Dr. Pastva believes movement matters – for all people, in all settings. Not only does she prioritize physical activity for her own health but her research career is dedicated to optimizing rehabilitation strategies to improve functional capacity in patients, especially those with chronic and medically-complex conditions (i.e., heart failure, respiratory failure, stroke, cancer). To that end, Dr. Pastva has a broad research portfolio utilizing physical activity-based interventions. For example, she is the Duke site principle investigator for two of the largest to-date international multisite ICU rehabilitation trials: eStimCycle and CYCLE RCT, which investigate rehabilitation interventions, including assistive technology ones (e.g, supine cycling), for patients with critical illness. She was a key investigator on federally-funded landmark trials: the Patient Centered Outcomes Research Institute (PCORI)-funded COMPASS Study, a large pragmatic trial of comprehensive post-acute stroke services across the state of North Carolina, and the National Institute of Health (NIH)-funded REHAB-Heart Failure, a multisite trial of physical rehabilitation in older adults with acute heart failure. Building from these trials, she continues to expand her research dossier as detailed below. Across all the trials, she oversees physical rehabilitation invention fidelity and assesses social and functional determinants of health that influence patient recovery and intervention participation. In addition to being a Senior Fellow in the Duke Center for the Study of Aging and Human Development, Dr. Pastva serves as Co-Lead of the Health and Mobility Measures Core of the NIH-supported Duke Claude D Pepper Older Americans Independence Center, contributing her expertise in physical activity methodology and functional measures to Center projects. She also serves on the American Physical Therapy Association’s ICU Rehabilitation Clinical Guideline Development Group, on the Research Committee of its Academy of Cardiovascular and Pulmonary Physical Therapy, and on the Editorial Board of the Physical Therapy and Rehabilitation Journal. Dr. Pastva cherishes working with learners and is a research mentor in the Duke Doctor of Physical Therapy Program, in the Duke Health's Cardiovascular and Pulmonary Physical Therapy Residency Program, in the Duke Center for the Study of Aging and Human Development, and in doctoral and post-doctoral programs external to Duke.
Current Research Studies
CYCLE RCT: International RCT of early in-bed cycling with mechanically ventilated patients
Funding Source: Canadian Institute of Health Research
(PI: Kho M; Role: Steering Committee, Duke Site PI)
The major goal of this project is to determine whether in-bed cycling will improve clinical/functional outcomes and health service utilization compared to usual care in those who are critically ill.
Duke Claude D. Pepper Older American Independence Center (OAIC)
Funding Source: National Institute of Aging P30AG028716
(PI: Schmader K; Role: Co-I/Co-Lead Health and Mobility Measures Core)
The goal of this project is to understand/optimize physiologic reserve and physical resilience in older adults.
Achieving Blood Pressure Goals after Stroke – PLACER
Funding Source: Patient Centered Outcomes Research Institute PCS-1403-14532
(PI: Bushnell C; Role: Steering Committee, Consortium PI)
The goal of this multicenter patient-randomized trial is to examine the comparative effectiveness of Intensive Tailored Telehealth Management versus Intensive Clinic Management to control BP among stroke patients discharged home from the hospital or rehabilitation facility.
Community use of rehabilitation after stroke
Funding Source: National Institute of Child and Human Development R01HD101493
(Multiple PI: Freburger J, Jones S, Pastva AM)
The goal of this project is to determine the effectiveness of a transitional care model in improving access to and appropriate delivery of post-acute stroke physical rehabilitation care.
Remotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM HIIT-COVID-19)
(Multiple PI: Wischmeyer P, Pastva AM)
Funding Source: National Institute of Child and Human Development R01HD107103
The goal of this multicenter randomized trial is to determine whether treatment with multidomain structured and progressive post-acute exercise will improve functional recovery and quality of life in patients who have experienced COVID-19 critical illness.
Physical Rehabilitation for Older Patients with Acute HFpEF-The REHAB-HFpEF Trial
Funding Source: National Institute of Aging R01AG078153
(PI: Kitzman D; Role: Co-I/Lead, Intervention Management Core)
The goal of this phase III national trial is to determine whether an innovative, transitional, tailored, progressive, multi-domain physical rehabilitation intervention will improve the combined endpoint of rehospitalizations or death and secondary outcome of major mobility disorder for hospitalized acute decompensated heart failure patients with heart failure with preserved ejection fraction.
Clinical practice guideline for physical therapy management of critically ill adult patients in the ICU.
Funding Source: American Physical Therapy Association
(Role: Multiple PI, Core Development Group)
The goal of this project is to develop clinical practice guidelines for physical therapy management of critically ill adult patients.
Selected Completed Studies
Early supported discharge for improving functional outcomes after stroke
Funding Source: Patient Centered Outcomes Research Institute PCS-1403-14532
(PI: Duncan PW; Role: Co-I/Rehab Intervention Lead)
The goal of this project is to determine whether transitional care and early supported discharge for stroke patients who go home directly from the hospital improves patients’ daily function compared with usual care.
REHAB-HF: A trial of Rehabilitation Therapy in Older Acute Heart Failure Patients
Funding Source: National Institute of Aging R01 AG045551
(PI: Kitzman D; Role: Co-I/Rehab Intervention Lead)
The goal of this project is to determine whether multi-domain rehabilitation intervention administered to older patients with acute decompensated heart failure beginning early in hospitalization and continuing for 3 months will improve functional and utilization outcomes.
Duke Roybal Center – Pilot Project HF Active
Funding Source: National Institute of Aging R01 P30AG064201
(Co-PIs: Bettger JP, Keefe FJ; Role: Co-PI of Pilot Project)
The overall goal of the Center is to catalyze the development of cross-disciplinary research to develop and test innovative behavioral and social interventions for older adults. The goal of its inaugural pilot study, HF-Active, is to develop a tailored physical activity toolkit for older adults with heart failure.
BuildStamina
Funding Source: Oncology Nurse Foundation
(PI: Albrecht T; Role: Co-I/Rehab Intervention Lead)
The goal of this project is to test the efficacy of Build Stamina, a 3-month multidomain exercise
program, improves function and quality of life in adults with acute leukemia.
EStimCycle
Funding Source: National Health and Medical Research Council, Australia
(PI: Berney S; Role: Duke Site PI)
The goal of this international multisite trial is to determine whether functional electrical stimulation-assisted cycling improves physical and neurocognitive outcomes compared to usual care in those who are critically ill.
Impact of age on outcomes associated with early mobilization in medical intensive care
Funding Source: Gerontological Advanced Practice Nurses Association Foundation
(Role: Co-PI with Sabol V)
The goal of this study is to assess the impact of age on clinical and functional outcomes in patients who were critically ill in the medical intensive care unit and who participated in an early mobility program.
ERiCC: Early Rehabilitation in Critical Care
Funding Source: American Thoracic Society Unrestricted Research Award
(Role: PI)
The goal of this randomized trial is to determine whether functional electrical stimulation-assisted cycling will improve physical and neurocognitive outcomes compared to usual care in those who are critically ill.