Walking and mHealth to Increase Participation in Parkinson Disease (WHIP-PD)

步行和移动医疗可提高帕金森病患者的参与率 (WHIP-PD)

• 批准号: 10371060
• 负责人: GAMMON M. EARHART
• 金额: $ 52.58万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10371060
• 关键词: Accelerometer; Affect; Behavior; Behavioral; Chronic; Clinical; Clinical Trials; Cognitive; Control Groups; Disease; Disease Progression; Dose; Elderly; Elements; Environment; Exercise; Feedback; Gait; Goals; Health; Health Technology; Housekeeping; Impairment; Individual; Instruction; Intervention; Life; Link; Longevity; Longitudinal Studies; Mediating; Medical; Natural History; Nature; Neurologic; Outcome; Parkinson Disease; Participant; Persons; Physical Function; Physical activity; Pilot Projects; Plant Roots; Prevalence; Quality of life; Rehabilitation therapy; Self Efficacy; Signal Transduction; Societies; Sterile coverings; Surgical Management; Testing; Thinking; Time; Training; Translating; Travel; Walking; Work; active control; arm; disability; exercise program; expectation; experience; improved; improved functioning; insight; mHealth; meter; motor impairment; novel; physical therapist; preservation; prevent; primary outcome; psychologic; sedentary; social cognitive theory; therapy design; walking program

PROJECT SUMMARY Parkinson disease (PD) is one of the most disabling chronic health conditions affecting older adults globally. While advances in medical and surgical management of PD have increased lifespans, they have not effectively altered the progressive decline in physical function and quality of life associated with PD. Identifying effective ways to improve function, slow decline and prevent or reduce disability remains of utmost importance in PD. Of particular concern in PD is gait decline, which is considered a red flag signaling emerging disability. Our prior work showed that people with PD experienced a 12% decline in amount of walking over one year – despite relative stability of motor impairments during that year. Treatment targeting walking, the most rapidly changing aspect of disability in PD, may have the greatest influence on slowing the impact of disease progression on physical function and reducing disability. Traditionally, rehabilitation has targeted impairments and functional limitations with the expectation that gains would translate into greater participation in real-world activities. However, the evidence suggests that this does not occur. In this proposal, we suggest a paradigm shift in which the primary target of the intervention is real- world walking behavior, as greater walking activity could preserve walking function and slow disability. The primary factors that limit engagement in walking in PD are psychological (e.g., low self-efficacy) rather than physical (e.g., motor impairments) in nature. As such we will evaluate a cognitive-behavioral approach, grounded in social-cognitive theory and targeted at enhancing walking activity. Our “connected behavioral approach” links physical therapists to persons with PD using a mobile health (mHealth) platform to deliver strategies to increase self-efficacy and provide goal-oriented, dynamic walking routines and walking enhancing exercises over one year. We will compare this approach to a control intervention which provides equivalent components and dosing of walking and a walking enhancing exercise program delivered by physical therapists but without a cognitive-behavioral mHealth approach. We hypothesize that the mHealth group will demonstrate higher amounts of walking activity and greater walking capacity relative to the control group. With regard to mechanism underlying improvements in the mHealth group, we hypothesize that self-efficacy will mediate changes in amount of walking and that changes in amount of walking will mediate changes in walking capacity over one year. The insights to be gained regarding mechanisms underlying changes noted will be critical to inform rehabilitation interventions designed to encourage sustained, long-term physical activity. If effective, our “connected behavioral approach” offers a unique, generalizable and scalable means to increase walking activity and improve walking capacity, thereby reducing disability in PD and perhaps in other chronic progressive conditions.

项目摘要 帕金森病（PD）是影响全球老年人的最致残的慢性健康状况之一。 虽然PD的医疗和手术管理的进步延长了寿命，但它们并没有有效地 改变了与PD相关的身体功能和生活质量的进行性下降。确定有效 改善功能、减缓衰退和预防或减少残疾的方法在PD中仍然是最重要的。 在PD中特别值得关注的是步态下降，这被认为是一个红旗信号出现残疾。我们 先前的研究表明，PD患者在一年内的步行量下降了12%， 尽管在那一年中运动障碍相对稳定。治疗目标是步行， 改变PD中残疾的方面，可能对减缓疾病的影响有最大的影响 改善身体功能和减少残疾。 传统上，康复的目标是损伤和功能限制， 将转化为更多地参与现实世界的活动。然而，有证据表明， 不发生在这一提议中，我们提出了一种范式转变，其中干预的主要目标是真实的- 世界步行行为，因为更大的步行活动可以保持步行功能和缓慢的残疾。的 限制PD患者参与行走的主要因素是心理因素（例如，低自我效能（而不是 物理的（例如，运动障碍）。因此，我们将评估认知行为方法， 以社会认知理论为基础，旨在增强步行活动。我们的“关联行为 方法”使用移动的健康（mHealth）平台将物理治疗师与PD患者联系起来， 策略，以提高自我效能，并提供目标导向的，动态的步行程序和步行增强 一年多的练习。我们将比较这种方法与控制干预， 步行的组成部分和剂量以及由物理治疗师提供的步行增强锻炼计划 但没有认知行为的移动健康方法。我们假设mHealth小组将 显示出相对于对照组更高的步行活动量和更大的步行能力。与 关于mHealth组改善的机制，我们假设自我效能将 调节步行量的变化，步行量的变化将调节步行量的变化。 能力超过一年。将对所注意到的变化的机制进行深入了解， 关键是为旨在鼓励持续、长期身体活动的康复干预提供信息。如果 有效，我们的“连接行为方法”提供了一种独特的，可推广的和可扩展的方法，以增加 步行活动和改善步行能力，从而减少PD和其他慢性 进步的条件。

项目成果

Digital Therapeutics in Parkinson's Disease: Practical Applications and Future Potential.

• DOI: 10.3233/jpd-202407
• 发表时间: 2021
• 期刊: Journal of Parkinson's disease
• 作者: Ellis TD;Earhart GM
• 通讯作者: Earhart GM

Does clinically measured walking capacity contribute to real-world walking performance in Parkinson's disease?

• DOI: 10.1016/j.parkreldis.2022.11.016
• 发表时间: 2022-12
• 期刊: PARKINSONISM & RELATED DISORDERS
• 影响因子: 4.1
• 作者: Zajac, Jenna A.;Cavanaugh, James T.;Baker, Teresa;Duncan, Ryan P.;Fulford, Daniel;Girnis, Jaimie;LaValley, Michael;Nordahl, Timothy;Porciuncula, Franchino;Rawson, Kerri S.;Saint -Hilaire, Marie;Thomas, Cathi A.;Earhart, Gammon M.;Ellis, Terry D.
• 通讯作者: Ellis, Terry D.

Are Mobile Persons With Parkinson Disease Necessarily More Active?

• DOI: 10.1097/npt.0000000000000362
• 发表时间: 2021-10-01
• 期刊: Journal of neurologic physical therapy : JNPT
• 作者: Zajac JA;Cavanaugh JT;Baker T;Colón-Semenza C;DeAngelis TR;Duncan RP;Fulford D;LaValley M;Nordahl T;Rawson KS;Saint-Hilaire M;Thomas CA;Earhart GM;Ellis TD
• 通讯作者: Ellis TD

Design of the WHIP-PD study: a phase II, twelve-month, dual-site, randomized controlled trial evaluating the effects of a cognitive-behavioral approach for promoting enhanced walking activity using mobile health technology in people with Parkinson-disease

• DOI: 10.1186/s12883-020-01718-z
• 发表时间: 2020-04-20
• 期刊: BMC NEUROLOGY
• 影响因子: 2.6
• 作者: Rawson, Kerri S.;Cavanaugh, James T.;Ellis, Terry D.
• 通讯作者: Ellis, Terry D.