Tailored telehealth weight management tool to overweight adults with disabilities

描述(申请人提供)：与普通人群相比，残疾人的健康状况较差，肥胖率也较高。对于美国5400多万残疾人来说，管理不善的医疗保健的风险要高得多。据估计，2006年全国与残疾相关的医疗支出总额为3979亿美元，占全国医疗支出的26.7%。使问题更加复杂的是，缺乏训练有素的健康促进专业人员，他们了解残疾人的健康需求，并能够为这一服务不足的弱势群体提供适当的服务。当医生和其他医疗保健提供者确定残疾患者的健康问题时，目前他们无处可去 转介他们的患者接受个性化的支持服务。没有定制的健康促进提供系统来指导脊髓损伤等残疾人士减肥或保持体重，使这些服务不足的人群非常容易受到肥胖、缺乏运动和营养不良的健康影响。这项申请是为了响应RFA PA-11-335(实验室到市场：生物医学和行为研究的工具)，这是一个为期2年的特殊第一阶段SBIR计划，旨在加快行为研究从学术到市场的转化。该项目基于过去15年在康复、残疾信息学和健康促进方面建立的广泛研究成果和专业知识，并在阿拉巴马大学伯明翰分校的共同PI詹姆斯·里默博士的领导下，获得了大量联邦资金，用于促进残疾人的健康。这一应用在很大程度上依赖于疾控中心资助的针对成年残疾人生活方式体重管理的循证研究(特别是“个性化锻炼计划”(PEP)项目：#R04CCR518810和#R01DD000134)和残疾信息学，作为疾控中心资助的国家健康、体力活动和残疾中心的一部分(#U59DD000437)。我们的首要目标是促进残疾人士的健康。由于这些展示肢体残疾人士体重减轻的项目取得了成功的结果，本提案旨在开发基于网络的个性化在线体重和运动响应系统(POWERS)、专门为残疾人设计的智能个性化体重管理教练解决方案和临床决策支持系统。它的目标用户是在临床中心工作的健康促进专家、在公共卫生项目工作的残疾和健康专业人员、康复专业人员和健身专业人员，他们将作为“远程健康教练”帮助残疾人实现减肥并改善他们的健康促进行为(改善营养和增加体力活动)。POWERS支持计划的参与者预计：1)身体活动和营养行为有更大的增加；2)身体活动障碍和健康饮食模式的障碍有更大的减少；3)对体育活动和健康营养的态度有更大的改善；最终4)体重和身体质量指数有更大的下降。第一阶段项目有三个具体目标：1)通过焦点小组和访谈从24个利益相关者那里收集关于系统功能、可用性设计和感知有用性的反馈；2)以用户为中心的设计过程扩展POWERS原型，包括两个涉及12名健康专业人员和12名残疾人的正式可用性测试；以及3)进行Pilo随机研究，以研究这种方法的有效性和可行性，受试者为60人。

DESCRIPTION (provided by applicant): People with disabilities experience poorer health and have much higher rates of obesity compared to the general population. For the more than 54 million individuals with disabilities in the U.S., there is a significantly higher risk of poorly managed health care. It is estimated that the total national disability-associated health care expenditures (DAHE) were $397.9 billion in 2006, representing 26.7 percent of national health care spending. Compounding the problem is the lack of trained health promotion professionals who understand the health needs of adults with disabilities and are able to provide adequate services for this underserved, vulnerable population. When physicians and other healthcare providers identify health issues in patients with disabilities, there is currently nowhere they can refer their patients for individualized support services. There is no customized health promotion delivery system that can guide a person with a disability such as spinal cord injury in losing or maintaining weight, leaving this underserved population highly vulnerable to the health effects of obesity, inactivity and poor nutrition. This application is in response to RFA PA-11-335 (Lab to Marketplace: Tools for Biomedical and Behavioral Research), a special 2-year Phase I SBIR program to accelerate the translation of behavioral research from academic to the marketplace. The project is based on the extensive research results and expertise in rehabilitation, disability informatics, and health promotion established over the last 15 years with substantial federal funding for promoting health among people with disabilities under the leadership of Dr. James Rimmer, our co-PI at the University of Alabama at Birmingham. This application relies heavily on evidence-based research funded by the CDC for lifestyle weight management for adults with disabilities (particularly, the "Personalized Exercise Program" (PEP) projects: #R04CCR518810 and #R01DD000134) and disability informatics as part of the CDC-funded National Center on Health, Physical Activity and Disability (#U59DD000437). Our overarching goal is to promote the health of people with disabilities. As the result of obtaining successful outcomes from these projects demonstrating weight loss in people with physical disabilities, this proposal aims to develop a web-based Personalized Online Weight and Exercise Response System (POWERS), an intelligent individualized weight management coaching solution and clinical decision support system designed specifically for individuals with disabilities. Its target users are health promotion specialists working in clinical centers, disability and health professionals working in public health programs, rehabilitation professionals, and fitness professionals, who would serve as "telehealth coaches" to assist individuals with disabilities achieve weight loss and improve their health promotion behaviors (improved nutrition and increased physical activity). Participants in the POWERS-supported program are expected to have 1) greater increase in physical activity and nutritional behaviors; 2) greater reduction in the number of barriers to physical activity and healthy eating patterns; 3) greater improvement in attitudes toward physical activity and healthy nutrition; and ultimately 4) greater reduction in weight and Body Mass Index. This Phase I project has three specific aims: 1) collect feedback from 24 stakeholders on system features, usability design, and perceived usefulness via focus groups and interviews; 2) extend the POWERS prototype with a user- centric design process including two formal usability tests involving 12 health professionals and 12 individuals with disabilities; and 3) conduct a pilo randomized study to study the efficacy and feasibility of this approach with 60 subjects.