The Effect of Physical Activity Guidelines on Arthritis-Related Disability

描述（由申请人提供）：超过1700万美国人因关节炎而残疾，使关节炎成为美国残疾的主要原因。膝骨关节炎（膝OA）和类风湿性关节炎（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：如何减少膝关节OA和RA患者的残疾进展。本研究将测试身体活动管理（PAM）干预对预防膝关节OA和RA患者残疾进展的有效性。拟议的研究被整合到美国国立卫生研究院资助的PAM随机临床试验中，该试验提供了研究后勤和经济节约的效率。PAM试验入组了240例膝关节OA患者和240例RA患者。PAM干预是一种量身定制的患者自我管理干预，补充了医生咨询，以增加体力活动行为。对照组仅为医师体力活动辅导。每半年资助一次的PAM试验评估包括疼痛、功能和通过加速度计进行的最先进的身体活动测量。拟议的研究要求资金增加与基线水平相比的残疾和残疾进展的测量，并根据客观的、资助的加速计监测评估PAM试验参与者是否达到推荐的身体活动指南。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方法学强有力的框架，以确定PAM与对照干预相比是否能有效预防残疾进展，并确定这种效果是否是由于膝关节OA和RA患者符合推荐体力活动指南的频率提高。2.测量达到推荐的公共卫生体力活动指南（如美国外科医生推荐的指南）的效果，以减少残疾进展，功能下降和疼痛。我们还调查了与这些结果的身体活动剂量反应关系。PAM干预提供了一种潜在的有效方法，通过在卫生系统层面促进身体活动来减少残疾进展。激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措施可以减少残疾，这是关节炎医疗保健成本的关键驱动因素，那么这一发现对于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。这是这些患者的临床管理和公共卫生计划的设计，以减少关节炎相关的残疾的关键信息。这项研究的结果将推动公共卫生工作，以改善4800万美国关节炎成年人的生活质量。这项研究将使用随机临床试验的方法学强有力的框架，以确定身体活动管理（PAM）干预是否减少残疾，并提高膝关节骨关节炎（OA）和类风湿性关节炎（RA）患者符合推荐的身体活动指南的频率。本研究还测量了达到推荐的公共卫生指南以减少膝关节OA和RA患者的残疾进展并维持功能的效果。这是这些患者临床管理的关键信息，也是推进公共卫生工作以改善4800万患有关节炎的美国成年人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.