Clinical Strategies to Reduce Osteoarthritis Disability

描述（由申请人提供）：当个人能力与特定任务的要求之间存在差距时，就会出现残疾。大多数减少老年人残疾的干预措施侧重于提高个人能力，而对减少环境需求的干预措施的有效性知之甚少。该项目的长期目标是开发和比较两种康复干预措施（以人为本和以环境为中心）在减少老年骨关节炎患者残疾方面的有效性。研究将在五个大型的政府资助安老院舍进行单盲随机对照试验。每个研究中心的合格参与者将使用随机数字表随机分配到以人为中心的组、以环境为中心的组或对照组。控制程序，旨在提供信息，社区生活的老年人骨关节炎可能会收到没有正式的干预，将包括一个两小时的讲座，涵盖的主题，如疼痛和其他骨关节炎症状的管理。为期两个月的治疗计划将包括每周两次的团体干预和治疗干预师的每月访问。以人为本的干预措施将通过渐进的体育锻炼计划和积极的生活方式改变教育来提高个人能力。以环境为重点的干预措施将通过示范和实践技术来减少环境障碍，以促进活动的开展，并提供辅助装置和家庭改造。将在基线、干预后立即、6个月和12个月由经过培训的助手进行全面评估，这些助手对参与者组分配不知情。具体目标是：1）确定以人为中心的干预和以环境为中心的干预是否比对照计划更有效地减少残疾; 2）确定以环境为中心的干预是否比以人为中心的干预更有效地减少残疾。

DESCRIPTION (provided by applicant): Disability occurs when there is a gap between personal capability and the demands of a given task. Most interventions to reduce disability in older adults focus on increasing personal capability, while little is known about the effectiveness of interventions that reduce environmental demand. The long-term goal of this project is to develop and compare the effectiveness of two rehabilitation interventions (person-focused and environment-focused) in reducing disability for older adults with osteoarthritis. A single-blind randomized controlled trial will be conducted in five large publicly-subsidized senior housing sites. Eligible participants at each site will be randomly assigned to the person-focused group, environment-focused group, or control group using a random number table. The control program, designed to provide information that community-living older adults with osteoarthritis may receive without formal intervention, will consist of a two-hour lecture covering topics such as the management of pain and other osteoarthritis symptoms. The two-month treatment program will include group intervention twice a week and monthly visits from the therapist interventionist. The person-focused intervention will work to increase person capability through a progressive physical exercise program and education about positive lifestyle changes. The environment-focused intervention will work to decrease environmental barriers through demonstration and practice of techniques to facilitate activity performance and provision of assistive devices and home modifications. A comprehensive assessment will be done at baseline, immediately after the intervention, six months, and twelve months by trained assistants blind to participant group assignment. The specific aims are to 1) to determine whether the person-focused intervention and environment-focused intervention are more effective at reducing disability than the control program and 2) to determine whether the environment-focused intervention is more effective at reducing disability than the person-focused intervention.