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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:

Emma Fitzelle-Jones

Health science specialist

VA Boston health care

Phone: (857) 364-4204

Email: emma.fitzelle-jones@va.gov

Announcements

Congratulations to Haijng Hallenbeck, PhD, who received RR&D’s VA Boston REAP Pilot Research Award!
Dr. Haijing Hallenbeck is a second-year postdoctoral fellow at National Center for PTSD, Dissemination and Training Division, at VA Palo Alto. She received her PhD in clinical psychology at Washington University in St. Louis and completed her predoctoral internship at VA Palo Alto. In graduate school, Dr. Hallenbeck used smartphone technology to better understand depression in everyday life through ecological momentary assessment (EMA). As a postdoctoral fellow, Dr. Hallenbeck is studying comorbid PTSD and depression and its impact on psychosocial functioning. She hopes to leverage technology to better assess and treat symptoms as well as functioning. For example, in her REAP pilot “Active and Passive Monitoring of Symptoms of PTSD and MDD and Psychosocial Functioning,” she is testing an assessment approach that includes EMA as well as passive data collection from smartphones and wearables (i.e., data related to location, social communication, physical activity, and sleep). Dr. Hallenbeck hopes that this approach will ultimately highlight opportunities for early intervention, which could be delivered in-the-moment with the aid of technology. To explore these questions, she has pursued advanced statistical training, including in multilevel modeling, structural equation modeling, and machine learning.

Dr. Haijing Hallenbeck, postdoctoral fellow at National Center for PTSD, Dissemination and Training Division, VA Palo Alto.

Haijing Hallenbeck PhD

Postdoctoral fellow at the National Center for PTSD, Dissemination and Training Division, VA Palo Alto

VA Boston health care

Phone: 650-493-5000 ext. 61676

Email: haijing.hallenbeck@va.gov

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: 857-364-2786

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: 857-203-6622

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: 857-364-5696

Email: ericarose.scioli@va.gov

  • Jane Driver, MD, MPH, SDC Core Director
    Dr. Driver is a Geriatrician and Oncologist with expertise in developing care innovations for older patients. She also serves as the Chief of Geriatrics and Extended Care at the VA Boston Healthcare System
  • 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.
  • Emma Fitzelle-Jones, MPH, Data Manager/Project Coordinator
    Emma has experience and expertise in data management and works with the DMC core. She also assists 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 www.mocatest.org 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

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...

  • The Live Long Walk Strong Rehabilitation Program
  • Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in COPD
  • 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
  • Barriers to CPAP use in Veterans with Comorbid PTSD and OSA
  • Active and Passive Monitoring of Symptoms of PTSD and MDD and Psychosocial Functioning

Resources

Pilot Proposals / Trainees

Call for FY23 Pilot Research Proposals

Description:
The VA Rehabilitation Research & Development (RR&D) REAP at VA Boston Healthcare System is pleased to invite applications for the FY23 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) 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) biosketch on the VA template, (4) mentor letter of support, and (5) 1-year budget and budget justification.

How to Submit the Application:
Please email your application as a single PDF to Emma Fitzelle-Jones at
emma.fitzelle-jones@va.gov

Key Dates:
Application due date: July 6, 2022
Notification on or before: Sept. 7, 2022
Earliest funding start date: Oct. 1, 2022

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