The Effect of Physical Activity Guidelines on Arthritis-Related Disability

描述（由申请人提供）：超过1700万美国人因关节炎而残疾，使关节炎成为美国残疾的主要原因。膝关节骨性关节炎和类风湿关节炎是导致关节炎相关残疾的主要原因。本研究提出了一个重要的公共卫生问题：如何减少膝关节OA和RA患者的残疾进展。本研究将测试身体活动管理（PAM）干预预防膝关节OA和RA患者残疾进展的有效性。拟议的研究被纳入美国国立卫生研究院资助的PAM随机临床试验，这在研究后勤和经济节约方面提供了效率。PAM试验招募了240名膝关节OA患者和240名RA患者。PAM干预是一种量身定制的患者自我管理干预，补充医生咨询，以增加身体活动行为。控制组仅由医生进行体育活动咨询。半年度资助的PAM试验评估包括疼痛、功能和通过加速度计进行的最先进的身体活动测量。拟议的研究要求基金增加与基线水平相比的残疾和残疾进展的测量，并基于客观的、资助的加速度计监测来评估PAM试验参与者的推荐体育活动指南的实现情况。拟议的研究旨在以最小的成本客观和明确地解决以下目标：采用随机临床试验的强有力的方法学框架来确定PAM与对照干预相比在预防残疾进展方面是否有效，并确定这种效果是否由于膝关节OA和RA患者达到推荐的身体活动指南的频率提高。2. 衡量达到推荐的公共卫生体育活动指南（如美国外科医生推荐的指南）的效果，以减少残疾进展、功能下降和疼痛。我们还研究了体力活动与这些结果的剂量-反应关系。PAM干预提供了一种潜在的有效方法，通过在卫生系统层面促进身体活动来减少残疾进展。激励关节炎患者增加体育活动是2010年健康人的既定目标。如果像PAM这样的卫生系统干预可以减少残疾，这是关节炎医疗费用的关键驱动因素，那么这一发现对于遏制不断上升的医疗费用具有重要的公共政策和保险报销意义。此外，本研究将评估满足推荐的体育活动指南对关节炎患者维持功能和减少残疾的有效性。这对于这些患者的临床管理和设计公共卫生计划以减少关节炎相关残疾是关键信息。这项研究的结果将推动公共卫生工作，以改善4800万美国关节炎患者的生活质量。本研究将采用随机临床试验的强有力的方法学框架，以确定体育活动管理（PAM）干预是否能减少残疾，并提高膝关节骨关节炎（OA）和类风湿性关节炎（RA）患者达到推荐体育活动指南的频率。本研究还测量了在膝关节OA和RA患者中达到推荐的公共卫生指南以减少残疾进展和维持功能的效果。这对于这些患者的临床管理和推进公共卫生工作以改善4800万美国关节炎患者的生活质量是关键信息。公共卫生相关性。本研究将采用随机临床试验的强有力的方法学框架，以确定体育活动管理（PAM）干预是否能减少残疾，并提高膝关节骨关节炎（OA）和类风湿性关节炎（RA）患者达到推荐体育活动指南的频率。本研究还测量了在膝关节OA和RA患者中达到推荐的公共卫生指南以减少残疾进展和维持功能的效果。这对于这些患者的临床管理和推进公共卫生工作以改善4800万美国关节炎患者的生活质量是关键信息。

DESCRIPTION (provided by applicant): Over 17 million Americans are disabled as a result of their arthritis, making arthritis the major cause of disability in the US. Knee osteoarthritis (knee OA) and rheumatoid arthritis (RA) are major causes of arthritis- related disability. This proposed study addresses an important public health problem: how to reduce disability progression for persons with knee OA and RA. This study will test the effectiveness of the Physical Activity Management (PAM) intervention to prevent disability progression in patients with knee OA and RA. The proposed research is integrated into the NIH- funded PAM Randomized Clinical Trial, which provides efficiency in study logistics and economic savings. The PAM Trial is enrolling 240 patients with knee OA and 240 patients with RA. The PAM intervention is a tailored patient self-management intervention supplementing physician counseling to increase physical activity behavior. The control group is physician physical activity counseling alone. Semi-annual funded PAM Trial assessments include pain, function, and state-of-the art physical activity measurement via accelerometer. The proposed study requests funds to add measurements of disability and disability progression compared to baseline levels and to assess the attainment of recommended physical activity guidelines in PAM Trial participants based on objective, funded accelerometer monitoring. The proposed study is designed to objectively and definitively address the following aims at minimal cost: 1. Use the methodologically strong framework of a randomized clinical trial to determine if the PAM compared to control intervention is effective in preventing disability progression and to determine if this effect is due to improved frequency at which persons with knee OA and RA meet recommended physical activity guidelines. 2. Measure the effect of attaining recommended public health physical activity guidelines, such as those recommended by the US Surgeon General, to reduce disability progression, functional decline, and pain. We also investigate a physical activity dose-response relationship with those outcomes. The PAM intervention offers a potentially effective method to reduce disability progression by promoting physical activity at the health systems level. Motivating persons with arthritis to increase physical activity is a stated objective of Healthy People 2010. If a heath systems intervention such as PAM reduces disability, a key driver of health care costs in arthritis, this finding has important public policy and insurance reimbursement implications for the containment of rising medical costs. Furthermore, this study will evaluate effectiveness of meeting recommended physical activity guidelines to maintain function and reduce disability for persons with arthritis. This is key information for the clinical management of these patients and for the design of public health programs to reduce arthritis-related disability. Findings from this study will advance public health efforts to improve quality of life among 48 million US adults having arthritis. This study will use the methodologically strong framework of a randomized clinical trial to determine if the Physical Activity Management (PAM) intervention reduces disability and improves the frequency at which persons with knee osteoarthritis (OA) and rheumatoid arthritis (RA) meet recommended physical activity guidelines. This study also measures the effect of attaining recommended public health guidelines to reduce disability progression and maintain function in knee OA and RA patients. This is key information for the clinical management of these patients and to advance public health efforts to improve quality of life among 48 million US adults having arthritis. PUBLIC HEALTH RELEVANCE. This study will use the methodologically strong framework of a randomized clinical trial to determine if the Physical Activity Management (PAM) intervention reduces disability and improves the frequency at which persons with knee osteoarthritis (OA) and rheumatoid arthritis (RA) meet recommended physical activity guidelines. This study also measures the effect of attaining recommended public health guidelines to reduce disability progression and maintain function in knee OA and RA patients. This is key information for the clinical management of these patients and to advance public health efforts to improve quality of life among 48 million US adults having arthritis.