Group Physical Therapy for Veterans with Knee Osteoarthritis

项目摘要 膝骨性关节炎是最常见的健康问题之一，也是致残的主要原因之一。 在退伍军人中。物理治疗(PT)和持续的锻炼与减轻疼痛和改善病情有关 膝骨性关节炎患者的身体功能，但大多数退伍军人膝骨性关节炎患者身体不活跃。 此外，在退伍军人保健系统中，PT服务是一种有限的资源，供不应求。 膝关节骨性关节炎的VA患者一般只接受一到两次PT检查。先前的研究表明， 临床接触时间不足以为患者提供所需的评估、指导和支持 采用并保持锻炼计划，特别是在慢性疼痛的情况下。因此 开发、测试和实施机制，以经济高效地扩展膝关节骨性关节炎的PT服务 可能在改善这一大群退伍军人的疼痛和其他结果方面发挥关键作用。这项研究 研究了一种基于小组的方法来提供膝盖骨关节炎的PT，这种方法可以将服务扩展到更多的退伍军人， 以更低的人力成本为每个退伍军人提供更多的会议次数。这项研究的目的是比较 膝关节骨性关节炎分组PT方案与膝关节骨性关节炎常规个体化PT护理的有效性。 这项研究将是N=376人中为期12周、基于小组的PT计划的随机对照试验 达勒姆VAMC有症状的退伍军人膝盖骨关节炎。参与者将被随机分配到 基于团体的PT计划或个人PT(通常护理)。小组PT分支将包括6个半小时的访问 (每隔一周)由一名物理治疗师和运动生理学家领导，每组8名参与者。这个 个人PT手臂，模仿达勒姆VAMC膝关节骨关节炎和其他医疗保健的典型PT护理 环境，将包括2个1小时的物理治疗师访问，间隔2-3周。小组PT会议将 包括联合护理(活动调步和关节投影)小组指导、锻炼小组讨论 成功和障碍、集体锻炼和与理疗师预定的个人会诊(2 每位参与者15-20分钟)，以满足特定的功能和治疗需求。而个人 PT会议将在结构上有所不同，它们将包括相同的信息、评估和治疗 将内容作为小组会话。这两组人将接受相同的家庭锻炼计划的指导。 这项研究的主要结果将是安大略省西部大学和麦克马斯特大学的骨性关节炎 指数(WOMAC)。第二个结果将被客观地评估身体功能(简短的身体功能 性能测试协议)。这些结果将在基线和12周的随访中进行评估。这个 WOMAC还将在24周内通过电话进行评估，以检查是否观察到 保持干预效果。将使用混合线性模型来比较两项研究的结果 手臂。我们还将对以集团为基础的PT计划进行经济分析。

Project Summary Knee osteoarthritis (OA) is one of the most common health problems and a leading cause of disability among veterans. Physical therapy (PT) and ongoing exercise are associated with reduced pain and improved physical function among patients with knee OA, yet the majority of veterans with OA are physically inactive. Furthermore, PT services are a limited resource in the VA health care system, with demand exceeding supply. VA patients with knee OA generally receive only one or two PT visits. Prior research indicates this amount of clinical contact time is not sufficient to provide patients with the assessment, instruction, and support needed to adopt and maintain an exercise program, particularly in the context of a chronic pain condition. Therefore development, testing, and implementation of mechanisms to cost-effectively expand PT services for knee OA may play a key role in improving pain and other outcomes in this large group of veterans. This research examines a group-based approach to delivering PT for knee OA, which can extend services to more veterans, for a greater number of sessions per veteran, at lower staffing costs. The objective of this study is to compare the effectiveness of a group-based PT program for knee OA with usual individual PT care for knee OA. This study will be a randomized controlled trial of a 12-week, group-based PT program among N=376 veterans with symptomatic knee OA at the Durham VAMC. Participants will be randomly assigned to the group-based PT program or individual PT (usual care). The group PT arm will include 6 1 to 1 1/2 hour visits (every other week) led by a physical therapist and exercise physiologist, with 8 participants per group. The individual PT arm, modeled after typical PT care for knee OA at the Durham VAMC and other health care settings, will include 2 1-hour visits with a physical therapist, 2-3 weeks apart. The group PT sessions will include group instruction in joint care (activity pacing and joint projection), group discussion of exercise successes and barriers, group exercise, and scheduled individual consultations with the physical therapist (2 per participant, 15-20 minutes each) to address specific functional and therapeutic needs. While the individual PT sessions will differ in structure, they will include the same informational, assessment, and therapeutic content as the group sessions. Both groups will be given instructions for the same home exercise program. The primary outcome for this study will be the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). The secondary outcome will be objectively assessed physical function (Short Physical Performance Test Protocol). These outcomes will be assessed at baseline and 12-week follow-up. The WOMAC will also be assessed via telephone at 24-week follow-up to examine whether any observed intervention effects are maintained. Mixed linear models will be used to compare outcomes for the two study arms. We will also conduct an economic analysis of the group-based PT program.