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本）在减少老年骨关节炎患者残疾方面的有效性。在5个大型公费老年住宅小区进行单盲随机对照试验。每个站点的符合条件的参与者将使用随机数字表随机分配到以人为中心组，以环境为中心组或对照组。控制项目旨在提供社区生活的老年骨关节炎患者在没有正式干预的情况下可能接受的信息，将包括两个小时的讲座，涵盖诸如疼痛和其他骨关节炎症状的管理等主题。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师每月的访问。以人为本的干预将通过渐进的体育锻炼计划和积极改变生活方式的教育来提高人的能力。以环境为重点的干预措施将通过示范和实践促进活动执行、提供辅助设备和改造家庭的技术来减少环境障碍。综合评估将在基线、干预后立即、6个月和12个月由不了解参与者小组分配的训练有素的助理进行。具体目的是：1)确定以人为本的干预和以环境为本的干预在减少残疾方面是否比对照项目更有效；2)确定以环境为本的干预在减少残疾方面是否比以人为本的干预更有效。

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.