Optimizing Mobility in Elders with Knee Osteoarthritis: Gait and Power Training

描述（由申请人提供）：膝关节骨关节炎（OA）占活动受限的很大比例，是日益增长的老年人面临的最严重的致残问题之一。本研究的长期目标是减少有症状的膝关节OA老年人的残疾。训练的特异性原则表明，接近目标功能活动的练习在提高该活动期间的身体表现方面最有效。基于这一原则，本项目的具体目标是通过分析补偿性关节力矩和能量消耗来设计患者特定的步态训练干预，然后评估这种步态训练干预和移动特定的力量训练计划对改善有症状的膝关节OA老年人的移动限制、残疾和生活质量的影响。这将通过在随机对照试验中评估每次干预对病理（单层CT显示的肌肉组成）、损伤（肌肉力量）和功能限制（站立和行走）的影响来实现。力量训练干预是一个加权背心计划，以前显示，以改善社区居住的老年人的功能移动性。下一个合乎逻辑的步骤是将这项研究扩展到膝关节OA患者。了解这些干预措施中的每一种在下肢肌肉中发生的变化将指导未来的治疗干预措施，并描述哪些受试者可能需要额外关注。成功完成将为维持或改善活动性的康复提供信息，并探索其作用机制。该项目是作为职业发展计划的一部分提出的。候选人的长期职业目标是维持一个独立的以患者为导向的研究计划，该计划将指导治疗，以最大限度地减少膝关节OA老年人的活动限制和残疾。建议的指导、教学和专业经验将提供肌肉组成、力量和力量评估方面的培训，生物力学运动分析和体能测试的使用，以及研究方法和负责任行为方面的技能。候选人是爱荷华州大学（Ul）骨科和康复系的助理教授。这个部门，以及医学的Ul学院，老龄化的Ul中心，和一般临床研究中心都坚定地致力于支持候选人和研究，以造福老年人。这一实质性的承诺将提高培训和研究的生产力，使候选人成为一个独立的研究者谁将促进老年人的身体功能。

DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) accounts for a significant proportion of mobility limitations and is one of the most disabling problems facing the growing population of older adults. The long-term objective of this research is to reduce disablement of older adults with symptomatic knee OA. The principle of specificity of training indicates that exercises that closely approximate the goal functional activity are most effective in improving physical performance during that activity. Based on this principle, the specific aims of this project are to design a patient-specific gait training intervention using analysis of compensatory joint moments and energy expenditure, and then to assess the effect of this gait training intervention and a mobility-specific power training program on improving mobility limitations, disability and quality of life in older adults with symptomatic knee OA. This will be accomplished through assessing the effects on pathology (muscle composition by single slice CT), impairments (muscle power), and functional limitations (standing and walking) with each intervention in a randomized controlled trial. The power training intervention is a weighted vest program, previously shown to improve functional mobility among community dwelling older adults. The next logical step is to extend this research to individuals with knee OA. Understanding the changes that occur in lower limb muscle with each of these interventions will guide future therapeutic interventions and characterize which subjects may need additional attention. Successful completion will inform rehabilitation for maintaining or improving mobility as well as explore the mechanism of effect. This project is proposed as part of a career development plan. The candidate's long-term career goal is to sustain an independent patient-oriented research program that will guide therapy for minimizing mobility limitations and disability in older adults with knee OA. The mentorship, didactic, and professional experiences proposed will provide training in assessment of muscle composition, strength and power, use of biomechanical motion analysis and physical performance testing, and skills in research methodologies and responsible conduct. The candidate is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at the University of Iowa (Ul). This department, as well as the Ul College of Medicine, the Ul Center on Aging, and the General Clinical Research Center are strongly committed to supporting the candidate and research to benefit older adults. This substantial commitment will enhance training and research productivity, enabling the candidate to become an independent investigator who will advance physical function in older adults.