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

项目总结 社会需要有效的非手术治疗来管理慢性膝关节症状(CKS) 由膝骨性关节炎(KOA)引起。CKS与疼痛、丧失独立性、 并增加了死亡率。由于衰老、肥胖和久坐不动，CKS的发病率正在上升 社会。由于CKS首先出现在工作年龄的成年人中，它是导致工作残疾的主要原因 和工作效率损失。超过1300万45岁及以上的美国成年人有症状 膝关节骨性关节炎和膝关节骨性关节炎，1/3的工作成年人(45-岁)患有关节炎。 KOA，超过一半的人有严重残疾，将接受全膝关节置换(TKR)。可悲的是， CKS患者在等待TKR期间进行疗效较低的治疗，部分原因是 有规律的体力活动(PA)的行为挑战。体力活动有 已被证明可以减轻疼痛，改善功能，并防止个体丧失独立性 整个膝关节骨性关节炎疾病谱。尽管它的价值，PA水平在成人中仍然很低 CKS和工作场所的成年人。低PA与较高的医疗支出和 员工生产力为雇主支持PA计划创造了一种激励。许多工作场所 然而，他们接受了健康计划，以支持员工改善健康 患有CKS的员工与没有CKS的员工相比，PA率更低。 之前的研究发现，Fitbit跟踪可以改善一些患有CKS的人的行为 但其他人则受益于更密集的培训形式。所需辅导量的确切数量 仍然不为人知。员工利益相关者要求提供低资源形式的培训 可通过工作场所获得。支持使用CKS的员工的可能性存在 可接受的、低资源的教练策略。该计划的目标是测试一个简短的、可扩展的 PA教练干预，可帮助有CKS的员工获得并保持健康的PA 中西部两个工地的行为。卡帕是一个为期12周的随机对照试验 试验将1)使用计算机引导的行动计划行为干预来支持 员工在为他们的健康制定PA行动计划时，2)使用从个人 健身跟踪器(Fitbit)，支持教练和员工了解PA的表现，以及3) 告知不会大幅增加PA的参与者的最佳上升时间。卡帕 将把PA反馈放在运动仪表板中，以支持研究参与者。卡帕 干预将使用每个参与者的首选通信模式(文本、语音呼叫或视频 Chat)在伊利诺伊州蓝十字蓝盾获得并维持健康的PA行为 倡导极光健康。PA、疼痛和身体功能的后续措施计划在 治疗完成和研究完成后三个月。 具体目标是：1)评估干预的效果，客观地增加- 测量的体力活动，2)检查可行性、可接受性和可持续性 针对各个工作场所的CAPPA干预，以及3)通知以下项目的初始升级时间 未来参与者之间的阶段性干预不会大幅增加他们的体能 活动。这项研究利用了联合的临床和技术专长， 西北大学风湿病研究组体力活动组成员， 西北大学关节炎中心加速度计单元，马奎特大学的行为， 参与度和健康技术评估实验室和泛在计算实验室 伊利诺伊州十字蓝盾公司和极光健康倡导者。如果卡帕是可行的并且 显示初步效果，随后将进行多站点随机对照试验/U01方案 以证明CAPPA干预在更大的工作场所人群中的有效性。这 研究可能会对改善这些患者的症状和生活质量产生巨大影响 有CKS和早期KOA。如果伊利诺伊州蓝十字蓝盾的治疗成功 倡导极光健康他们可以受雇于他们为其他人提供的服务 组织。

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.