Physical Activity Management for Clients with Arthritis

描述(申请人提供)：关节炎是导致残疾的主要原因。在美国近7000万患有关节炎和/或慢性关节症状的人中，近800万人因关节炎而致残。膝骨性关节炎(OA)和类风湿性关节炎(RA)是其最常见和最致残的两种形式。尽管有证据表明，体育锻炼可以改善功能和健康相关的生活质量(HRQOL)结果，并降低医疗保健成本，但美国人口中从事推荐量体育锻炼的比例很低，在关节炎患者中甚至更低。此外，临床医生在促进关节炎患者的体力活动方面也有相当大的差异。护理提供者很少询问客户的身体活动行为，并报告说他们感觉没有准备好促进身体活动。这项应用研究旨在促进体力活动的行为干预，包括生活方式体力活动，对关节炎特定和一般HRQOL结果的影响。拟议的体力活动管理计划(PAM)基于一种慢性护理模式，在这种模式下，专职健康专业人员促进患者在传统医生办公室之外的自我管理活动。该计划是一种个性化的咨询和转介干预，由体力活动经理进行，指导对患者个体与体力活动表现相关的障碍和优势进行基于理论的综合评估。这项随机对照试验的具体目标是 对480例类风湿性关节炎和膝关节骨性关节炎患者进行24个月的随访，以测试体力活动管理结合医生体力活动促进(PAM组)和仅医生体力活动促进(对照组)在改善关节炎特有和一般HRQOL、观察功能指标以及客观测量和自我报告体力活动水平方面的有效性。此外，还将进行探索性分析，以评估与PAM计划相关的HRQOL和体力活动表现的改善是否分别由体力活动水平和基于理论的动机变量的增加所调节。这项研究旨在产生可行的方法，通过这些方法，卫生保健提供者和卫生保健系统可以增加关节炎患者的体力活动水平，并产生广泛适用的健康行为改变策略。

DESCRIPTION (provided by applicant): Arthritis is a major cause of disability. Of the nearly 70 million persons in the US with arthritis and/or chronic joint symptoms, nearly 8 million are disabled because of their arthritis. Knee osteoarthritis (OA) and rheumatoid arthritis (RA) are two of its most common and disabling forms. Despite evidence that physical activity can improve functional and health related quality of life (HRQOL) outcomes and lower health care costs, the proportion of the US population engaging in the recommended amount of physical activity is low and even lower among those with arthritis. Moreover, there is considerable variation in clinicians' promotion of physical activity for arthritis clients. Care providers infrequently ask clients about their physical activity behavior and report feeling unprepared to promote physical activity. This application studies the effects of a behavioral intervention aimed at promoting physical activity, including lifestyle physical activity, on arthritis-specific and generic HRQOL outcomes. The proposed physical activity management program (PAM) is based on a chronic care model in which allied health professionals promote patient self-management activities outside of traditional physician office encounters. The program is an individualized counseling and referral intervention, conducted by physical activity managers, directed by a theory-based comprehensive assessment of individual patient barriers and strengths related to physical activity performance. The specific aims of this randomized, controlled trial of 480 clients with RA and knee OA followed for 24 months are to test the effectiveness of physical activity management combined with physician physical activity promotion (PAM group) compared to physician physical activity promotion only (control group) in improving arthritis-specific and generic HRQOL, observed measures of function, and objectively measured and self-reported physical activity levels. In addition, exploratory analyses will be done to assess whether the improvements in HRQOL and physical activity performance associated with the PAM program are mediated by increases in physical activity levels and theory-based motivational variables, respectively. This study is intended to generate feasible methods by which health care providers and health care systems can increase physical activity levels in clients with arthritis and to result in widely applicable strategies for health behavior change.