Physical Activity Interventions for Leg Ulcer Patients

 描述（由申请人提供）：移动的健康（mHealth）技术可以帮助个人采取健康的生活方式行为，特别是在身体活动（PA）方面，以治疗和自我管理慢性疾病。随着以患者为中心的护理与新兴的以患者为中心的技术融合，需要促进有效的患者-提供者沟通。这对于很少走动的慢性病患者尤其重要。我们提出了FOOTFIT，这是一种新型的下肢调节mHealth干预措施，用于下肢静脉溃疡患者。我们的目标是比较两个版本，其中一个是增强型（FOOTFIT+），以确定哪一个对PA依从性、患者-提供者沟通和腿部功能的影响最大。FOOTFIT和FOOTFIT+共有三个组件：1）低成本、三轴蓝牙（r）支持的高灵敏度加速度计和跟踪设备（BEAT），在训练期间佩戴在脚上，2）由跟踪器跟踪的小腿功能（CALF）阶段性调节活动，3）智能手机，可捕获来自BEAT的信号，提供激励消息、CALF指令和自动进度反馈。FOOTFIT+增加了一个组件，通过智能手机的互联网连接促进患者与提供者的沟通。我们设计了这种PA干预作为第一步，在条件严重失调的下肢最低限度的走动患者谁有有限的访问PA程序。据我们所知，一个系统，连接加速计和病人提供者的沟通，以检查坚持PA在腿部溃疡人群尚未进行测试。这种干预有两个重要特点值得注意。首先，基于脚的加速度计（例如Fitbit（r））被很好地记录用于捕获移动的、更健康的人群中的活动和能量消耗。由我们的研究团队开发和测试，我们有效和可靠的基于足部的BEAT强调捕获强度较低的活动（例如脚趾和足部运动），这通常是这些去适应患者最多只能一次走几步的最大强度。其次，该研究将测试将患者-提供者通信链接作为FOOTFIT+的一部分的可行性和可接受性。这些患者将通过智能手机（电子邮件、短信、直接呼叫）与提供者联系，并将从提供者处接收自动化和个性化的激励信息以及基于理论的口头交流。我们试图发现腿部溃疡患者是否按照建议使用FOOTFIT系统，以及它是否增加了PA的依从性，促进了患者和提供者之间的沟通，减少了身体上的痛苦症状，并增强了下肢功能能力。我们相信，FOOTFIT+将促进患者与提供者之间围绕患者进展反馈进行更及时、更有效的沟通。我们将评估这将如何在真实的世界与应变工作 它可能会放在忙碌的供应商。在这项为期六周的研究中，将有40名患者参与，其中20名将接受FOOTFIT，20名将接受FOOTFIT+。

 DESCRIPTION (provided by applicant): Mobile Health (mHealth) technology can help individuals adopt healthy lifestyle behaviors, particularly in physical activity (PA) for the treatment and self-management of chronic diseases. As patient centered care melds with emerging patient centered technology, a need exists to promote effective patient-provider communication. This is especially important for minimally ambulatory, chronically ill populations. We propose FOOTFIT, a novel lower leg conditioning mHealth intervention for patients with venous leg ulcers. We aim to compare two versions, one of which is enhanced (FOOTFIT+), to determine which has the greatest impact on PA adherence, patient-provider communication, and leg function. FOOTFIT and FOOTFIT+ share three components: 1) a low-cost, tri-axial Bluetooth(r) enabled highly sensitive accelerometer and tracking device (BEAT) worn on the foot during, 2) phased conditioning activities for lower leg function (CALF) tracked by a, 3) Smartphone that captures signals from BEAT, provides motivational messages, CALF instruction, and automated feedback on progress. FOOTFIT+ has the added component that promotes patient-provider communication through Internet connectivity via the Smartphone. We designed this PA intervention as an initial step in conditioning severely deconditioned lower legs of minimally ambulatory patients who have limited access to PA programs. To our knowledge, a system that connects accelerometers and patient-provider communication to examine adherence to PA in leg ulcer populations has not been tested. Two important features of this intervention are worth noting. First, foot-based accelerometry (e.g. Fitbit(r)) is well documented for the capture of activity and energy expenditure in mobile, healthier populations. Developed and tested by our study team, our valid and reliable foot-based BEAT emphasizes the capture of less intense activity (e.g. toe and foot movements) that is often the maximum intensities displayed by these deconditioned patients who can at best only take a few steps at a time. Secondly, the study will test the feasibility and acceptability of having a patient-provider communication link as part of FOOTFIT+. These patients will have access to the provider via the Smartphone (email, text, direct calling), and will receive automated and personalized, motivational messages and theory-based verbal exchanges from the provider. We seek to discover whether patients with leg ulcers use the FOOTFIT system as recommended and if it increases adherence to PA, promotes communication between patients and providers, reduces physically distressing symptoms, and enhances lower extremity functional abilities. We believe FOOTFIT+ will facilitate more timely and effective patient-provider communication around feedback on patient progress. We will evaluate how this will work in the real world with the strain that it might place on busy providers. Forty patients will be targeted in this six-week study, 20 o which will receive FOOTFIT and 20 FOOTFIT+.