Physical Activity Pathway for Patients with Osteoarthritis in Primary Care

项目总结/摘要 骨关节炎（OA）是老年人疼痛和残疾的主要原因。身体活动（PA）是关键 用于管理OA并改善许多结果，包括身体功能和残疾风险。不幸 绝大多数患有OA的个体身体不活跃，只有10%符合PA的建议。 迫切需要改善这一弱势患者群体的PA水平。该项目将开发 并测试OA初级保健身体活动护理途径（OA-PCP），这是一种可扩展的干预措施，包括：1） 在初级保健中进行身体活动不足筛查的实用程序，2）简短的、量身定制的PA咨询 通过电话干预，3）将患者与社区计划和其他资源联系起来，以支持 PA，以及4）与患者进行随访，以提供额外的适当咨询和转诊到PA资源。 OA-PCP在设计时考虑到了实施和可持续性，特别是针对 慢性病管理服务的收费背景。该项目的目标1将涉及重点小组， 与OA患者、初级保健提供者和社区/临床PA项目的结构化访谈 领导人开发OA-PCP。目标2将在n=60中评估OA-PCP的可行性和可接受性 两个初级保健诊所的髋关节和膝关节OA患者。试验中的所有患者都将参加OA-PCP 并将在基线和4个月随访时完成评估。可行性指标将包括 招募、干预参与和保留;将从患者和 卫生保健提供者。目标3将涉及一项随机试点试验，评估精制OA-PCP的疗效 (from目的1和2）在6个不同的初级保健诊所的n=240例膝关节和髋关节OA患者中。患者 研究将随机分配至OA-PCP组或注意力控制组，并将在 基线、6个月和12个月。主要结局将是客观评估的体力活动， 通过加速度计测量。线性混合模型将比较OA-PCP和注意力之间的结果 对照组。OA-PCP将被设计为广泛实施，因此具有强大的 在人群健康水平上改善OA患者PA的潜力。这一系列的探索/ 发展项目将为大型多站点实施的发展奠定基础并提供信息- 对OA-PCP的重点研究。

Project Summary/Abstract Osteoarthritis (OA) is a leading cause of pain and disability among older adults. Physical activity (PA) is critical for managing OA and improves many outcomes including physical function and disability risk. Unfortunately the vast majority of individuals with OA are physically inactive, with only 10% meeting PA recommendations. There is a critical need to improve PA levels in this vulnerable patient group. The proposed project will develop and test an OA primary care Physical activity Care Pathway (OA-PCP), a scalable intervention that includes: 1) a practical process for physical inactivity screening in primary care, 2) a brief, tailored PA counseling intervention via telephone, 3) connection of patients with community programs and other resources to support PA, and 4) follow-up with patients to deliver additional appropriate counseling and referrals to PA resources. The OA-PCP is designed with implementation and sustainability in mind, particularly modeled for delivery in the context of billable Chronic Care Management services. Aim 1 of the project will involve focus groups and structured interviews with patients who have OA, primary care providers, and community / clinical PA program leaders to develop the OA-PCP. Aim 2 will assess the feasibility and acceptability of the OA-PCP among n=60 patients with hip and knee OA in two primary care clinics. All patients in the trial will participate in the OA-PCP and will complete assessments at baseline and 4-month follow-up. Feasibility metrics will include rates of recruitment, intervention engagement and retention; acceptability will be assessed from both patients and health care providers. Aim 3 will involve a randomized pilot trial assessing the efficacy of the refined OA-PCP (from Aims 1 and 2) among n=240 patients with knee and hip OA in six diverse primary care clinics. Patients in the study will be randomized to the OA-PCP or an attention control group and will complete assessments at baseline, 6-months and 12-months. The primary outcome will be objectively assessed physical activity, measured via accelerometry. Linear mixed models will compare outcomes between the OA-PCP and attention control groups. The OA-PCP will be designed for widespread implementation and therefore has strong potential to improve PA among individuals with OA at a population health level. This series of exploratory / developmental projects will set the stage for and inform the development of a large, multisite implementation- focused study of the OA-PCP.