Efficacy and mechanism of a community wellness promotion program for middle-aged adults living with long-term physical disability

项目摘要/摘要 对数以百万计的美国人来说，中年(45岁-)是健康脆弱的时期。超过50%的美国人。 到60岁时会有两种或两种以上的慢性疾病，这会增加日后残疾的风险。然而，对于 患有长期肢体残疾(LTPD)的个人，如脊髓损伤或多发性硬化症，这些风险是 放大了。这一弱势群体尤其需要干预措施，以促进社区参与和 提高中年疾病自我管理能力。 在过去的5年里，我们的研究团队调整了一种为老年人设计的循证健康促进干预措施 为中老年人提供LTPD服务。我们现在有了该干预的试用版本(称为 “增强残疾健康”；EW-D)在试点测试中取得了令人振奋的结果，准备进行更大规模的社区试验。 通过与3个地区独立生活中心建立新的合作伙伴关系，我们现在可以为有以下情况的人测试这一计划 美国西北部14个县的LTPD。 这项建议的广泛、长期目标是测试该计划相对于两种控制条件(和 关注与健康教育相匹配的健康教育控制和治疗在600名45岁-社区成年人中的应用 LTPD，使用适合LTPD患者的现代结局量表。我们的主要成果是有能力参与 有价值的社区活动。我们将寻求确定干预是否有效，如果有效，是什么 变革的机制推动了这一效应。除了自我报告外，我们还将收集社区的客观衡量标准 通过GPS和旅行日记，在随机选择的300名参与者中进行活动。我们的具体目标如下： 具体目标1.确定八个疗程的EW-D的有效性，相对于注意力控制条件或 中年LTPD患者按常规治疗。我们的主要成果将是自我报告的参与能力 有价值的社区活动。 具体目的2.确定观察到的干预效果是否源于(1)改进的疾病管理自我效能， (2)减少因疼痛和疲劳而造成的干扰，或(3)提高心理韧性。 二次分析。以确定1)干预效果是否维持在12个月；以及2)干预效果是否 在基于GPS的客观活动测量中被检测到(量化为外出旅行的次数、外出的时间 住房、旅行地区和既定类别中的活动)。我们还将研究潜在的缓和效应 生物性行为对治疗反应的影响。 这种方法与最近NIA和NINR计划公告中描述的目标是一致的，包括 呼吁采取适合年龄的干预措施以改善慢性病的自我管理(PA 14-344)，并呼吁 用于中年成年人的预防研究(PA-15-098)。如果假设得到证实，这项工作将支持 可用于促进健康的老年人和中年人的健康和健康的计划 LTPD，这对该领域来说将是新的，并可以扩大覆盖范围。

Project Summary/Abstract Middle-age (45-64) is a time of health vulnerability for millions of Americans. More than 50% of individuals in the U.S. will have two or more chronic conditions by age 60, contributing to increased risk of later disability. However, for individuals with long-term physical disabilities (LTPDs) such as spinal cord injury or multiple sclerosis, these risks are magnified. This vulnerable population is especially in need of interventions to promote community participation and improve disease self-management during midlife. Over the past 5 years, our research team has adapted an evidence-based health promotion intervention designed for older adults to serve middle-aged and older adults with LTPD. We now have a trial version of this intervention (called “EnhanceWellness for Disability”; EW-D) with promising findings in pilot testing, ready for a larger community trial. Through a new partnership with 3 regional Centers for Independent Living, we can now test this program for people with LTPD in 14 counties in the Northwest U.S.A. The broad, long-term aims of this proposal are to test the efficacy of this program relative to two control conditions (an attention-matched health education control, and treatment as usual), in 600 community dwelling adults aged 45-64 with LTPD, using modern outcome scales appropriate for people with LTPD. Our primary outcome is ability to participate in valued community activities. We will seek to determine whether the intervention was effective, and if so, what mechanisms of change drove the effect. In addition to self-report, we will also collect objective measures of community activity, via GPS and travel diaries, in a randomly selected subset of 300 participants. Our specific aims are as follows: Specific Aim 1. To determine the efficacy of eight sessions of EW-D, relative to an attention control condition or treatment as usual, in middle-aged adults with LTPD. Our primary outcome will be self-reported ability to participate in valued community activities. Specific Aim 2. To determine if observed intervention effects are due to (1) improved disease management self-efficacy, (2) decreased interference due to pain and fatigue, or (3) improvements in psychological resilience. Secondary Analyses. To determine if 1) intervention effects are maintained at 12 months; and 2) intervention effects can be detected in objective, GPS based measures of activity (quantified as number of trips outside the home, time outside the home, area of travel, and activity in established categories). We will also examine the potential moderating effects of biological sex on treatment response. This approach is consistent with goals described in recent NIA and NINR program announcements, including those calling for age-appropriate interventions to improve self-management of chronic conditions (PA 14-344) and those calling for prevention research for adults in midlife (PA-15-098). If hypotheses are confirmed, this work would support a program that could be used to promote health and wellness in both able-bodied older adults and middle-aged adults with LTPD, which would be novel to the field, and could improve reach.