Movement Matters for Adults with Multiple Comorbid Conditions and Medical Complexity

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 is a key investigator on two 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. In these trials she oversees 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 on the Physical 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.

Because of Dr. Pastva’s dedication to optimizing patient cardiovascular health and care, she has been appointed to Duke Chancellor Washington’s Translating Duke Health Cardiovascular Initiative called “Keeping the Heart Young”; she serves on the Steering Committee, contributing to the future of cardiovascular clinical care and research at Duke. She also serves on the American Physical Therapy Association’s ICU Rehabilitation Clinical Guideline Development Group and on the Research Committee of its Cardiovascular and Pulmonary Section. Dr. Pastva cherishes working with learners and is a research mentor in Duke Health's Cardiovascular and Pulmonary Physical Therapy Residency Program and the Duke Doctor of Physical Therapy Program.

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  KE Schmader (PI)
(PI: Schmader K; Role: Co-I/Physical Measures Core)
The goal of this project is to understand/optimize physiologic reserve and physical resilience in older adults.

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.

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.

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.

Selected Completed Studies

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.