Clinical Strategies to Reduce Osteoarthritis Disability

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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.