Mind Your Walk Intervention for Community-Based Management of Knee OA: A Feasibility Study

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PROJECT SUMMARY/ ABSTRACT: The overarching goal of this research is to develop an effective walking- based intervention that reduces disability and also maintains joint structure for people with knee osteoarthritis (OA). Walking disability leads to an increased risk of early death in people with knee OA. Furthermore, people with knee OA walk with movement patterns that overload the cartilage and may lead to rapid OA progression. Current gait retraining interventions use expensive devices, target a single joint, or focus on only reducing the knee adduction moment. Furthermore, these interventions may not address adherence, dissemination, and scalability, and may not utilize the ubiquity of mobile technology. This project proposed to demonstrate the feasibility of an innovative community based intervention (“Mind Your Walk”) that incorporates whole-body movement retraining based on biomechanical principles, along with mindful body-awareness skills, for people with knee OA. The goal is to use the results from this project to support the design of a larger randomized trial comparing this intervention with standard exercise programs. To achieve this goal, this project will focus on - 1) demonstrating feasibility of recruitment, adherence, and retention with the Mind Your Walk intervention, 2) quantifying the variability of biomechanical and functional outcomes, and 3) usability testing of a mobile health (mHealth) application for monitoring adherence and maintaining engagement for Mind Your Walk intervention. Subjects with radiographic and symptomatic knee OA (n=62) will participate in the feasibility study. Another group (n=10) will participate in usability testing of the mHealth application. The intervention will be delivered using community-based group sessions over 6-months. After that the subjects will practice on their own for another 6-months. The attention-matched control group will receive education on OA. In addition to feasibility data, knee loading during walking will be quantified using an EMG-Driven knee model and gait analyses at baseline and 6-months. Daily physical activity using accelerometers and self-reported pain will be recorded at baseline and every 3-months for a period of 1-year. The principal investigator (PI) has expertise in rehabilitation, biomechanics, and applications of quantitative imaging. The PI's long-term goal is to lead an inter-disciplinary translational musculoskeletal research program in OA; that is focused on unraveling the biomechanical pathways underlying OA, and using this knowledge to develop targeted interventions. This award will enable the applicant to gain additional training in all aspects of clinical trials and use of mHealth technologies in knee OA. Additional training will focus on advanced biostatistics for clinical trials and longitudinal data, and on leadership and team science. The mentoring team comprises of established senior scientists in rheumatology, clinical trials, mobile health technologies, and biostatistics. The PI has strong Institutional support, and this project will accelerate the PI's transition to an independent investigator, and enable collection of critical data for design of the clinical trial.