I CARE for Vets: InCreasing Activity & REcovery for Veterans with PTSD

患有创伤后应激障碍（PTSD）的退伍军人身体机能较差， 有效解决这一问题的现有干预措施。我们的长期目标是制定和实施 有效的干预措施，以改善退伍军人的身体功能，降低其不良健康后果的风险 创伤后应激障碍拟议项目的总体目标是开发和试点测试一种新的干预措施 旨在为患有创伤后应激障碍的退伍军人启动和维持更高水平的体力活动。这次新的干预 将解决态度和行为障碍，增加身体活动的退伍军人与创伤后应激障碍。特别 PTSD患者的相关障碍可能包括对积极的长期行为控制的低感知， 长期生活方式的改变和个人对身体活动的危害（与益处）的态度。 建议的工作将满足两个具体目标：1）适应分级运动疗法（GET）， 结合动机访谈和移动的健康技术（mHealth）， 退伍军人与创伤后应激障碍;和2）进行试点研究，以检查干预的可行性和可接受性 用于未来的随机对照试验为了实现目标1，我们将制定治疗手册， 介入医生的程序和评估介入保真度的过程。干预将使用 GET通过增强有关适当活动的知识和帮助 参与者为身体活动设定适当和可实现的每日目标。我们还将激励 访谈技术和移动健康，以提高对体育活动的积极个人态度。我们将 与我们的创伤后应激障碍退伍军人参与小组，以完善主题和沟通材料。在目标2中，我们 招募3组6-8名受试者（共18-24名），并使用并行混合方法快速评估 可行性和可接受性。定量措施将包括征聘（占总人数的比例 合格）;出勤率（亲自参加75%访问的比例）;和保留（完成 干预后数据收集）。定性评估将包括以下方面的半结构化访谈： 干预成分的可接受性（例如，面对面访问的形式和主题、mHealth的可用性），以及 出席的障碍和促进因素。在基线、干预期间和干预后，我们还将全面衡量 和身体功能，并收集其他临床变量（创伤后应激障碍症状，抑郁症状， 疼痛、疲劳和睡眠质量），以告知未来的有效性试验。 拟议的工作是创新的，因为它是GET，动机访谈， 和mHealth来增加身体活动。这也将是第一个关注改变身体活动的干预措施 作为改善创伤后应激障碍患者身体功能的一种手段。成功经验与此 该计划还可以帮助参与者建立对他们的一般能力的信心， 健康，从而增加他们参与（并坚持）心理健康治疗的可能性。如果这样 协同作用最终得到证明，它将为VA RR&D和VHA临床护理开辟新的方向， 以身体功能为重点的干预措施应与心理健康服务更紧密地结合起来。 此外，这个项目将是第一个与我们的创伤后应激障碍退伍军人参与小组合作的项目。 research.我们小组的形式是根据以前的患者利益相关者模型改编的， 订婚我们的模式解决了许多阻碍利益相关者有效参与的障碍，包括 及时招募有相关经验的患者面临挑战， investigators.这个项目的完成将有助于建立我们的经验丰富的利益相关者模型的效用 参与迅速制定有效的干预措施，提高可行性和可接受性。因此， 这项工作将使退伍军人参与未来的VA研究项目。

Veterans with posttraumatic stress disorder (PTSD) have poor physical functioning and there are no existing interventions that effectively address this problem. Our long-term goal is to develop and implement effective interventions to improve physical functioning and reduce risk for adverse health outcomes for Veterans with PTSD. The overall objectives of the proposed project are to develop and pilot test a novel intervention aimed at initiating and maintaining higher levels of physical activity for Veterans with PTSD. This new intervention will address attitudinal and behavioral barriers to increasing physical activity for Veterans with PTSD. Particularly relevant barriers for those with PTSD may include low perceived behavioral control for making positive long- term lifestyle changes and personal attitudes about the harms (vs. benefits) of physical activity. The proposed work will meet two specific aims: 1) Adapt graded exercise therapy (GET) and incorporate motivational interviewing and mobile health technology (mHealth) to increase physical activity for Veterans with PTSD; and 2) conduct a pilot study to examine the feasibility and acceptability of the intervention for a future randomized controlled trial. To achieve Aim 1, we will develop treatment manuals, training procedures for interventionists, and processes for assessment of intervention fidelity. The intervention will use GET to increase perceived behavioral control by enhancing knowledge about appropriate activities and helping participants set appropriate and attainable daily goals for physical activity. We will also incorporate motivational interviewing techniques and mHealth to enhance positive personal attitudes about physical activity. We will work with our Veteran Engagement Panel for PTSD to refine topics and communication materials. In Aim 2, we will enroll 3 groups of 6-8 participants (18-24 total) and use a concurrent mixed-methods approach to rapidly assess feasibility and acceptability. Quantitative measures will include recruitment (proportion enrolled out of total eligible); attendance (proportion who attend 75% of in-person visits); and retention (proportion who complete post-intervention data collection). Qualitative assessment will consist of semi-structured interviews on acceptability of intervention components (eg, format and topics of in-person visits, usability of mHealth), and barriers and facilitators to attendance. At baseline, during, and post-intervention, we will also measure overall and physical functioning, and collect data on other clinical variables (PTSD symptoms, depressive symptoms, pain, fatigue, and sleep quality) to inform a future effectiveness trial. The proposed work is innovative because it is a novel combination of GET, motivational interviewing, and mHealth to increase physical activity. It will also be the first intervention to focus on changing physical activity as a means to improving physical functioning for individuals with PTSD. Successful experiences with this program may also help participants build confidence about their general ability to make positive changes related to health, thus increasing the likelihood they will engage in (and adhere to) mental health treatments. If such synergy is ultimately demonstrated, it will open a new direction for VA RR&D and VHA clinical care by indicating that interventions focusing on physical functioning should be more closely integrated with mental health services. Additionally, this project will be one of the first to collaborate with our Veteran Engagement Panel on PTSD research. The format of our panel is adapted from and builds upon previous models of patient stakeholder engagement. Our model addresses many of the barriers to effective stakeholder engagement, including challenges to timely recruitment of patients with relevant experiences, and lack of facilitation expertise among investigators. Completion of this project will help establish the utility of our model of Veteran stakeholder engagement for rapidly developing effective interventions with improved feasibility and acceptability. Thus, this work will enable incorporation of Veteran engagement in future VA research projects.