Using Integrated Care and Wearable Technology to Evaluate Outcomes of the Shields & Stripes Program for Veterans and First Responders

To assess changes in anxiety symptoms before and after participation in the 12-week Shields & Stripes program using validated self-report measures.

Score range: 0 to 21

Higher scores indicate: Worse anxiety symptoms

To assess changes in depression symptoms before and after participation in the 12-week Shields & Stripes program using validated self-report measures.

Score range: 0 to 27

Higher scores indicate: Worse depressive symptoms

To assess changes in post-traumatic stress symptoms before and after participation in the 12-week Shields & Stripes program using validated self-report measures.

Score range: 0 to 80

Higher scores indicate: Worse PTSD symptoms

Change in heart rate variability as measured by the Oura Ring wearable device. HRV will be reported as the nightly average root mean square of successive differences (RMSSD).

Time Frame:

Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)

Unit of Measure:

Milliseconds (ms)

Directionality:

Higher values indicate better autonomic nervous system balance and recovery.

Change in sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), a validated 19-item self-report questionnaire assessing sleep quality and disturbances over the past month.

Time Frame:

Baseline (Week 0) to Post-Program (Week 12)

Unit of Measure:

Total PSQI global score (range: 0 to 21)

Directionality:

Higher scores indicate worse sleep quality.

Change in health-related quality of life as measured by the RAND 36-Item Health Survey (RAND-36), a validated self-report questionnaire assessing eight domains including physical functioning, role limitations (physical and emotional), energy/fatigue, emotional well-being, social functioning, pain, and general health perceptions.

Time Frame:

Baseline (Week 0) to Post-Program (Week 12)

Unit of Measure:

RAND-36 subscale scores transformed to a 0-100 scale.

Directionality:

Higher scores indicate better health-related quality of life and functioning.

Change in total cholesterol measured via standard laboratory testing.

Unit of Measure:

mg/dL

Directionality:

Lower values indicate improved lipid profile.

Participant and provider feedback will be collected using a semi-structured interview guide developed for this study. Thematic analysis will identify recurring themes related to participant satisfaction, perceived effectiveness, and experiences with integrated occupational therapy, mental health, physical therapy, and nutrition services.

Time Frame: Post-Program (within 4 weeks of completion) Unit of Measure: Not applicable (qualitative thematic analysis)

Change in self-reported physical function measured by the Patient-Specific Functional Scale (PSFS), reflecting improvements in self-identified functional goals and mobility.

Time Frame: Baseline (Week 0) to Post-Program (Week 12) Unit of Measure: Mean PSFS total score (0-10 scale) Directionality: Higher scores indicate better functional performance

Change in total nightly sleep duration as measured by the Oura Ring wearable device.

Time Frame:

Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)

Unit of Measure:

Hours (or minutes - choose one and stay consistent)

Directionality:

Higher values indicate longer sleep duration

Change in sleep efficiency as measured by the Oura Ring wearable device. Sleep efficiency is calculated as the percentage of time in bed spent asleep.

Time Frame:

Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)

Unit of Measure:

Percentage (%)

Directionality:

Higher values indicate better sleep quality.

Change in resting heart rate as measured by the Oura Ring wearable device.

Time Frame:

Pre-Program (T-4 weeks), Program Start (Week 0), and Post-Program (Week 12)

Unit of Measure:

Beats per minute (bpm)

Directionality:

Lower values generally indicate better cardiovascular fitness and recovery.

Change in average daily activity level as measured by the Oura Ring wearable device.

Unit of Measure:

Oura Activity Score (0-100 scale)

Directionality:

Higher values indicate greater physical activity.

Change in insomnia symptom severity as measured by the Insomnia Severity Index (ISI), a validated 7-item self-report questionnaire assessing perceived insomnia severity.

Time Frame:

Baseline (Week 0) to Post-Program (Week 12)

Unit of Measure:

Total ISI score (range: 0 to 28)

Directionality:

Higher scores indicate more severe insomnia symptoms.

Change in high-density lipoprotein (HDL) cholesterol measured via standard laboratory testing.

Unit of Measure:

mg/dL

Directionality:

Higher values indicate improved lipid profile.

Change in low-density lipoprotein (LDL) cholesterol measured via standard laboratory testing.

Unit of Measure:

mg/dL

Directionality:

Lower values indicate improved lipid profile.

Description:

Change in triglyceride levels measured via standard laboratory testing.

Unit of Measure:

mg/dL

Directionality:

Lower values indicate improved lipid profile.

Description:

Change in fasting blood glucose measured via standard laboratory testing.

Unit of Measure:

mg/dL

Directionality:

Lower values indicate improved glycemic control.

Description:

Change in hemoglobin A1c (HbA1c), a measure of average blood glucose over approximately three months, measured via standard laboratory testing.

Unit of Measure:

Percent (%)

Directionality:

Lower values indicate improved glycemic control.

Description:

Change in high-sensitivity C-reactive protein (hs-CRP), a biomarker of systemic inflammation, measured via standard laboratory testing.

Unit of Measure:

mg/L

Directionality:

Lower values indicate reduced systemic inflammation.

Description:

Change in serum 25-hydroxyvitamin D levels measured via standard laboratory testing.

Unit of Measure:

ng/mL

Directionality:

Higher values indicate improvement toward normal vitamin D status.

Description:

Change in thyroid stimulating hormone (TSH) levels measured via standard laboratory testing.

Unit of Measure:

mIU/L

Directionality:

Movement toward the normal reference range indicates improved thyroid function.