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

项目总结/摘要 中年（45-64岁）是数百万美国人健康脆弱的时期。超过50%的美国人 到60岁时将有两种或两种以上的慢性病，这会增加日后残疾的风险。但对于 对于患有长期身体残疾（LTPD）的人，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特别需要采取干预措施，以促进社区参与， 改善中年时期的疾病自我管理。 在过去的5年里，我们的研究团队采用了一种基于证据的健康促进干预措施， 成年人为中老年LTPD患者服务。我们现在有了这种干预的试用版（称为 “增强残疾人的健康”; EW-D）在试点测试中有很好的发现，准备进行更大的社区试验。 通过与3个地区独立生活中心的新合作，我们现在可以为患有以下疾病的人测试该计划： LTPD在美国西北部的14个县。 该提案的广泛的长期目标是测试该计划相对于两种控制条件（ 注意力匹配的健康教育控制，和治疗一样），在600个社区居住的45-64岁的成年人， LTPD，使用适合LTPD患者的现代结局量表。我们的主要成果是能够参与 有价值的社群活动。我们将努力确定干预是否有效，如果有效，是什么 变化的机制驱动了效果。除了自我报告，我们还将收集社区的客观措施， 活动，通过GPS和旅行日记，在随机选择的300名参与者的子集。我们的具体目标如下： 具体目标1。为了确定八次EW-D治疗的有效性，相对于注意力控制条件或 在中年LTPD患者中，治疗与往常一样。我们的主要结果将是自我报告的参与能力， 有价值的社群活动。 具体目标2。为了确定观察到的干预效果是否是由于（1）改善疾病管理自我效能， (2)减少因疼痛和疲劳引起的干扰，或（3）改善心理弹性。 次要分析。确定1）干预效果是否维持在12个月; 2）干预效果是否可以 在客观的、基于GPS的活动测量中被检测到（量化为离家旅行的次数、离家的时间、 家庭、旅行地区和既定类别中的活动）。我们还将研究以下因素的潜在调节作用： 生物性别对治疗反应的影响 这种方法与最近NIA和NINR计划公告中描述的目标一致，包括 呼吁采取与年龄相适应的干预措施，以改善慢性病的自我管理（PA 14-344）， 中年成人预防研究（PA-15-098）。如果假设得到证实，这项工作将支持一个 计划，可用于促进健康和健康，在健全的老年人和中年人与 LTPD，这将是新的领域，并可以提高达到。

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.