Assistant Professor in Orthopaedic Surgery, Division of Physical Therapy
Assistant Professor in Medicine
Assistant Research Professor in Cell Biology
Senior Fellow, Duke Center for the Study of Aging and Human Development
Dr. Pastva’s research passion is to understand the pathophysiological mechanisms of acute or chronic cardiovascular and pulmonary diseases and investigate how rehabilitative strategies, particularly physical activity-based ones, could influence those mechanisms to impact patient outcomes. She has participated as a clinician-scientist at the principal investigator or co-investigator levels on university-, foundation-, and NIH-funded projects where she developed or assisted in the development of innovative rehabilitative strategies for medically complex patients aimed at improving patient-centered outcomes of physical function, quality of life, and health care utilization. With expertise in physical rehabilitation, exercise physiology, and cellular and molecular physiology, Dr. Pastva understands bodily processes at the functional level, organ physiological level, and cellular and molecular level. This skill set is vital to her leading or collaborating on projects that involve physical activity and exercise interventions and incorporate functional performance outcomes, especially for medically complex and/or older adults, and for translating relationships among biophysiological data and performance outcomes.
The major theme embodying Dr. Pastva’s current scholarly pursuits include rehabilitation strategies for improving the health and function of individuals living with chronic diseases and/or surviving critical illness.
For more information, visit dpt.duhs.duke.edu/faculty-staff/core-faculty/amy-pastva
Dr. Pastva and her collaborators were the first in the world to describe the use of novel assistive rehabilitation technology, functional electrical stimulation cycling, to help mitigate muscle mass loss in a critically ill patient who was on life-sustaining measures (mechanical ventilation and extracorporeal membranous oxygenation) and who ultimately received a bilateral orthotopic lung transplant.
Dr. Pastva is currently focusing on clinic research. She uses, and lends to multidisciplinary teams, her unique expertise in physiology and physical rehabilitation to explore rehabilitation strategies for optimizing the health and function of individuals living with chronic cardiovascular or pulmonary diseases and/or surviving critical illness. In these emerging studies, therapeutic strategies are implemented early in hospitalization or in the home or outpatient settings in an attempt to mitigate the muscle weakness and functional decline that accompanies an ICU and/or hospital admission. Examples of current projects include:
- Rehabilitation paradigms in critical illness: Long-term complications associated with intensive care unit (ICU) survival are prolonged neuromuscular weakness and functional impairment. A growing body of literature suggests that a multidisciplinary early rehabilitation program improves functional outcomes and reduces subsequent health care and rehabilitation costs. Projects in this focus area seek to: identify whether there are specific groups of patients who will benefit most from early rehabilitation; and determine optimal rehabilitation paradigms for combating post-ICU syndrome (PICS).
- Rehabilitation strategies for heart failure and stroke: Cardiovascular disease is a leading cause of death in both men and women in our country and can lead to heart failure and stroke. Heart failure and stroke are leading causes of long-term disability, especially in older adults. Even with optimal medical management upon hospital discharge, patients can have severe impairments in multiple physical domains: strength, balance, mobility, and endurance. Projects in this area seek to determine whether novel, tailored, progressive, multidisciplinary, and/or multi-domain rehabilitation interventions designed to address specific deficits in physical function of older adults with acute decompensated heart failure or of adults with stroke will lead to improved functional performance and reductions in health care utilization, disability, and mortality.
Selected Publications & Grants
Lew, Meagan V., Yi Ren, Yen P. Lowder, Sharareh Siamakpour-Reihani, Sendhilnathan Ramalingam, Kristi M. Romero, Jillian C. Thompson, et al. “Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplant Candidates Ages 18-80 Years.” Transplant Cell Ther, May 17, 2022. https://doi.org/10.1016/j.jtct.2022.05.018.More info
Freburger, Janet K., Amy M. Pastva, Sylvia W. Coleman, Kennedy M. Peter, Anna M. Kucharska-Newton, Anna M. Johnson, Matthew A. Psioda, et al. “Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial.” Arch Phys Med Rehabil 103, no. 5 (May 2022): 882-890.e2. https://doi.org/10.1016/j.apmr.2021.10.015.More info
Mayer, Kirby P., Amy M. Pastva, Gaixin Du, Sarah P. Hatchett, Mingguang Chang, Angela N. Henning, Baz Maher, Peter E. Morris, and Joseph B. Zwischenberger. “Mobility Levels With Physical Rehabilitation Delivered During and After Extracorporeal Membrane Oxygenation: A Marker of Illness Severity or an Indication of Recovery?” Phys Ther 102, no. 3 (March 1, 2022). https://doi.org/10.1093/ptj/pzab301.More info
Chew, Derek S., Yanhong Li, Michel Zeitouni, David J. Whellan, Dalane Kitzman, Robert J. Mentz, Pamela Duncan, et al. “Economic Outcomes of Rehabilitation Therapy in Older Patients With Acute Heart Failure in the REHAB-HF Trial: A Secondary Analysis of a Randomized Clinical Trial.” Jama Cardiol 7, no. 2 (February 1, 2022): 140–48. https://doi.org/10.1001/jamacardio.2021.4836.More info
Murray, Evan M., David J. Whellan, Haiying Chen, Alain G. Bertoni, Pamela Duncan, Amy M. Pastva, Dalane W. Kitzman, and Robert J. Mentz. “Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF.” Am J Med 135, no. 1 (January 2022): 82–90. https://doi.org/10.1016/j.amjmed.2021.08.001.More info
Whellan, David J., Dalane W. Kitzman, Haiying Chen, Michael B. Nelson, Amy M. Pastva, Melissa McCarey, Pamela W. Duncan, Robert J. Mentz, and Shelby D. Reed. “Characterizing Changes in Quality of Life and in Older Patients With Acute Decompensated Heart Failure Enrolled in a Rehab Intervention Clinical Trial.” In Circulation, Vol. 144, 2021.More info
Pandey, Ambarish, Amy M. Pastva, Pamela W. Duncan, Michael Nelson, Dalane W. Kitzman, David J. Whellan, Robert J. Mentz, Haiying Chen, Bharathi Upadhya, and Gordon R. Reeves. “Relationship Between Baseline Frailty Status and Benefits of a Novel Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized With Acute Decompensated Heart Failure: The REHAB-HF Trial.” In Circulation, Vol. 144, 2021.More info
Mentz, Robert J., David J. Whellan, Gordon R. Reeves, Amy M. Pastva, Pamela Duncan, Bharathi Upadhya, M Benjamin Nelson, et al. “Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction.” Jacc Heart Fail 9, no. 10 (October 2021): 747–57. https://doi.org/10.1016/j.jchf.2021.05.007.More info
Kitzman, Dalane W., Amy M. Pastva, and Robert J. Mentz. “Physical Rehabilitation in Patients with Heart Failure. Reply.” N Engl J Med 385, no. 14 (September 30, 2021): 1340–41. https://doi.org/10.1056/NEJMc2113494.More info
Rossler, K., M. A. Molloy, A. M. Pastva, M. Brown, and N. Xavier. “Healthcare Simulation Standards of Best PracticeTM Simulation-Enhanced Interprofessional Education.” Clinical Simulation in Nursing 58 (September 1, 2021): 49–53. https://doi.org/10.1016/j.ecns.2021.08.015.More info
- Gerontological Advanced Practice Nurses Association Foundation. Impact of Age on Outcomes Associated with Early Mobilization in Medical Intensive Care. The goal of this retrospective trial 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. 10/1/14-9/31/15. Role: co-PI (with V.Sabol)
- American Thoracic Society Unrestricted Research Award. ERiCC: Early Rehabilitation in Critical Care. 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. 12/1/14-11/30/15. Role: PI
- R01 AG045551. REHAB-HF: A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients. The goal of this multicenter randomized trial is to test whether, in addition to standard care, a progressive, multi-domain rehabilitation intervention administered to elders with acute decompensated heart failure beginning early in hospitalization and continuing for three months will improve functional and utilization outcomes. D Kitzman (PI), 7/01/14-6/30/19. Role: Investigator/Intervention Coordinator
- PCORI Pragmatic Clinical Study. Early Supported Discharge for Improving Functional Outcomes After Stroke. The goal of this pragmatic randomized trial of 50 North Carolina hospitals, in partnership with the North Carolina Stroke Care Collaborative registry, is to compare whether Comprehensive Post-Acute Stroke Services (COMPASS), which combines transitional care and early supported discharge for stroke patients who go home directly from the hospital, improves patients’ daily function compared with usual care. PW Duncan (PI), 7/01/15-6/30/20. Role: Investigator/Intervention Coordinator
- American Physical Therapy Association. Physical Therapist Management of Critically Ill Patients in Intensive Care. The goal of this project is to develop the clinical practice guidelines for the physical therapist management of critically ill patients in the intensive care setting. A Nordon-Craft (PI), 9/01/15-8/31/18. Role: Co-Investigator
- P30 AG028716. Skeletal Muscle Mass and Strength Trajectories in Older Patients Hospitalized with Medical Illness. The goal of this pilot project was to explore the relationship between level of physical activity and changes in lean body mass and strength over the course of hospitalization in older adults with medical illness. Claude D. Pepper OAIC, HJ Cohen (PI), SN Hastings (PI pilot award), 7/01/2014-06/30/15. Role: Co-Investigator
- K08 AI068822. The In Vivo Role of Surfactant Protein A in Allergen-Mediated Lung Disease. The goal of this project was to determine the role of surfactant protein A in modulating the transition between innate and adaptive immunity and influencing airway physiology using murine models and cell isolates. 7/01/08-6/30/12. Role: PI
Various positions occasionally become available for clinical coordinators, postdoctoral researchers, graduate/medical students, and technicians interested in rehabilitation in critical illness and in chronic disease. Send inquires to firstname.lastname@example.org.
2200 West Main Street, Suite B230
DUMC 104002, Durham, NC 27708