EVALUATING THE IMPLEMENTATION OF CONTINUOUS HEART RATE MONITORING INTO A CAMP FOR CHILDREN WITH NEUROMOTOR DISORDERS USING THE RE-AIM FRAMEWORK

Background & Purpose: Pediatric physical therapists have an explicit role in promoting health and physical fitness for children with neuromotor disorders (ND); however, opportunities for participation in exercise are limited. Previously, our intensive summer gait camp for children with ND led to significant endurance and strength gains; however, ensuring effective exercise intensity was challenging. Thus, we implemented continuous heart rate (HR) monitoring with visual feedback into our existing program and used the RE-AIM (R-reach, E-effectiveness, A-adoption, I-implementation, M-maintenance) framework to systematically evaluate the impact. We evaluated our program by investigating: (1) HR monitor wear time; (2) zone data collection time; (3) vigorous intensity exercise time; (4) endurance, strength, and functional improvements; (5) parent and participant satisfaction; and (6) reach to participants, referrer adoption, and camp maintenance potential.

Case Description: Eight children with ND (GMFCS I-III) participated. Camp, a billable physical therapy group intervention, ran for 2 hours daily, 4 days a week, for 4 weeks in a rehabilitation therapy space. Pre-camp, a maximal exertion test to determine maximal HR (HRmax) and functional testing (6MWT, GMFM-88 D + E, Functional Strength Battery, 10MWT, TUG) were completed. Based on HRmax, individual color-coded HR zones were calculated: Zone 0: Gray, < 50% HRmax; Zone 1 (Moderate): Blue, 50-70% HRmax; Zone 2 (Vigorous): Yellow, 70-85% HRmax; Zone 3 (Vigorous): Red >85% HRmax. During camp, participants wore HR sensors and used their zones to ensure exercise intensity. Post-camp, the same tests were completed. The RE-AIM framework evaluated our intervention.

Outcomes: Eight children were Reached, four children Maintained camp attendance from previous summers, and referrals from four physicians showed Adoption. Implementation feasibility was shown with > 60 minutes of HR monitor use per session and > 95% of exercise time within HR zones. Implementation fidelity was evident as participants spent 50-94% of the time exercising vigorously. The gait camp appears to be Effective, with all individuals meeting MDC/MCID improvements on at least two measures (clinical effectiveness), and caregivers and campers reporting high satisfaction (3.7/4) (program effectiveness).

Discussion: Continuous, color-coded HR zone feedback provided individualization of exercise prescription within a group setting and effectively motivated pediatric gait camp participants to exercise at intensities to promote aerobic and functional gains. Participants enjoyed this technology, as it facilitated participation with peers and empowered them to actively engage in their health. The RE-AIM framework provided an evidence-based method for evaluating our intervention’s impact and we advocate its use in clinical programs to increase programmatic effectiveness and promote sustainability. Clinicians in all pediatric rehabilitation settings must establish programs that provide such opportunities for children with ND.