Computer-guided Action Planning to Support Physical Activity (CAPPA) for Employees with Chronic Knee Symptoms

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PROJECT SUMMARY Society needs effective non-operative therapies to manage chronic knee symptoms (CKS) resulting from knee osteoarthritis (KOA). CKS is associated with pain, loss of independence, and increased mortality. Rates of CKS are increasing, fueled by an aging, obese, and sedentary society. Because CKS first presents in working age adults, it is a major cause of work disability and work productivity loss. Over 13 million US adults 45 years and older have symptomatic KOA and CKS,1 and one-third of working adults (45-64 years) have arthritis.2-4 Of those with KOA, over half have severe disability and will have a total knee replacement (TKR). Sadly, persons with CKS engage in treatments with low effectiveness while waiting for TKR, in part due to the behavioral challenges of engaging in regular physical activity(PA). Physical activity has been shown to relieve pain, improve function, and prevent losses in independence in individuals across the KOA disease spectrum. Despite its value, PA levels remain low among adults with CKS and for adults in the workplace. Low PA is linked to high healthcare spending and losses in worker productivity creating an incentive for employer-support PA initiatives. Many workplaces have embraced wellness programs to support employees in improving their health, however employees with CKS struggle with lower rates of PA than their peers without CKS. Previous research has found that Fitbit tracking can improve behavior for some with CKS but others benefit from more intensive forms of coaching. The exact amount of coaching needed remains unknown. Employee stakeholders have asked for low resource forms of coaching available through the workplace. The potential exists to support employees with CKS using an acceptable, low-resource coaching strategy. The goal of this program is to test a brief, scalable PA coaching intervention that can assist employees with CKS attain and maintain healthy PA behavior in two worksites in the Midwest. CAPPA is a 12-week pilot randomized controlled trial that will 1) use computer-guided action-planning behavioral intervention to support employees in making PA action plans for their health, 2) use data transmitted from a personal fitness tracker (Fitbit) to support coach and employee knowledge about PA performance, and 3) Inform on optimal step up times for participants who do not substantially increase PA. CAPPA will put PA feedback in a Movement Dashboard to support study participants. The CAPPA intervention will use each participant’s preferred communication mode (text, voice call, or video chat) to attain and sustain healthy PA behavior at Blue Cross Blue Shield of Illinois and Advocate Aurora Health. Follow-up measures of PA, pain and physical function are planned at treatment completion and three months following study completion. Specific aims are to: 1) Estimate the efficacy of the intervention to increase objectively- measured physical activity, 2) Examine the feasibility, acceptability and sustainability of the CAPPA intervention for the respective workplaces, and 3) Inform the initial step up time for future stepped interventions among participants not substantially increasing their physical activity. This study leverages the combined clinical and technologic expertise of the members of the Physical Activity in Rheumatology Research group at Northwestern University, Northwestern’s Arthritis Center Accelerometer unit, Marquette University’s Behavior, Engagement and Health Technology Assessment Lab and Ubiquitous Computing Lab, the Blue Cross Blue Shield of Illinois Corporation, and Advocate Aurora Health. If CAPPA is feasible and shows preliminary effectiveness, a multi-site randomized controlled trial/U01 proposal will follow to demonstrate the effectiveness of the CAPPA intervention in larger worksite populations. This research could have a tremendous impact on improving symptoms and quality of life for those with CKS and early KOA. If treatments are successful at Blue Cross Blue Shield of Illinois and Advocate Aurora Health they may be employed in the services they provide to other organizations.