The Effect of Physical Activity Guidelines on Arthritis-Related Disability

描述(申请人提供)：超过1700万美国人因关节炎而致残，使关节炎成为美国致残的主要原因。膝骨性关节炎(膝骨性关节炎)和类风湿关节炎(RA)是关节炎相关残疾的主要原因。这项拟议的研究解决了一个重要的公共卫生问题：如何减少膝盖骨关节炎和类风湿关节炎患者的残疾进展。这项研究将测试体力活动管理(PAM)干预对预防膝骨性关节炎和类风湿关节炎患者残疾进展的有效性。建议的研究被整合到由NIH资助的PAM随机临床试验中，该试验在研究后勤方面提供了效率，并节省了经济成本。PAM试验招募了240名膝骨性关节炎患者和240名RA患者。PAM干预是一种量身定制的患者自我管理干预，补充了医生的咨询，以增加身体活动行为。对照组仅接受医生体力活动辅导。每半年资助一次的PAM试验评估包括疼痛、功能和通过加速计测量最先进的体力活动。拟议的研究要求提供资金，以增加相对于基线水平的残疾和残疾进展的测量，并根据客观的、由资金资助的加速度计监测来评估PAM试验参与者达到推荐的体力活动指南的情况。这项拟议的研究旨在以最低的成本客观和明确地解决以下目标：1.使用随机临床试验的强大方法学框架，确定与对照干预相比，PAM在防止残疾进展方面是否有效，并确定这种效果是否源于膝盖骨关节炎和类风湿关节炎患者满足推荐体力活动指南的频率提高。2.衡量达到推荐的公共卫生体力活动指南的效果，如美国卫生局局长推荐的指南，以减少残疾进展、功能衰退和疼痛。我们还调查了体力活动与这些结果的剂量-反应关系。PAM干预提供了一种潜在的有效方法，通过在卫生系统一级促进体力活动来减少残疾进展。鼓励关节炎患者增加体力活动是2010年《健康人》的既定目标。如果像PAM这样的健康系统干预减少了残疾，这是关节炎医疗成本的关键驱动因素，这一发现对遏制不断上涨的医疗成本具有重要的公共政策和保险报销意义。此外，这项研究将评估满足推荐的体力活动指南的有效性，以维持关节炎患者的功能并减少残疾。这是对这些患者的临床管理和设计公共卫生计划以减少与关节炎相关的残疾的关键信息。这项研究的发现将推动公共卫生努力，以改善4800万患有关节炎的美国成年人的生活质量。这项研究将使用随机临床试验的强大方法框架，以确定体力活动管理(PAM)干预是否减少残疾，并提高膝骨性关节炎(OA)和类风湿性关节炎(RA)患者达到推荐体力活动指南的频率。这项研究还衡量了达到推荐的公共卫生指南的效果，以减少膝盖骨关节炎和类风湿关节炎患者的残疾进展和维持功能。这是对这些患者的临床管理以及推进公共卫生努力以提高4800万患有关节炎的美国成年人的生活质量的关键信息。

DESCRIPTION (provided by applicant): Over 17 million Americans are disabled as a result of their arthritis, making arthritis the major cause of disability in the US. Knee osteoarthritis (knee OA) and rheumatoid arthritis (RA) are major causes of arthritis- related disability. This proposed study addresses an important public health problem: how to reduce disability progression for persons with knee OA and RA. This study will test the effectiveness of the Physical Activity Management (PAM) intervention to prevent disability progression in patients with knee OA and RA. The proposed research is integrated into the NIH- funded PAM Randomized Clinical Trial, which provides efficiency in study logistics and economic savings. The PAM Trial is enrolling 240 patients with knee OA and 240 patients with RA. The PAM intervention is a tailored patient self-management intervention supplementing physician counseling to increase physical activity behavior. The control group is physician physical activity counseling alone. Semi-annual funded PAM Trial assessments include pain, function, and state-of-the art physical activity measurement via accelerometer. The proposed study requests funds to add measurements of disability and disability progression compared to baseline levels and to assess the attainment of recommended physical activity guidelines in PAM Trial participants based on objective, funded accelerometer monitoring. The proposed study is designed to objectively and definitively address the following aims at minimal cost: 1. Use the methodologically strong framework of a randomized clinical trial to determine if the PAM compared to control intervention is effective in preventing disability progression and to determine if this effect is due to improved frequency at which persons with knee OA and RA meet recommended physical activity guidelines. 2. Measure the effect of attaining recommended public health physical activity guidelines, such as those recommended by the US Surgeon General, to reduce disability progression, functional decline, and pain. We also investigate a physical activity dose-response relationship with those outcomes. The PAM intervention offers a potentially effective method to reduce disability progression by promoting physical activity at the health systems level. Motivating persons with arthritis to increase physical activity is a stated objective of Healthy People 2010. If a heath systems intervention such as PAM reduces disability, a key driver of health care costs in arthritis, this finding has important public policy and insurance reimbursement implications for the containment of rising medical costs. Furthermore, this study will evaluate effectiveness of meeting recommended physical activity guidelines to maintain function and reduce disability for persons with arthritis. This is key information for the clinical management of these patients and for the design of public health programs to reduce arthritis-related disability. Findings from this study will advance public health efforts to improve quality of life among 48 million US adults having arthritis. This study will use the methodologically strong framework of a randomized clinical trial to determine if the Physical Activity Management (PAM) intervention reduces disability and improves the frequency at which persons with knee osteoarthritis (OA) and rheumatoid arthritis (RA) meet recommended physical activity guidelines. This study also measures the effect of attaining recommended public health guidelines to reduce disability progression and maintain function in knee OA and RA patients. This is key information for the clinical management of these patients and to advance public health efforts to improve quality of life among 48 million US adults having arthritis.