Effectiveness Of Tailored Activity Pacing For Symptomatic Osteoarthritis

描述(由申请人提供)： 项目概述骨关节炎(OA)在退伍军人中很常见，会导致严重的残疾，并与巨大的经济负担相关。尽管有问题的症状是人们寻求医疗护理的主要原因，但提供的治疗主要是药物治疗，尽管有人建议，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，由医疗保健专业人员提供的针对个人最近经历的症状和体力活动模式而量身定做的简短活动起搏干预对日常活动中的疲劳严重程度和疲劳干扰有很大影响。这项研究的总体目标是使用随机对照试验设计，通过6个月的随访期来检验量身定制的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，量身定做的活动步调在降低症状严重程度和改善身体功能方面将是最有效的。年龄在50-80岁之间(N=156)的退伍军人和非退伍军人，如果有膝盖或髋关节骨关节炎的放射证据，并有中度到重度疼痛，将按年龄和性别随机分为三个治疗组之一：量身定制的活动起搏、一般活动起搏或常规护理。量身定做的一般活动起搏干预包括三次门诊和两次家庭监测期，参与者在此期间佩戴增强型手腕佩戴的加速度计，测量持续的体力活动，并允许输入症状严重程度。量身定做的干预措施和一般干预措施都涉及与职业治疗师进行个别治疗时的活动调整，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。所有参与者的结果测量将在基线、基线后10周和6个月收集。将使用方差模型的重复测量分析来分析治疗对主要结果的影响。拟议的研究将对活动调步的有效性进行严格的测试，这是一种建议用于开放式学习的方法，除了在前面提到的试点工作中以外，它还没有作为一种独立的方式进行测试。由于骨性关节炎的症状是慢性的、波动的，并干扰日常活动，有针对性的、个性化的症状管理方法可能会提供持久的益处，并加强目前可用的非药物治疗方案。

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.