VA Office of Research and Development
Approximately 40,000 older Veterans with complex care needs receive long-term care in VA Community Living Centers (CLCs). Many CLC staff have limited specialized training to engage Veterans with dementia. Preventing Loss of Independence through Exercise (PLIÉ) is a gentle, multi-domain, group movement program for people with cognitive impairment that has shown physical, cognitive, social, and emotional benefits. This effectiveness-implementation study will train interprofessional CLC staff via a remote program and evaluate PLIÉ-CLC delivered as part of routine clinical care at up to 12 VA CLCs. We will assess resident physical function (primary outcome) and secondary outcomes (e.g., social engagement, mood, cognition, behaviors, falls, pain, and quality of life), as well as person-centered care practices, staff engagement, burnout, and workplace climate, and the sustainment of the program after external facilitation ends.
Background \& Significance: Many Veterans in CLCs have comorbid neurocognitive, mental health, and physical impairments; staff often lack specialized training for optimal engagement. PLIÉ-CLC adapts a structured, mind-body movement program for CLC residents (including those using wheelchairs) and provides an experiential staff training model. Prior VA work developed and piloted a remote PLIÉ staff training program with \>50 staff trained across multiple sites. Design: A Type 2 Hybrid Effectiveness-Implementation study using a Stepped Wedge Cluster Randomized Trial (SW-CRT) across up to 12 CLC…
Inclusion Criteria: VA Community Living Centers (CLCs) internal facilitators/champions Inclusion criteria: * Full-time CLC clinical staff member (including registered nurses, certified nursing assistants, nurse aids, recreation therapists, occupational therapists, physical therapists, mental health professionals or others) * Willingness to facilitate PLIÉ-CLC implementation at their site * Willingness to participate in initial and debrief site visit PLIÉ-CLC staff instructors Inclusion criteria: * CLC clinical staff member or volunteer interested in learning to lead PLIÉ-CLC classes * Will…
Preventing Loss of Independence through Exercise (PLIÉ) is a multi-domain, mind-body, group movement program for people with dementia that improves quality of life. Classes begins and ends with fully body tapping/massaging and breathing exercises that bring participants into awareness of their bodies in the present moment and create a calming ritual. Participants are invited to share appreciations of things in their lives that make them feel happy or grateful. Instructors lead participants through progressive, functional movement sequences that are designed to be repetitive (to build procedural or "muscle" memory) and to build slowly in functional complexity over time. Movements are tailored to the ability levels of the group. Resting, breathing and mindful body awareness exercises are incorporated throughout each class to provide breaks and to improve focus and attention. A non-judgmental errorless learning process is used, and all movements are performed slowly and purposefully.
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