Development of a Mind Body Program to Reduce Knee Pain in Obese Osteoarthritis Patients with Comorbid Depression

项目摘要 开发身心计划以减少肥胖性骨关节炎的软骨破坏和膝关节疼痛 共病抑郁症患者 这是一个遵循最近发布的IMMPACT标准的R34应用程序， 功能、残疾和健康分类框架，以适应多模式、有理论基础的 身心计划（放松反应恢复力计划; 3RP），既往在以下患者中获得成功： 针对肥胖膝关节骨关节炎（OA）患者需求的初步和有效性研究中的医疗疾病 和抑郁症，并专门针对增加的体力活动（p3 RP-OA）。抑郁症、肥胖症和OA 相互加剧，并共享一个共同的病理生理学，涉及全身炎症和促炎症反应， 炎症细胞因子，反映了复杂的身心互动。目前膝关节OA的治疗方法 与安慰剂相比，几乎没有益处，并且不强调身心练习或身体活动，以针对 潜在的病理生理学单独的体力活动在治疗抑郁症，肥胖症， 和开放式获取，但充分实施仍然具有挑战性。我们的指导假设是， 正念，适应性思维，积极心理学和健康生活技能之间的协同作用， 适应OA患者需求并针对增加的体力活动的3RP减少了前 炎性细胞因子的表达同时也促进软骨的最佳机械负荷， 症状性膝关节OA的进展。为了实现这一目标，本R34提案旨在：1）使3RP适应 患有抑郁症（PHQ-9）和肥胖症（BMI ≥ 30 kg/m2）的膝关节OA患者的需求，重点是增加 体育活动; 2）建立方案和研究的可行性，可信度和可接受性 程序.使用R34 NCCIH机制，我们建议使用迭代混合方法策略来适应 3RP针对肥胖OA伴抑郁患者的特定需求，包括增加活动， 可行性、可接受性和可信度。这项R34赠款将为我们开展一项全面的 通过R61/R33机制评估OA相关生物心理社会机制的RCT 进展

PROJECT SUMMARY Development of a mind body program to reduce cartilage breakdown and knee pain in obese osteoarthritis patients with comorbid depression This is a R34 application that follows the recently released IMMPACT criteria, and the International Classification of Functioning, Disability and Health (ICF) framework to adapt a multimodal, theory grounded mind body program (The Relaxation Response Resilience Program; 3RP) with prior success in patients with medical illness in pilot and effectiveness studies for the needs of obese patients with knee osteoarthritis (OA) and depression and to specifically target increased physical activity (p3RP-OA). Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro- inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over a placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Physical activity alone has shown benefit in the treatment of depression, obesity and OA individually, but adequate implementation remains challenging. Our guiding hypothesis is that the synergistic interaction between mindfulness, adaptive thinking, positive psychology and healthy living skills of the 3RP adapted for the needs of OA patients and to target increased physical activity reduces pro- inflammatory cytokine expression while also promoting optimal mechanical loading of the cartilage will slow the progression of symptomatic knee OA. Toward this goal, this R34 proposal aims to 1) adapt the 3RP for the needs of knee OA patients with depression (PHQ-910) and obesity (BMI30 kg/m2) with a focus of increasing physical activity; and 2) establish the feasibility, credibility and acceptability of the programs and research procedures. Using the R34 NCCIH mechanism, we propose to use an iterative mixed methods strategy to adapt the 3RP for the specific needs of obese OA patients with depression including increased activity to maximize their feasibility, acceptability, and credibility. This R34 grant will set the stage for us to conduct a fully powered RCT through the R61/R33 mechanisms to assess the biopsychosocial mechanisms associated with OA progression.