Effectiveness Of Tailored Activity Pacing For Symptomatic Osteoarthritis

描述（由申请人提供）： 骨关节炎（OA）在退伍军人中很普遍，导致严重残疾，并伴随着巨大的经济负担。虽然有问题的症状是人们寻求医疗保健的主要原因，但提供的治疗主要是药物治疗，尽管建议管理症状的行为策略是OA治疗的重要组成部分。研究小组在之前的一项试点研究中证明，专门针对个人最近经历的症状和身体活动模式并由医疗保健专业人员提供的简短活动起搏干预对疲劳严重程度和日常活动中的疲劳干扰有很大影响。本研究的总体目标是采用随机对照试验设计（随访期为6个月），检查定制活动起搏干预对疼痛、疲劳和身体功能的有效性。主要的假设是，定制的活动起搏将是最有效的减少症状的严重程度和改善身体功能。年龄在50-80岁之间的退伍军人和非退伍军人（N = 156），存在膝关节或髋关节OA的影像学证据和中度至重度疼痛，将按年龄和性别随机分层至三个治疗组之一：定制活动起搏、一般活动起搏或常规护理。定制的一般活动起搏干预包括三次门诊和两个家庭监测期，其中参与者佩戴增强型腕戴式加速度计，该加速度计测量持续的身体活动并允许输入症状严重程度。量身定制的和一般的干预措施都解决了与职业治疗师的个人会话中的活动起搏，但只有量身定制的干预措施涉及基于个人症状和家庭监测期间的活动模式的教育。将在基线、基线后10周和6个月收集所有受试者的结局指标。将使用重复测量方差分析模型分析治疗对主要结局的影响。拟议的研究将对活动起搏的有效性进行严格测试，这是一种推荐的治疗OA的方法，除先前提到的试点工作外，尚未作为独立模式进行测试。由于OA症状是慢性的，波动的，并干扰日常活动，一个集中的，个性化的症状管理方法可能会提供持久的好处，并加强目前可用的非药物治疗方案的OA。

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.