Implementation of Routine Walking Speed Measurements in Older Veterans

Walking Speed as a Vital Sign: Enhancing Function in Older Veterans

Walking speed is a powerful predictor of mortality and adverse health consequences (e.g. fall or hospitalization) in older adults. Knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Furthermore, walking speed is a modifiable risk factor such that early recognition of physical function decline allows for appropriate and timely intervention prior to the occurrence of adverse health events. Therefore, this proposal seeks to implement routine measures of walking speed into VHA primary care as a 'vital sign' to routinely monitor Veteran physical function and help guide provider referrals.

Study Overview

• Status: Not yet recruiting
• Conditions: Aging; Mobility Limitation; Fall Risk
• Intervention / Treatment: Other: Usual Care; Other: FASTER

Detailed Description

Background: Walking speed is a vital sign that can predict mortality and adverse health outcomes in older adults. However, it is not routinely assessed in outpatient primary care clinics, potentially leading to missed opportunities for timely intervention and rehabilitative care. Current literature identifies walking speed as a sensitive measure of overall health and functional status, with a walking speed of <0.6 m/s indicating increased risk of adverse events and reduced independence. Consequently, knowledge of individuals' walking speed can provide unique insight into current physical function and need for healthcare services. Importantly, walking speed is also a modifiable risk factor and is sensitive to change in multiple populations with varying medical conditions, making it an ideal measure for longitudinal monitoring of physical function. The investigators' preliminary work implementing walking speed measurement into outpatient geriatric clinical care, along with recent literature, demonstrates that routine walking speed assessments are feasible, quick, and safe.

Significance: Current VHA standard of care within primary care clinics relies on subjective information to evaluate a Veteran's physical function, which can be unreliable and inaccurate. Implementation of walking speed will introduce an objective measure that can accurately assess how a Veteran's physical function changes over time, thus helping providers identify whether referrals to rehabilitation services are needed.

Innovation and Impact: This proposal is innovative as it will be one of the first studies to assess the implementation and effect of walking speed across multiple primary care clinics. Additionally, examination of contextual factors influencing the implementation and effect of walking speed is innovative and will lead to adaptations that facilitate future widespread implementation.

Methodology: Pragmatic hybrid type 2 effectiveness-implementation study using a stepped-wedge cluster randomized trial design to evaluate and improve walking speed implementation and assess its effectiveness across VHA PACT clinics.

• Study Type: Interventional
• Enrollment (Estimated): 10500
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jennifer E Stevens-Lapsley, PhD; Phone Number: (303) 949-9304; Email: Jennifer.Stevens-Lapsley@va.gov
• Study Contact Backup: Name: Joyce A Middleton; Phone Number: (303) 908-8935; Email: joyce.middleton@va.gov

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80045-7211
      • Rocky Mountain Regional VA Medical Center, Aurora, CO
      • Principal Investigator: Jennifer E. Stevens-Lapsley, PhD
      • Contact: Jennifer E Stevens-Lapsley, PhD; Phone Number: 303-949-9304; Email: Jennifer.Stevens-Lapsley@va.gov
      • Contact: Joyce A Middleton; Phone Number: (303) 908-8935; Email: joyce.middleton@va.gov

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Site Inclusion Criteria:

• VHA primary care clinics

VHA Personnel Inclusion Criteria:

• Providers working in a VHA primary care clinic where FASTER is implemented
• Nursing staff working in a VHA primary care clinic where FASTER is implemented

Veteran Inclusion Criteria:

• Veterans 60 years and older receiving care in a VHA primary care clinic where FASTER is implemented

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Usual Care; Usual care will continue in clinical practice with this phase occurring before FASTER implementation.	Other: Usual Care; During the Usual Care phase, participating clinics will continue with usual care with the addition that walking speed will be measured and recorded. Veterans and providers will be blinded to walking speed measurement so as to not influence care.
Experimental: FASTER; The FASTER intervention includes measurement, recording, and use of walking speed measurement to help guide care in older Veterans.	Other: FASTER; During the FASTER phase, walking speed will be measured during clinic visits, recorded in the medical record, and used by providers to guide care. An Action Toolkit will be provided with resources for providers to support informed care decisions based on Veterans' walking speeds.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Walking Speed	Time to complete 4-meter walk at usual speed converted to meters per second. Higher speed indicates better function.	Change in walking speed before exposure and change in walking speed after exposure to FASTER intervention (up to 12 months).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse Events (Injurious Falls)	Falls that result in a medical visit	Start of usual care to end of implementation (anticipated 24 months).
Adverse Events (Emergency Department Visits and Hospitalizations)	Emergency department visits and hospitalizations	Start of usual care to end of implementation (anticipated 24 months).

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
RE-AIM Component: Reach	Proportion of visits with a walking speed measured out of all in-person primary care visits (Veterans ≥65 years of age)	Start of usual care to end of implementation (anticipated 24 months).
RE-AIM Component: Adoption (Providers)	Proportion of providers that state they will use walking speed information	Start of implementation.
RE-AIM Component: Adoption (Assessors)	Proportion of assessors that state they will measure walking speed	Start of usual care.
RE-AIM Component: Adoption (Clinics)	Proportion of clinics that state they will implement walking speed	Start of usual care.
RE-AIM Component: Implementation (Walking Speed Measurement)	Proportion of completed walking speed measurement elements out of all elements	Start of usual care to end of implementation (anticipated 24 months).
RE-AIM Component: Implementation (Walking Speed Initiative Elements)	Proportion of completed walking speed initiative elements out of all intervention elements	Start of usual care to end of implementation (anticipated 24 months).
RE-AIM Component: Implementation (Walking Speed Measurement Total Time)	Time to complete walking speed measurement and documentation	Start of usual care to end of implementation (anticipated 24 months).
RE-AIM Component: Implementation (Walking Speed Measurement Relative Time)	Time to complete walking speed measurement relative to total rooming procedures	Start of usual care to end of implementation (anticipated 24 months).
RE-AIM Component: Maintenance (Walking Speed Measurement)	Proportion of completed walking speed measurement elements out of all elements	Up to 6 months after Implementation phase.
RE-AIM Component: Maintenance (Walking Speed Initiative Elements)	Proportion of completed walking speed initiative elements out of all intervention elements	Up to 6 months after Implementation phase.
Referrals (Physical Therapy/Gerofit)	Change in VHA referrals to physical therapy/Gerofit	Start of usual care to end of implementation (anticipated 24 months).
Referrals (Follow-Through)	Proportion of referrals that result in follow-through	Start of usual care to end of implementation (anticipated 24 months).
Referrals (Recommendations)	Count of recommendations for community exercise programs, home exercise, physical activity promotion	Start of usual care to end of implementation (anticipated 24 months).
Adaptations	Number and type of adaptations at each VHA primary care clinical site	Start of usual care to end of implementation (anticipated 24 months).

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Jennifer E. Stevens-Lapsley, PhD, Rocky Mountain Regional VA Medical Center, Aurora, CO

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2027
• Primary Completion (Estimated): January 1, 2030
• Study Completion (Estimated): June 30, 2030

Study Registration Dates

• First Submitted: March 24, 2026
• First Submitted That Met QC Criteria: March 30, 2026
• First Posted (Actual): April 7, 2026

Study Record Updates

• Last Update Posted (Actual): April 7, 2026
• Last Update Submitted That Met QC Criteria: March 30, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Screening; Implementation Science; Preventative Care; PRISM; RE-AIM
• Additional Relevant MeSH Terms: Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Mobility Limitation
• Other Study ID Numbers: HSR6-009-24S; I01HX003877 (Other Grant/Funding Number: VA Office of Research and Development)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The research team intends to share study data that may be requested from other research investigators in a data-sharing agreement provided at the study end. Data prepared for distribution under a data-sharing agreement will be further redacted to ensure privacy of study participant identity yet allow analyses to occur by other investigators. The data-sharing agreement will include requirements to protect participants' privacy and data confidentiality. All participants will be de-identified using a coded participant ID to maintain confidentiality and will not be individually identifiable by name.
• IPD Sharing Time Frame: The data will be available starting 6 months after primary study publication.
• IPD Sharing Access Criteria: Data will be made available upon reasonable written request to the study team. The PI, Dr. Jennifer Stevens-Lapsley will review requests.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No