, and sociodemographic characteristics. Multiple regression analysis was used to predict county-level utilization rate from county-level variables. Results: County-level HISA use was highly skewed and ranged from 0.09 to 59.7%, with a mean of 6.6% and median of 5%. Percent uninsured adults and rate of preventable hospital stays emerged as significant predictors of county-level HISA utilization rate. Specifically, county percentage of uninsured adults was negatively related to county-level HISA utilization rate (b = -8.99, P = .005). The higher the proportion of uninsured adults the lower the HISA utilization rate. The county rate of preventable hospital stays was positively related to county-level HISA utilization rate (b = .0004, P = .009). County-level predictors of housing quality were not significantly associated with county-level HISA utilization rate. Conclusions: Our research fills a gap in the literature about the impact of county-level variables and the geographic distribution and use of HISA. More research is needed to understand and account for geographical variation in HISA use. This work serves as a first step at quantifying and predicting HISA utilization rate at a broad level, with the goal of increasing access to HMs for veterans with disabilities.

Practical Considerations in Qualitative Health Research During the COVID-19 Pandemic.

The COVID-19 pandemic has forced both quantitative and qualitative health researchers to adapt and strategize data collection strategies without causing any harm to the participants or researchers. This has resulted in utilizing various types of strategies such as online surveys and synchronous virtual platforms such as Zoom and Webex. This transition from face-to-face to synchronous online platforms has helped in increasing coverage as well as reaching participants who are otherwise unreachable. While quantitative health researchers seem to have made a seamless transition to synchronous online platforms, qualitative health researchers who rely on studying participants in their "real-world-settings" are facing unique challenges with online data collection strategies. This article critically examines the benefits and challenges of implementing qualitative health research studies via synchronous online platforms and provides several practical considerations that can inform qualitative health researchers. It can also assist Institutional Review Board members in reviewing and implementing qualitative health research study protocols in a manner that preserves the integrity, richness, and iterative nature of qualitative research methodology.

Home Modifications for Rural Veterans With Disabilities.

BACKGROUND: Appropriate home modifications (HMs) can make the home environment accessible and relatively safe by reducing the risk of falls. Of special concern are individuals living alone, living in rural communities, and/or living in substandard housing. The Home Improvements and Structural Alterations (HISA) is a Veterans Health Administration (VHA) benefit program providing HMs for veterans with disabilities. METHODS: The objective of this study was to detail the profile of rural veteran (RV) HISA users and report on national HISA utilization patterns. We compare use at US Department of Veterans Affairs (VA) medical centers of varying complexity levels, and in VA regions. An examination of the relationship between travel time/distance and HISA utilization is also provided. This retrospective database study uses GeoSpatial analyses and 3 VA sources: The National Prosthetics Patient Database, the VHA Medical Inpatient Dataset, and the VHA Outpatient Dataset. RESULTS: From 2015 through 2018, 10,810 RVs used HISA with a mean age of 70.9 years. A majority of participants were White (79.5%), married (74.3%), and male (96.5%) veterans. They traveled a mean of 79.8 miles for 94.5 minutes to reach a facility where they received a HISA prescription. Nearly 75% of HISA users were able to receive a HISA prescription from their nearest facility, while about one-quarter traveled to a facility farther away, of which 43% travelled between 100 and 200 miles to obtain the HISA benefit. The top categories of diagnoses were musculoskeletal (19.1%), neurologic (12.5%), and cardiovascular (5.4%). There were about 11,166 HM prescriptions afforded to rural HISA users during the period, including bathroom (82.4%), doorway (4.9%), and railing (3.6%) modifications. CONCLUSIONS: This study documents the national demographics and clinical characteristics of rural HISA users, data that may be useful to policy makers, HM service providers and advocate as well as HISA administrators in predicting future use and users.

Immediate Effect of Local Vibration Therapy for Sport-induced Fatigue Based on Traditional Chinese Medicine's Holistic Theory.

INTRODUCTION: Vibration therapy has been widely used and published in alleviating muscle fatigue. However, reports on applying vibration therapy based on the holisitic theory of traditional Chinese medicine (TCM) remains limited. This study is to evaluate the immediate effect of vibration therapy on exercise-induced muscle fatigue. METHODS: For this retrospective parallel controlled study, all data were from a previously approved and completed clinical trial. Participants (n=40) in the clinical trial included local Greco-Roman wrestling and Judo athletes in south China. The participants were equally randomly divided into the intervention group (n=20) and control group (n=20). The intervention group received a seven-week vibration intervention-based TCM holistic theory combined with conventional therapy, such as stretching, massage, and flapping, while the control group only received the conventional therapy. Surface electromyography (sEMG) of the lumbar segment of erector spinae was measured for each participant pre- and postintervention, and the two-point discrimination thresholds of the data were differentiated and compared with panel data analysis. RESULTS: For the control group, the pre- and postintervention sEMG measure showed no significant difference (p=0.333), whereas significant difference (p=0.004) was observed for the intervention group. Further, the pre- and postintervention two-point discrimination test also showed a significant difference (p=0.016) for the intervention group. DISCUSSION: The application of vibration therapy based on TCM holistic theory may have an immediate effect in reducing sport-induced muscle fatigue from intensive training. Future larger sample size and robust designed clinical trial is warranted to evaluate the long-term effect of the intervention.