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Rehabilitation Promoting Prevention and Improved Resilience (REPPAIR)

REPPAIR stands for “Rehabilitation Promoting Prevention and Improved Resilience.” REPPAIR is a research program funded by VA Rehabilitation Research & Development (RR&D). The goal of this program is to help redesign rehabilitative care so that it can help Veterans maintain their health and independence as they age. To do this, we focus on the 3 M’s: Mind, Mobility and Motivation.

REPPAIR graphic of brain: Rehabilitation Promoting Prevention and Improved Resilience

Research has shown that maintaining functional independence is the biggest priority for an older individual who seeks medical care. By targeting the priorities valued most by patients, we can proactively design personalized care that the Veterans Health Administration prioritizes in its strategic goals.

To do this, we focus on optimizing cognition and mood (the Mind), optimizing physical functioning (Mobility), and optimizing long-term engagement in healthy behaviors (Motivation).

REPPAIR includes separate research projects that focus on the 3 M’s among different groups of Veterans. While each study is separate, the information received from each study is combined into a single data repository that will be a very useful platform for future research serving Veterans. REPPAIR is also designed to serve as a vital platform for advancing the careers of research trainees and creating a data repository accessible for VA researchers to support future RR&D research.

Become a REPPAIR Participant

REPPAIR seeks individuals who are:

  1. Currently enrolled in a REAP-REPPAIR qualifying study (see below)
  2. 50 years or older, and
  3. Have one of these health conditions of interest: COPD, PTSD, slow walking speed

To find out if you are eligible for one of our studies or if you would like further information about our studies, please contact:

Elisa Ogawa

Research fellow

VA Boston health care

Email: elisa.ogawa@va.gov

Announcements

Congratulations to Alexander Garbin, PT, DPT, PhD, who received RR&D’s VA Boston REAP Pilot Research Award!
Alexander Garbin, PT, DPT, PhD, is a third year Advanced Research Fellow in the Eastern Colorado VA Healthcare System Geriatrics, Research, Education and Clinical Center (GRECC) and postdoctoral fellow at the University of Colorado Anschutz Medical Campus. He received his PhD in Biokinesiology at the University of Colorado, during which he employed gerontological datasets to investigate sources of heightened fall risk in older adults with a fear of falling. During his Advanced Fellowship, Dr. Garbin has worked to implement routine walking speed assessments into primary care settings. In his REAP pilot ’Understanding fall risk identification and management within VA primary care: a mixed methods study’, he is examining the prevalence of fall risk, falls, and fall risk factors in older Veterans seen within VHA primary care, and identifying providers’ and Veterans’ perceptions of fall prevention. To answer these questions, Dr. Garbin will receive training in qualitative and mixed methods. Data from his REAP pilot will support the need for development of a VHA primary care specific fall prevention model.

Alexander Garbin PT, DPT, PhD

Advanced research fellow

VA Boston health care

Email: alexander.garbin@cuanschutz.edu

Our Team

Our team represents collaborators from a variety of research centers at VA Boston Healthcare System including the New England Geriatric Research Education and Clinical Center (NEGRECC), the National Center for Posttraumatic Stress Disorder (NCPTSD), Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Center for Healthcare Organization and Implementation Research (CHOIR), and Neuroimaging Research for Veterans Center (NeRVe).

The Principal Investigators:

Dr. Jonathan F. Bean, MD, MPH, director of REPPAIR and the NEGRECC.

Jonathan Bean MD, MPH

Dr. Bean is the director of the REPPAIR and is trained as a physician in the specialty of physical medicine and rehabilitation. He provides oversight and supervision of all REAP activities. He is also the director of the New England Geriatric Research Education and Clinical Center (NEGRECC).

VA Boston health care

Phone:

Email: jonathan.bean4@va.gov

Dr. Marilyn Moy, MD, MSc, associate director of REPPAIR and medical director of the VA Boston Pulmonary Rehabilitation Program.

Marilyn Moy MD, MSc

Dr. Moy is the associate director of REPPAIR. She is a clinical investigator and staff pulmonologist at VA Boston. She shares in the administrative, scientific and budgetary leadership of REPPAIR. She leads the research training activities for REPPAIR. Dr. Moy is also the medical director of the VA Boston Pulmonary Rehabilitation Program.

VA Boston health care

Phone:

Email: marilyn.moy@va.gov

Dr. Erica Scioli, PhD, clinical research psychologist, member of the REPPAIR Steering Committee, and full-time researcher affiliated with the National Center for PTSD, Women’s Health Sciences Division (NCPTSD-WHSD).

Erica Scioli PhD

Dr. Scioli is a clinical research psychologist and serves on the REPPAIR Steering Committee. She is a full-time researcher affiliated with the National Center for PTSD, Women’s Health Sciences Division (NCPTSD-WHSD).

VA Boston health care

Phone:

Email: ericarose.scioli@va.gov

The REPPAIR Team:

  • Luc Djousse, MD, ScD, MPH, DMC Core Director
    Dr. Djousse is physician researcher with expertise in Epidemiology and data management. He also works within the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC).
  • Michael Esterman, PhD
    Dr. Esterman is a cognitive neuroscience researcher who serves on the REPPAIR Steering Committee and supports the DMC. He is also a faculty member within the National Center for PTSD and NeRVe.
  • Elisa Ogawa, PhD, Research Study Coordinator
    Elisa has extensive experience in research and works alongside all REPPAIR cores to assist with research management.
  • David Gagnon, MD, PhD, MPH, Biostatistician
    Dr. Gagnon is Research Professor of Biostatistics at the Boston University School of Health. He works closely with both Drs. Djousse and Ward within the DMC. He is also director of biostatistics in the division of Population Health and Data Science at MAVERIC.
  • Rebekah Harris, PhD, PT, DPT, SDC Core Director
    Dr. Harris is a Physical Therapist with expertise in Geriatric care and research. She serves as a SDC Core Director
  • Jennifer Moye, PhD, ABPP
    Dr. Moye is a Staff Psychologist with expertise in geriatric mental health and medical education. She assists with REPPAIR research training activities. She also serves as the Associate Director for Education and Evaluation of the NEGRECC.
  • David Salat, PhD, Neuroimaging Lead
    Dr. Salat is a Neuroimaging Researcher who directs the VA Boston Healthcare System Neuroimaging Research Center for Veterans (NeRVe). He serves as the Neuroimaging Lead for the SDC providing supervision with analysis and interpretation of neuroimaging data.
  • Jennifer Sullivan, PhD
    Dr. Sullivan serves on the REPPAIR Steering Committee. She is an Associate Director at the Long-Term Services and Supports Center of Innovation at VA Providence Healthcare System and an Associate Professor (Research) at Brown University School of Public Health.
  • Rachel Ward, PhD, MPH, Epidemiologist/Analyst
    Dr. Ward provides epidemiological, statistical and data management expertise to the DMC. She works within MAVERIC along with Dr. Gagnon and Dr. Djousse.
  • Amy Linsky, MD, MSc
    Dr. Linsky serves on the REPPAIR Steering Committee. She is also a research faculty member within CHOIR and the Section of General Internal Medicine.

Research

All REPPAIR related research studies focus on the 3M’s:

Mind - this includes measures that are part of a comprehensive neuro-cognitive and mood assessments as well as the assessment of neuroimaging.

  • Mini-Montreal Cognitive Assessment (MoCA)
    Please refer to the MoCA website at https://mocacognition.com/ for more information on the MoCA
  • D-KEFS Verbal Fluency Test
    Homack, S., D. Lee, and C.A. Riccio, Test Review: Delis-Kaplan Executive Function System. Journal of Clinical and Experimental Neuropsychology, 2005. 27(5): p. 599-609.
  • Hopkins Verbal Learning Test-Revised
    Benedict, R.H.B., et al., Hopkins Verbal Learning Test – Revised: Normative Data and Analysis of Inter-Form and Test-Retest Reliability. The Clinical Neuropsychologist, 1998. 12(1): p. 43-55.
  • Oral Trail Making Test
    Mrazik, Yuspeh, Drane, Klingler, Huthwaite, & Dildine: The Oral Trail Making Test: Demographic Influences & Validation with the Written Trail Making Test. Presented at the 21st Annual Meeting of the National Academy of Neuropsychology, San Francisco, November 2001.
  • Wais-IV Digit Span Test
    Blackburn HL, Benton AL. Revised administration and scoring of the digit span test. J Consult Psychol. 1957 Apr;21(2):139-43. doi: 10.1037/h0047235. PMID: 13416432.

Mobility - this includes measures of physical functioning using performance-based, patient-reported, and accelerometry assessments.

  • Activity Measure for Post-Acute Care- basic mobility (AMPAC)
    Haley, S. M., Andres, P. L., Coster, W. J., Kosinski, M., Ni, P., & Jette, A. M. (2004). Short-form activity measure for post-acute care. Archives of Physical Medicine and Rehabilitation, 85(4), 649-660. doi: 10.1016/j.apmr.2003.08.098
  • Short Physical Performance Battery (SPPB)
    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49(2):M85-94. doi: 10.1093/geronj/49.2.m85. PMID: 8126356.
  • Gait Assessment
    Brach JS, Berthold R, Craik R, VanSwearingen JM, Newman AB. Gait variability in community-dwelling older adults. J Am Geriatr Soc. 2001 Dec;49(12):1646-50. doi: 10.1046/j.1532-5415.2001.t01-1-49274.x. PMID: 11843
  • Actigraphy

Choi, L et al. Validation of Accelerometer Wear and Nonwear Time Classification Algorithm. Medicine & Science in Sports & Exercise: February 2011 - Volume 43 - Issue 2 - p 357-364 doi: 10.1249/MSS.0b013e3181ed61a3

Mood & Motivation - this includes a comprehensive assessment of behavioral health factors linked to engagement with physical activity, rehabilitation, and social activities.

  • Trans-theoretical Model (TTM) (4 Measures)
    1. TTM: Exercise Stage of Change
    2. TTM: Confidence
    3. TTM: Decisional Balance
    4. TTM: Process of Change
    Nigg, C. R., & Riebe, D. (2002). The Transtheoretical Model: Research review of exercise behavior and older adults, (pp. 147-180). In P. Burbank & D. Riebe (Eds.), Promoting exercise and behavior change in older adults: interventions with the Transtheoretical Model. New York, NY: Springer Publishing Company.
  • Patient Health Questionnaire (PHQ)-2
    Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.
  • Generalized Anxiety Disorder (GAD)-7 item scale
    Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092-7.
  • Duke Social Support Index- 11 item scale
    Koenig et al. (1993). Abbreviating the Duke Social Support Index for use in chronically ill older adults. Psychosomatics, 34, 61-69. PMID: 8426892
  • Primary Care Post Traumatic Stress Disorder- DSM 5
    Prins, A., Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A., & Schnurr, P. P. (2015). The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). [Measurement instrument].

The REPPAIR data repository includes data from the following studies...

Qualifying Studies:

  • The Live Long Walk Strong Rehabilitation Program
  • Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in COPD

Existing Contributing Studies:

  • Defining Biotypes of PTSD with Resting-State Connectivity
  • Neuroimaging and Neuropsychological Biomarkers of Vascular Risk Factors
  • Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD

Pilot Studies:

  • Barriers to CPAP use in Veterans with Comorbid PTSD and OSA
  • Active and Passive Monitoring of Symptoms of PTSD and MDD and Psychosocial Functioning
  • Assessing Functional Goals in Treatment-Seeking Veterans with PTSD Using a Rehabilitative Framework
  • Understanding fall risk identification and management within VA primary care: a mixed methods study

Resources

Pilot Proposals / Trainees

Description:

The VA Rehabilitation Research & Development (RR&D) REAP at VA Boston Healthcare System is pleased to invite applications for the FY25 Pilot Research Award. 

The Rehabilitation Promoting Prevention and Improved Resilience (REPPAIR) REAP promotes multidisciplinary research aimed at understanding the complex relationships between Mobility, the Mind (cognition/mood), and Motivation (long-term engagement) in Veterans. REPPAIR focuses on innovations in the development of personalized rehabilitative care treatments that optimize the functional status of Veterans.  It emphasizes rehabilitation as preventative care.

The award will support novel investigation that advances the REPPAIR theme: “The 3 M’s Mobility, Mind, and Motivation” among older adults with or without chronic disease. The award is intended to support collection of preliminary data to prepare for future submission of a successful VA RR&D Career Development Award.

The award provides a maximum of $30,000. The scope of the project should generally allow for completion within a one-year time frame.

Funding decisions will be based on the proposal’s significance, innovation, relevance to the REPPAIR mission, and potential for future VA RR&D CDA funding. 

Eligibility:

All faculty, postdoctoral fellows, students and research staff in the VA community who anticipate submission of a VA RR&D Career Development Award are invited to apply.

Application Instructions:

Applicants should submit...

  1. An abstract of up to 350 words,
  2. A 3-page proposal (Arial 11 font, 0.5" margins, single spaced) that includes: title, specific aim, research plan, innovation, relevance to REPPAIR theme, IRB status/plan if applicable, and potential for future VA RR&D CDA funding,
  3. A biosketch on the VA template,
  4. A mentor letter of support, and
  5. A one-year budget and budget justification

How to Submit the Application:

Please email your application as a single PDF to Elisa Ogawa at 
elisa.ogawa@va.gov 

Key Dates:
Application due date: dates pending 
Notification on or before: dates pending
Earliest funding start date: dates pending

Questions:
Please address all questions to Marilyn Moy, MD, MSc, associate director of the REPPAIR REAP, at marilyn.moy@va.gov. 

Questions:
Please address all questions to Marilyn Moy, MD, MSc, associate director of the REPPAIR REAP, at marilyn.moy@va.gov. 

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