Developing a Novel Clinical Care Model for Chronic Patellar Tendinopathy Utilizing Whole Person Healthcare

摘要 患有慢性MSK疼痛疾病的个体，在身体活动中经历与残疾相关的限制 参与的人身心健康状况不佳的风险更高。慢性髌腱病是一种 高度流行的慢性MSK疾病，严重限制了性能，身体活动，自我感知 功能和生活质量。全人健康（WPH）是一个全面的框架， 促进健康的相互关联的领域（生物、行为、社会、环境），旨在 促进多组分治疗干预。申请人的长期职业目标是建立 一个资助的研究计划，开发和评估WPH模型，以减少残疾和改善 慢性肌肉骨骼疼痛患者的生活质量。现行临床护理标准 对于慢性髌腱病患者，采用单焦点方法，强调局部肌腱疼痛， 能力，不包括其他因素（心理，社会，环境），可能有助于 患者的整体健康。这项职业发展奖研究的总体目标是制定一个 WHP框架，该框架对文献中的关键空白做出了回应，并将为未来的干预提供信息 髌腱病的手术方法该方法将扩大护理标准的渐进负荷 运动治疗（PLE）利用个性化的生物反馈增强运动再训练和行为 分级暴露技术，以开发和完善新型髌腱WPH干预（WPH），以及 评估关键生物心理社会结果的可行性、可接受性和反应性（着陆力学， 心理困扰、肌腱僵硬）。这项研究的中心假设是， 使用新型WPH进行髌腱病康复的髌腱病患者将证明 自我报告的功能、着陆生物力学和组织容量的改善。假设是 通过三个具体目标进行测试：1）通过小型病例系列研究完善WPH干预方案 使用混合方法，2）建立可行性和可接受性基准，3）确定安全性 与PLE相比，WPH在主要结局（a）患者自我报告的功能和 心理困扰和（B）着陆生物力学和（c）髌腱僵硬的次要结局 通过一项初步随机对照研究。拟议的工作是创新的，因为：1）它将是第一个 研究利用WPH框架与标准治疗进行比较，并评价新的结局组合 用于治疗慢性肌腱病。这项研究意义重大，因为它解决了一个重要的差距， 知识，超越过时的传统护理模式，创造新的临床护理模式， 减轻肌腱疼痛对生活质量的影响。这样做是向前迈出了实质性的一步， 增强慢性肌肉骨骼疼痛患者以患者为导向的长期结果。

Abstract Individuals with chronic MSK pain conditions who experience disability-related limitations in physical activity participation are at higher risk for poor physical and mental health outcomes. Chronic patellar tendinopathy is a highly prevalent chronic MSK condition that severely limits performance, physical activity, self-perceived function, and quality of life. Whole person health (WPH) is a comprehensive framework that considers interconnected domains (biological, behavioral, social, environmental) that foster health, and is designed to facilitate multicomponent therapeutic interventions. The applicant’s long-term career objective is to establish a funded research program that develops and evaluates a WPH model to decrease disability and improve quality of life for individuals with for chronic musculoskeletal pain conditions. Current standard of clinical care for patients with chronic patellar tendinopathy take a unifocal approach, emphasizing local tendon pain and capacity, does not incorporate other factors (psychological, social, environmental) that may contribute to the patient’s overall health. The overall objective of this study for this career development award is to develop a WHP framework that is responsive to the critical gaps in the literature and will inform future intervention approaches for patellar tendinopathy. The approach will expand the standard of care progressive loading exercise treatment (PLE) utilizing individualized biofeedback augmented movement retraining and behavioral graded exposure techniques to develop and refine a novel patellar tendon WPH intervention (WPH), and evaluate feasibility, acceptability, and responsiveness of key biopsychosocial outcomes (landing mechanics, psychological distress, tendon stiffness). The central hypothesis of this study is that individuals with chronic patellar tendinopathy who utilize novel WPH for patellar tendinopathy rehabilitation will demonstrate improvements in self-reported function, landing biomechanics, and tissue capacity. The hypothesis will be tested through three specific aims: 1) refine WPH intervention protocols through a small case series study using mixed-methods approach, 2) establish feasibility and acceptability benchmarks, and 3) determine safety and responsiveness of WPH compared to PLE on primary outcome of (a) patient self-reported function and psychological distress, and secondary outcomes of (b) landing biomechanics and (c) patellar tendon stiffness through a pilot randomized controlled study. The proposed work is innovative, in that: 1) it will be the first study to utilize a WPH framework compared to standard of care and evaluate a novel combination of outcomes for the treatment of chronic tendinopathy. The study is significant as it addresses an important gap in knowledge, moving beyond outdated traditional care models to create novel clinical care model designed to mitigate the debilitating effects of tendon pain on quality of life. Doing so takes a substantial step forward to enhance patient-oriented long-term outcomes for individuals with chronic musculoskeletal pain conditions.