Physical Activity Pathway for Patients with Osteoarthritis in Primary Care

项目摘要/摘要 骨关节炎(OA)是老年人疼痛和残疾的主要原因。体力活动(PA)至关重要 用于管理骨性关节炎，并改善许多结果，包括身体功能和残疾风险。不幸的是 绝大多数患有骨性关节炎的人身体不活跃，只有10%符合PA的建议。 在这一脆弱的患者群体中，迫切需要提高PA水平。拟议中的项目将开发 并测试OA初级保健体力活动护理路径(OA-PCP)，这是一种可扩展的干预措施，包括：1) 初级保健中身体缺乏活动筛查的实用程序，2)简短的、量身定做的PA咨询 通过电话进行干预，3)将患者与社区计划和其他资源联系起来以提供支持 PA，以及4)对患者进行跟踪，以向PA资源提供额外的适当咨询和转介。 OA-PCP的设计考虑到了实施和可持续性，特别是为在 可收费的慢性护理管理服务的背景。该项目的目标1将涉及重点小组和 对有骨性关节炎、初级保健提供者和社区/临床PA计划的患者进行结构化访谈 领导制定办公自动化--PCP。目标2将在n=60人中评估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骨性关节炎患者。试验中的所有患者都将参加OA-PCP 并将在基线和4个月的随访中完成评估。可行性指标将包括 招募、介入参与和保留；可接受性将从患者和 医疗保健提供者。目标3将包括一项随机试点试验，评估精炼的OA-PCP的疗效 (来自目标1和目标2)在六个不同的初级保健诊所的240名膝关节和髋关节骨性关节炎患者中。入院的病人 这项研究将被随机分配到OA-PCP或注意控制组，并将在 基线、6个月和12个月。主要结果将是客观地评估体力活动， 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将为广泛实施而设计，因此具有强大的 在人群健康水平上改善骨性关节炎患者的PA的潜力。这一系列的探索性/ 发展项目将为大型、多地点实施奠定基础并为其发展提供信息-- 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.