MOVE!+UP: Testing a Tailored Weight Management Program for Veterans with PTSD

项目摘要 背景：在退伍军人中普遍存在的创伤后应激障碍(PTSD)使退伍军人的压力增加 肥胖和相关疾病的风险。患有创伤后应激障碍的退伍军人在退伍军人管理局的行动中体重减轻了！重量 管理计划，由于创伤后应激障碍症状干扰活动和健康饮食。此外，还有许多 接受循证创伤后应激障碍治疗的退伍军人仍然有症状。一种行为减肥计划 这增加了标准的创伤后应激障碍护理，并针对与创伤后应激障碍相关的减肥障碍，称为Move！上一次是 在44名患有创伤后应激障碍的超重退伍军人中进行试点和反复精炼。全面发展的招式！UP是 由一名心理学家和一名经验丰富的同伴支持顾问领导，他们提供互补的专业知识。它包括 16次面对面小组会议，90分钟的一般减肥支持，加上认知行为 解决创伤后应激障碍的治疗技巧。每节课还包括30分钟的社区步行，以 解决基于高度警惕的活动障碍，并加强基于课堂的学习。退伍军人收到两份 个别营养师拜访，并根据需要打电话咨询。接受最后一步行动的队伍！UP套餐 报告的满意度很高，在总体行动中比患有创伤后应激障碍的退伍军人有更好的减肥效果！ 程序。他们还报告说，创伤后应激障碍症状大幅减少。治疗目标如进食行为， 活动、失眠也有所改善。移动!UP的有效性必须在随机试验中进行测试。 重要性/影响力：行动起来！UP是及时和有效的，同时解决了身体和精神上的问题 一个优先退伍军人团体的健康。移动!UP定位于通过促进心智来解决HSR和D的优先事项 健康和改善创伤后应激障碍症状、获得护理的机会和整体健康。这项研究与HSR&D保持一致 并通过使用混合类型1试验来排序方法优先级。这项研究的成本和利用率分析，以及 系统地确定实施障碍和促进者，将把有效性调查结果放在 如果移动，上下文和方便的快速翻译到现场！UP是有效的。这项研究也将提供一些见解 关于将军行动的方式！可以加强创伤后应激障碍的护理，以提高覆盖范围和有效性。 创新：行动起来！UP是第一个旨在解决患有创伤后应激障碍的退伍军人肥胖问题的减肥计划。 具体目标：本研究建议对患有创伤后应激障碍的超重/肥胖退伍军人进行随机分组 在Move注册后，对日常护理的护理得到了增强！(控制)或通过移动增强日常护理！向上 (干预)，并以三个目标为指导：1)测试干预参与者是否有更长的6个月 体重减轻(主要结果)，6个月创伤后应激障碍症状减轻和12个月体重减轻(次要结果) 探索性结果)，相对于对照；2)评估是否与对照相比，干预参与者 在6个月的治疗目标上有更大的改善：体力活动、饮食行为、失眠、 抑郁和社会支持；3)估计干预和控制条件的成本和利用，并确定 移动!设置实施障碍和促进者，以便将目标1与具体情况联系起来，并为今后的实施提供信息。 方法：对164名患有创伤后应激障碍的超重/肥胖退伍军人进行混合型1试验，纳入创伤后应激障碍护理。 实施/后续步骤：此混合类型1试验将提供准备行动所需的数据！向上 如果移动，则实施更广泛的退伍军人管理局的实施方案！UP是有效的。如果没有效果，目标2 3将帮助理解如何在未来更好地支持患有创伤后应激障碍的超重退伍军人。 将与现有的地方、志愿人员和国家业务伙伴协调执行活动。

Project Summary Background: Post-traumatic stress disorder (PTSD), prevalent among Veterans, puts Veterans at increased risk for obesity and related conditions. Veterans with PTSD lose less weight in VA’s MOVE! weight management program, due to PTSD symptoms that interfere with activity and healthy diet. In addition, many Veterans who receive evidence-based PTSD treatment remain symptomatic. A behavioral weight loss program that augments standard PTSD care and targets PTSD-related weight loss barriers called MOVE!+UP was piloted and iteratively refined among 44 overweight Veterans with PTSD. The fully developed MOVE!+UP is led by a psychologist and a Veteran peer support counselor, who provide complementary expertise. It includes 16 in-person group sessions with 90 minutes of general weight loss support, coupled with Cognitive Behavior Therapy skills to address PTSD-specific barriers. Each session also includes a 30-minute community walk to address hypervigilance-based activity barriers and enhance classroom-based learning. Veterans receive two individual dietician visits, and counseling calls as needed. The cohort receiving the final MOVE!+UP package reported high satisfaction and had better weight loss outcomes than Veterans with PTSD in the general MOVE! program. They also reported substantial PTSD symptom reduction. Treatment targets like eating behaviors, activity, and insomnia also improved. MOVE!+UP effectiveness must be tested in a randomized trial. Significance/Impact: MOVE!+UP is timely and efficient, simultaneously addressing physical and mental health of a priority Veteran group. MOVE!+UP is positioned to address HSR&D priorities by promoting mental health and improving PTSD symptoms, access to care, and whole health. This study is aligned with HSR&D and ORD methodological priorities by using a hybrid type 1 trial. This study’s cost and utilization analyses, and systematic identification of implementation barriers and facilitators, would place effectiveness findings in context and facilitate rapid translation to the field if MOVE!+UP is effective. This study will also provide insights about ways that general MOVE! and PTSD care can be enhanced to improve reach and effectiveness. Innovation: MOVE!+UP is the first weight loss program designed to address obesity in Veterans with PTSD. Specific Aims: This study proposes to randomize overweight/obese Veterans with PTSD enrolled in PTSD care to usual care enhanced with enrollment in MOVE! (control) or usual care enhanced with MOVE!+UP (intervention), and is guided by three aims: 1) Test whether intervention participants have greater 6-month weight loss (primary outcome), and 6-month PTSD symptom reduction and 12-month weight loss (secondary exploratory outcomes), relative to controls; 2) Assess whether compared to control, intervention participants have greater improvements on 6-month treatment targets: physical activity, eating behavior, insomnia, depression, and social support; 3) Estimate intervention and control condition costs and utilization, and identify MOVE!+UP implementation barriers and facilitators, to contextualize Aim 1 and inform future implementation. Methodology: Hybrid type 1 trial with 164 overweight/obese Veterans with PTSD enrolled in PTSD care. Implementation/Next Steps: This hybrid type 1 trial will provide data needed to prepare a MOVE!+UP implementation package for broader VA implementation if MOVE!+UP is effective. If it is not effective, Aims 2 and 3 will help understand how overweight Veterans with PTSD could be better supported in the future. Implementation activities would be coordinated with existing local, VISN, and national operational partners.