Effectiveness Of Tailored Activity Pacing For Symptomatic Osteoarthritis

定制活动节奏对症状性骨关节炎的有效性

• 批准号: 8004504
• 负责人: Susan L. Murphy
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8004504
• 关键词: Address; Adopted; Age; Analysis of Variance; Arthritis; Behavioral; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Clinical Trials Design; Cognitive Therapy; Communities; Degenerative polyarthritis; Economic Burden; Education; Educational process of instructing; Effectiveness; Elderly; Equipment and supply inventories; Exercise; Fatigue; Gender; Goals; Health Professional; Health system; Hip Osteoarthritis; Hip region structure; Home environment; Impairment; Individual; Instruction; Intervention; Joints; Knee; Knee Osteoarthritis; Life; Measures; Medical; Methods; Modality; Modeling; Monitor; Occupational; Occupational Therapist; Ontario; Outcome Measure; Pain; Participant; Pattern; Persons; Pharmacological Treatment; Physical Function; Physical activity; Pilot Projects; Population; Public Health; Randomized Controlled Trials; Recommendation; Reporting; Research Support; Rest; Sampling; Self Efficacy; Severities; Symptoms; Testing; Time; Translations; Veterans; Walking; Work; Wrist; arm; base; behavior change; burden of illness; clinical practice; disability; evidence base; experience; follow-up; improved; indexing; novel; post intervention; prevent; primary outcome; programs; psychosocial; symptom management; treatment as usual; treatment effect

DESCRIPTION (provided by applicant): Project Summary Osteoarthritis (OA) is prevalent among veterans, causes substantial disability, and is associated with a huge economic burden. Although problematic symptoms are a primary reason that people seek medical care, the treatment provided is largely pharmacological, despite recommendations that behavioral strategies to manage symptoms are an important part of OA treatment. The study team has demonstrated in a previous pilot study that a brief activity pacing intervention specifically tailored to individuals' recently-experienced symptoms and physical activity patterns and provided by healthcare professionals had large effects on fatigue severity and fatigue interference in daily activities. The overall objective of this study is to examine the effectiveness of a tailored activity pacing intervention on pain, fatigue, and physical function using a randomized controlled trial design with a 6 month follow-up period. The main hypothesis is that tailored activity pacing will be most effective at reducing symptom severity and improving physical function. Veterans and non-veterans between the ages of 50-80 years (N = 156) who present with both radiographic evidence of knee or hip OA and moderate to severe pain will be randomly stratified by age and gender into one of three treatment arms: tailored activity pacing, general activity pacing, or usual care. The tailored and general activity pacing interventions involve three clinic visits and two home monitoring periods in which participants wear an enhanced wrist-worn accelerometer that measures continuous physical activity and allows for input of symptom severity. Both the tailored and general interventions address activity pacing in individual sessions with an occupational therapist, but only the tailored intervention involves education based on individuals' symptoms and activity patterns from the home monitoring periods. Outcome measures for all participants will be collected at baseline, 10 weeks, and 6 months post baseline. Repeated measures analysis of variance models will be used to analyze the effect of treatment on the primary outcomes. The proposed study will provide a rigorous test of effectiveness of activity pacing, a recommended approach for OA that has not been tested as a stand-alone modality other than in the previously mentioned pilot work. Because OA symptoms are chronic, fluctuating, and interfere with daily activities, a focused, individually-tailored approach to symptom management may provide lasting benefit and enhance currently available non-pharmacological treatment options for OA. PUBLIC HEALTH RELEVANCE: Project Narrative In the U.S., osteoarthritis (OA) is a growing public health issue and a leading cause of disability among older adults. Almost 50% of users of the VA health system present with OA. Veterans are a particularly important target group for OA treatment as they are twice as likely as non-veterans to report chronic joint symptoms and activity limitations. There are few evidence-based symptom management interventions offered by healthcare professionals, such as physical and occupational therapists, at the time when people are seeking treatment for symptoms. The proposed activity pacing intervention is individually tailored to a person's symptoms and activity patterns. This tailoring provides a personally relevant, focused intervention that can help people adopt this strategy into their daily lives. Methods used to tailor this intervention can also be applied to new VA clinical initiatives in veterans with high disease burdens, as they undergo exercise or pain relief interventions.

描述（由申请人提供）： 项目摘要骨关节炎（OA）在退伍军人中普遍存在，导致实质性残疾，并且与巨大的经济负担有关。尽管有问题的症状是人们寻求医疗服务的主要原因，但提供的治疗基本上是药理，尽管建议管理症状的行为策略是OA治疗的重要组成部分。研究小组在先前的一项试点研究中表明，短暂的活动起搏干预措施专门针对个人最近经验丰富的症状和体育活动模式，由医疗保健专业人员提供，对日常活动的疲劳严重程度和疲劳干扰具有很大的影响。这项研究的总体目的是检查使用随机对照试验设计和6个月的随访期，量身定制的活动起搏干预对疼痛，疲劳和身体机能的有效性。主要的假设是，量身定制的活动起搏将在减轻症状严重程度和改善身体机能方面最有效。在50-80岁之间（n = 156）之间的退伍军人和非退伍军人，他们既有膝关节或髋关节OA的放射线学证据，并且会根据年龄和性别随机分层为三个治疗臂之一：量身定制的活动加速，一般活动进攻或通常的护理。量身定制和一般活动的起搏干预措施涉及三次诊所就诊和两个家庭监测期，其中参与者穿着增强的腕部加速度计，可测量连续的体育活动并允许输入症状严重程度。量身定制和一般干预措施都解决了与职业治疗师的各个会议中的活动起搏，但只有量身定制的干预措施涉及基于个人监测期的个人症状和活动模式的教育。基线后10周和6个月，将对所有参与者的结果指标收集。重复测量方差模型的分析将用于分析治疗对主要结果的影响。拟议的研究将对活动起搏的有效性进行严格的测试，这是一种推荐的OA方法，除了先前提到的试验工作以外，尚未被视为独立模式。由于OA症状是长期的，波动的，并且会干扰日常活动，因此一种专注的，单独的症状管理方法可能会提供持久的益处，并增强目前可用的OA的非药物治疗选择。 公共卫生相关性： 在美国的项目叙述，骨关节炎（OA）是一个日益增长的公共卫生问题，是老年人残疾的主要原因。 VA卫生系统的使用者中，几乎有50％的用户使用OA。退伍军人是OA治疗的特别重要目标群体，因为他们报告了慢性关节症状和活动限制的可能性是非退伍军人的两倍。当人们寻求症状治疗时，医疗保健专业人员（例如身体和职业治疗师）提供的基于证据的症状管理干预措施，例如身体和职业治疗师。提出的活动起搏干预是根据一个人的症状和活动方式量身定制的。这种裁缝提供了一种个人相关，集中的干预措施，可以帮助人们将此策略采用到日常生活中。用于调整这种干预措施的方法也可以应用于疾病负担高的退伍军人的新VA临床计划，因为他们接受运动或缓解疼痛的干预措施。