MOVE!+UP: Testing a Tailored Weight Management Program for Veterans with PTSD

项目摘要 背景：创伤后应激障碍（PTSD）在退伍军人中普遍存在， 肥胖和相关疾病的风险。患有创伤后应激障碍的退伍军人在VA的移动中体重减轻！重量 管理计划，由于创伤后应激障碍症状，干扰活动和健康饮食。另外很多 接受循证PTSD治疗的退伍军人仍然有症状。一个行为减肥计划 增强标准的PTSD护理，并针对PTSD相关的减肥障碍，称为MOVE！+起来 在44名患有创伤后应激障碍的超重退伍军人中进行了试点和反复完善。全面发展的MOVE！+有坚实的马克思主义 由一名心理学家和一名资深同伴支持顾问领导，他们提供补充专业知识。它包括 16个面对面的小组会议，90分钟的一般减肥支持，加上认知行为 治疗技能，以解决PTSD特定的障碍。每节课还包括30分钟的社区步行， 解决基于高度警惕的活动障碍，加强课堂学习。退伍军人获得两个 个别营养师的访问，并咨询电话，如有需要。接受最后一次移动的队列！+ UP包 报告说，高满意度和有更好的减肥结果比退伍军人与创伤后应激障碍在一般移动！ 程序.他们还报告了大量的PTSD症状减轻。治疗目标如饮食行为， 活动，失眠也有所改善。移动！+ UP的有效性必须在随机试验中进行测试。 重要性/影响：MOVE！+ UP是及时和有效的，同时解决身体和精神 一个优先退伍军人群体的健康。移动！+ UP的定位是通过促进心理健康来解决HSR&D优先事项 健康和改善PTSD症状，获得护理和整体健康。本研究与HSR&D保持一致 和ORD方法学优先级通过使用混合1型试验。本研究的成本和利用率分析，以及 系统地确定实施障碍和促进因素，将把成效结果纳入 上下文和促进快速翻译到外地，如果移动！+ UP是有效的。这项研究还将提供见解 关于一般移动的方式！和创伤后应激障碍护理可以加强，以提高覆盖面和有效性。 创新：MOVE！+ UP是第一个减肥计划，旨在解决肥胖的退伍军人与创伤后应激障碍。 具体目的：本研究建议随机分配超重/肥胖的退伍军人与创伤后应激障碍登记在创伤后应激障碍 照顾到平时的照顾加强与入学的移动！（控制）或常规护理与MOVE增强！+起来 （干预），并遵循三个目标：1）测试干预参与者是否有更大的6个月 体重减轻（主要结局），6个月PTSD症状减轻和12个月体重减轻（次要结局 探索性结局）; 2）评估与对照组相比，干预参与者 在6个月的治疗目标上有更大的改善：身体活动，饮食行为，失眠， 抑郁症和社会支持; 3）估计干预和控制条件的成本和利用，并确定 移动！+ UP实施障碍和促进因素，以将目标1纳入背景，并为未来的实施提供信息。 方法：混合1型试验，164超重/肥胖的退伍军人与创伤后应激障碍登记在创伤后应激障碍护理。 实施/后续步骤：该混合1型试验将提供准备MOVE！+所需的数据起来 如果MOVE！+ UP是有效的。如果没有效果，目标2 和3将有助于了解如何超重退伍军人与创伤后应激障碍可以更好地支持在未来。 执行活动将与现有的地方、VISN和国家业务伙伴协调。

Project Summary Background: Post-traumatic stress disorder (PTSD), prevalent among Veterans, puts Veterans at increased risk for obesity and related conditions. Veterans with PTSD lose less weight in VA’s MOVE! weight management program, due to PTSD symptoms that interfere with activity and healthy diet. In addition, many Veterans who receive evidence-based PTSD treatment remain symptomatic. A behavioral weight loss program that augments standard PTSD care and targets PTSD-related weight loss barriers called MOVE!+UP was piloted and iteratively refined among 44 overweight Veterans with PTSD. The fully developed MOVE!+UP is led by a psychologist and a Veteran peer support counselor, who provide complementary expertise. It includes 16 in-person group sessions with 90 minutes of general weight loss support, coupled with Cognitive Behavior Therapy skills to address PTSD-specific barriers. Each session also includes a 30-minute community walk to address hypervigilance-based activity barriers and enhance classroom-based learning. Veterans receive two individual dietician visits, and counseling calls as needed. The cohort receiving the final MOVE!+UP package reported high satisfaction and had better weight loss outcomes than Veterans with PTSD in the general MOVE! program. They also reported substantial PTSD symptom reduction. Treatment targets like eating behaviors, activity, and insomnia also improved. MOVE!+UP effectiveness must be tested in a randomized trial. Significance/Impact: MOVE!+UP is timely and efficient, simultaneously addressing physical and mental health of a priority Veteran group. MOVE!+UP is positioned to address HSR&D priorities by promoting mental health and improving PTSD symptoms, access to care, and whole health. This study is aligned with HSR&D and ORD methodological priorities by using a hybrid type 1 trial. This study’s cost and utilization analyses, and systematic identification of implementation barriers and facilitators, would place effectiveness findings in context and facilitate rapid translation to the field if MOVE!+UP is effective. This study will also provide insights about ways that general MOVE! and PTSD care can be enhanced to improve reach and effectiveness. Innovation: MOVE!+UP is the first weight loss program designed to address obesity in Veterans with PTSD. Specific Aims: This study proposes to randomize overweight/obese Veterans with PTSD enrolled in PTSD care to usual care enhanced with enrollment in MOVE! (control) or usual care enhanced with MOVE!+UP (intervention), and is guided by three aims: 1) Test whether intervention participants have greater 6-month weight loss (primary outcome), and 6-month PTSD symptom reduction and 12-month weight loss (secondary exploratory outcomes), relative to controls; 2) Assess whether compared to control, intervention participants have greater improvements on 6-month treatment targets: physical activity, eating behavior, insomnia, depression, and social support; 3) Estimate intervention and control condition costs and utilization, and identify MOVE!+UP implementation barriers and facilitators, to contextualize Aim 1 and inform future implementation. Methodology: Hybrid type 1 trial with 164 overweight/obese Veterans with PTSD enrolled in PTSD care. Implementation/Next Steps: This hybrid type 1 trial will provide data needed to prepare a MOVE!+UP implementation package for broader VA implementation if MOVE!+UP is effective. If it is not effective, Aims 2 and 3 will help understand how overweight Veterans with PTSD could be better supported in the future. Implementation activities would be coordinated with existing local, VISN, and national operational partners.