JointADventure: A Worksite Activity-Diet Intervention for Chronic Knee Pain

描述（由申请人提供）：由于美国人口正在老龄化，肥胖正在急剧上升，关节炎相关残疾的流行及其相关费用将显著恶化，主要是由于膝关节骨关节炎（OA）的后果。膝关节炎已经是导致工作残疾和旷工/出勤的主要原因，每年有超过40万例全膝关节置换术。减轻体重和增加体力活动可以减轻膝关节OA患者的疼痛和活动限制，但这些健康的生活方式行为尚未被广大人群所接受。本研究的首要目标是找到一种有效的、可复制的、可持续的干预策略，可以帮助大量患有或有患膝关节炎风险的员工实现并保持这些健康行为。工作场所是一个理想的环境，可以接触到尚未患有严重膝关节OA的人，因此可能更容易接受行为干预，并从行为干预中获益更多。这也是理想的，因为个人和环境都是有针对性的。我们的研究目标是进一步完善、实施和测试一种名为JointADventure的创新工作场所干预的有效性，以减少膝关节OA的症状和活动限制，利用与伊利诺伊州蓝十字蓝盾公司（BCBSIL）的合作关系。BCBSIL是一个高度支持的健康合作伙伴，在员工和订户的健康投资方面有着悠久的历史。活动/饮食（AD）联合干预由经过动机性访谈培训的健康生活方式教练管理。在6个月的时间里，他们提供1)基于对妨碍健康身体活动和饮食行为的基线临床、功能和行为因素的综合评估的个性化咨询；2)团体教育，其内容模仿了非常成功的糖尿病预防项目身体活动/饮食干预，并为有膝关节症状的患者量身定制。后续评估将继续进行6个月。具体目的是：1)评估进行随机对照试验的可行性

DESCRIPTION (provided by applicant): Because the US population is aging and obesity is rising dramatically, the epidemic of arthritis-associated disability and its associated costs will significantly worsen, largely due to the consequences of knee osteoarthritis (OA). Knee OA is already a major cause of work disability and work absenteeism/presenteeism, and it is responsible for more than 400,000 total knee replacements annually. Weight reduction and increased physical activity can relieve the pain and activity limitations of individuals with knee OA, but these healthy lifestyle behaviors have not been embraced by this large population. The overarching goal of this study is to find an effective, replicable, and sustainable intervention strategy that can assist large groups of employees with or at risk for knee OA to attain and maintain these healthy behaviors. The worksite is an ideal setting to access persons who do not yet have severe knee OA and thus may be more amenable to and benefit more from a behavioral intervention. It is also ideal because both the individual and the environment can be targeted. Our research objective is to further refine, implement, and test the effectiveness of an innovative worksite intervention called JointADventure to reduce the symptoms and activity limitations of knee OA, utilizing a partnership with Blue Cross Blue Shield of Illinois (BCBSIL). BCBSIL is a highly supportive wellness partner, with a strong history of investment in the health of its employees and subscribers. The combined Activity/Dietary (AD) intervention is administered by health professionals trained in motivational interviewing as healthy lifestyle coaches. Over 6 months, they provide 1) individualized counseling based on a comprehensive assessment of baseline clinical, functional and behavioral factors that are barriers to healthy physical activity and dietary behaviors and 2) group education, the content of which is modeled after the highly successful Diabetes Prevention Program physical activity/dietary intervention and customized for those with knee symptoms. Follow-up assessments continue for 6 additional months. Specific aims are to: 1) assess the feasibility of conducting a randomized controlled trial of the JointADventure intervention at this worksite, 2) estimate the effectiveness of the intervention to decrease body weight, improve dietary habits, and increase objectively-measured physical activity, 3) to improve objectively measured functional performance, and 4) to improve self-reported arthritis-specific and generic health status and health utility. If successful, a multi-site randomized controlled trial/R01 proposal will follow to demonstrate the effectiveness/ cost-effectiveness of the JointADventure intervention in larger worksite populations. Given the influence that BCBS has in shaping future health practices and the scalability/generalizability of the proposed intervention, this research could have a tremendous impact on improving symptoms and quality of life for those with early knee OA as well as preventing the work absenteeism/presenteeism, work disability, and increased healthcare costs associated with knee OA. PUBLIC HEALTH RELEVANCE: JointADventure: A worksite activity-diet intervention for chronic knee pain is a randomized controlled trial evaluation of a physical activity and nutritiona worksite intervention to decrease symptoms and disability associated with knee osteoarthritis (OA), a major public health problem and a leading cause of work disability and work absenteeism/presenteeism in the US workforce. The overarching goal of this project is to find an effective and sustainable intervention strategy that can assist large populations of persons with or at risk for knee OA to attain and maintain healthy dietary and physical activity behaviors. This project has to potential to have a tremendous impact on improving symptoms and quality of life of persons with chronic knee pain and decreasing the functional limitation, work absenteeism/presenteeism, and soaring healthcare utilization associated with knee OA.