Physical Activity and Weight Loss to Improve Function and Pain after Total Knee Replacement

全膝关节置换术(TKR)的使用率继续增加，给 经济舱。由于TKR患者的存活时间更长，因此确定能够最大限度地提高长期疗效的策略至关重要。 随着成年人手术后年龄的增长，功能结果并促进与健康相关的生活质量和独立性。 大多数TKR患者符合超重/肥胖标准，手术后仍处于不活动状态， 这两种情况都会增加功能不良和残疾的风险。此外，大多数患者实际上会 手术后两年内体重增加。TKR后的患者也有更高的死亡风险 心血管疾病和精神疾病。促进体重管理可能是改善体重的有效策略 TKR后的长期功能和体力活动结果，降低因以下原因致残和死亡的风险 心血管和精神疾病，并提高昂贵的手术的价值。 我们建议检查以患者为中心(PACE)减肥计划在成人中的有效性。 在完全有效的双臂随机对照试验中进行TKR后。患者(n=250)将随机分为 接受(1)Pace减肥计划或(2)慢性病自我管理(CDSM)对照组。 PACE参与者将在TKR后12周开始以患者为中心的计划，并持续12个月。 PACE是根据患者的需求以及饮食和体力活动的独特障碍量身定做的。佩斯专注于 减少卡路里摄入量和增加体力活动(有氧和耐力)，以促进减肥 至少是初始体重的7%。每周将与训练有素的行为干预者进行电话辅导 1-4个月，5-6个月两周一次，7-12个月每月一次。在比赛期间不会进行教练训练 维护阶段(13-18个月)。CDSM将收到该计划的自我指导版本，并每月 呼吁讨论与研究结果无关的话题。数据收集将在基线(手术后12周)进行，6 3个月(强化干预结束)、12个月(治疗结束)和18个月(维持治疗)。 评估将包括体重、次要结果(例如，体力活动、疼痛、功能)和 我们概念模型中的潜在中介变量(例如，坚持、自我效能、自主性、能力)。数据 与实施PACE减肥干预措施相关的费用也将被收取 研究减轻体重对患者预后的成本效益。主要结果是体重 在6个月时发生变化。 这项研究的预期结果是确定联合治疗的有效性和长期维持 一个精致的以患者为中心的减肥计划，专门为TKR后的成年人量身定做。如果PACE在以下方面有效 改善短期和长期结果，并被发现是具有成本效益的整形外科中心和/或 保险公司可以考虑向TKR患者提供这一计划，为 越来越多的成年人低估了TKR。

Total knee replacement (TKR) utilization continues to increase, placing substantial burden on the economy. As patients live longer with TKR, it is essential to identify strategies that will maximize long-term functional outcomes and promote health-related quality of life and independence as adults age after surgery. The majority of TKR patients meet criteria for overweight/obesity and remain physically inactive after surgery, both of which heighten the risk of poor functional outcomes and disability. Further, most patients will actually gain weight within two years after surgery. Patients after TKR are also at an increased risk of death from cardiovascular and mental diseases. Promoting weight management may be an effective strategy to improve long-term functional and physical activity outcomes after TKR, reduce the risk of disability and death from cardiovascular and mental diseases, and improve the value of the costly surgery. We propose to examine the effectiveness of a Patient-Centered (PACE) weight loss program in adults after TKR in a fully-powered, two-arm randomized controlled trial. Patients (n=250) will be randomized to receive either (1) PACE weight loss program or (2) Chronic Disease Self-Management (CDSM) control group. PACE participants will start the patient-centered program 12 weeks after TKR and continue for 12 months. PACE is tailored to the patients’ needs and unique barriers to diet and physical activity. PACE focuses on reducing caloric intake and increasing physical activity (aerobic and resistance) to facilitate a weight loss of at least 7% of initial body weight. Coaching calls with a trained behavioral interventionist will occur weekly during months 1-4, biweekly during months 5-6, and monthly during months 7-12. No coaching will occur during the maintenance phase (months 13-18). CDSM will receive a self-directed version of the program and monthly calls on topics not related to study outcomes. Data collection will occur at baseline (12 weeks after surgery), 6 months (end of intensive intervention), 12 months (end of treatment), and 18 months (maintenance). Assessments will include measures of weight, secondary outcomes (e.g., physical activity, pain, function), and potential mediators from our conceptual model (e.g., adherence, self-efficacy, autonomy, competence). Data related to the cost of implementing the PACE weight loss intervention relative to Control will also be collected to examine the cost-effectiveness of reducing weight on patient outcomes. The primary outcome is weight change at 6 months. The expected outcome from this study is to determine the effectiveness and long-term maintenance of a refined patient-centered weight loss program tailored specifically for adults after TKR. If PACE is effective at improving short- and long-term outcomes, and is found to be cost-effective, orthopedic centers and/or insurance companies could consider offering this program to TKR patients, offering significant benefits to the rising number of adults underdoing TKR.