Physical Activity, Disability, and Health Utility in Rheumatic Disease

关节炎是一种对社会和个人来说代价高昂的疾病。美国每年因关节炎的费用 超过860亿美元。近800万美国人因关节炎而残疾，使关节炎成为一种严重的疾病。 美国残疾的主要原因。膝关节骨关节炎（OA）和类风湿性关节炎（RA）是主要的 关节炎相关残疾的原因。体育活动是公共卫生武器库中一个很有前途的武器， 改善关节炎患者的健康。我们最近的研究表明， 活动减少关节炎成人观察队列的残疾进展。由于医疗费用 由于关节炎是由残疾强烈驱动，确定一个可实施的身体活动干预， 减少关节炎患者的残疾可能提供一个有效的战略，以遏制不断上升的医疗保健 关节炎的费用 研究残疾进展和与促进身体活动有关的经济问题， 风湿性疾病，一个辅助研究的体力活动管理（PAM）试验的建议。的 PAM试验是一项由NIH资助的随机临床试验，入组了480例膝关节OA和RA患者。的 PAM试验的一项受资助的使命是测试身体活动对健康状况的有效性 管理计划，以加强医生的体力活动促进（PAM组）相比，只有 医生促进体力活动（对照组）。这项辅助研究扩展了这项随机临床研究， 试验超出了临床结果，涉及到与这种干预措施的公共政策评估相关的因素。 拟议的辅助研究要求资金增加1）残疾措施，2）以社区为基础的健康 健康相关生活质量的效用评估，以及3）对资助的PAM的医疗利用措施 审判这些新措施将扩大PAM体力活动管理的评估范围， 对疼痛和健康状况的影响，以评估政策相关的结果。具体来说，这种随机 临床试验将用于确定PAM是否是一种降低残疾的具有成本效益的干预措施 进展，并改善关节炎患者的健康相关生活质量。这是关键信息， 政策评估涉及到可能大规模传播PAM干预措施， 实践这项研究的结果将推动公共卫生和政策努力，以减少残疾， 医疗保健成本，并改善4800万美国成年人关节炎的生活质量。

Arthritis is a costly disease to society and the individual. The annual costs in the US due to arthritis exceed $86 billion. Nearly 8 million Americans are disabled as a result of their arthritis, making arthritis a primary cause of disability in the US. Knee osteoarthritis (OA) and rheumatoid arthritis (RA) are major causes of arthritis-related disability. Physical activity is a promising weapon in the public health arsenal to improve the health of persons with arthritis. Our recent work indicates that increased levels of physical activity reduced disability progression in an observational cohort of adults with arthritis. Since medical costs due to arthritis are strongly driven by disability, identifying an implementable physical activity intervention that reduces disability among persons with arthritis may provide an effective strategy to contain rising health care costs due to arthritis To examine disability progression and economic issues relevant to the promotion of physical activity in rheumatic disease, an ancillary study to the Physical Activity Management (PAM) Trial is proposed. The PAM Trial is an NIH-funded randomized clinical trial enrolling 480 patients with knee OA and RA. The funded mission of the PAM Trial is to test the effectiveness in terms of health status of a physical activity management program to augment physician physical activity promotion (PAM group) compared to only physician promotion of physical activity (control group). This ancillary study extends this randomized clinical trial beyond clinical outcomes to factors relevant to pubic policy evaluations of this intervention. The proposed ancillary study requests funds to add 1) disability measures, 2) a community-based health utility assessment of health related quality of life, and 3) medical utilization measures to the funded PAM Trial. These new measures will extend the evaluation of PAM physical activity management beyond its effect on pain and health status to an assessment of policy-relevant outcomes. Specifically, this randomized clinical trial will be used to determine if PAM is a cost-effective intervention that reduces disability progression and improves health related quality of life of patients with arthritis. This is key information for policy evaluations related to the potential large scale dissemination of the PAM intervention into widespread practice. Findings from this study will advance public health and policy efforts to reduce disability, rising health care costs, and improve the quality of life among 48 million US adults having arthritis.