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

描述(申请人提供)：由于美国人口老龄化和肥胖症急剧增加，关节炎相关残疾的流行及其相关成本将显著恶化，主要是由于膝骨性关节炎(OA)的后果。膝关节骨性关节炎已经是导致工作残疾和缺勤/出勤的主要原因，每年有40多万例膝关节置换手术是由它造成的。减轻体重和增加体力活动可以缓解膝骨性关节炎患者的疼痛和活动限制，但这些健康的生活方式并没有被这一大群人接受。这项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，以帮助大量患有膝骨性关节炎或面临膝骨性关节炎风险的员工获得并保持这些健康行为。对于那些还没有严重膝骨性关节炎的人来说，工作场所是一个理想的环境，因此他们可能更容易接受行为干预，并从行为干预中受益更多。这也是理想的，因为个人和环境都可以成为目标。我们的研究目标是利用与伊利诺伊州蓝十字蓝盾(BCBSIL)的合作伙伴关系，进一步完善、实施和测试名为JointADenture的创新工作场所干预措施的有效性，以减少膝盖骨关节炎的症状和活动限制。BCBSIL是一个高度支持健康的合作伙伴，在员工和订户的健康方面有着强大的投资历史。联合活动/饮食(AD)干预由接受过激励访谈的健康专业人员作为健康生活方式教练进行管理。在6个月的时间里，他们提供1)基于对阻碍健康体力活动和饮食行为的基线临床、功能和行为因素的全面评估的个性化咨询，以及2)团体教育，其内容仿照非常成功的糖尿病预防计划体力活动/饮食干预，并为有膝部症状的人定制。后续评估还将继续进行6个月。具体目标是：1)评估进行随机对照试验的可行性 该工作场所的JointAdenture干预措施包括：2)评估干预措施的有效性，以减轻体重、改善饮食习惯、增加客观测量的体力活动；3)改善客观测量的功能表现；4)改善自我报告的关节炎特有和一般健康状况及保健效用。如果成功，接下来将进行一项多站点随机对照试验/R01提案，以证明JointADenture干预在更大工作场所人群中的有效性/成本效益。鉴于BCBS在塑造未来健康实践中的影响力以及拟议干预措施的可扩展性/普适性，这项研究可能对改善早期膝骨性关节炎患者的症状和生活质量，以及防止与膝骨性关节炎相关的工作缺勤/出勤、工作残疾和增加医疗成本产生巨大影响。

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.