Study of Physical Activity Rewards after Knee Surgery (SPARKS)

描述(申请人提供)：体力活动(PA)已被证明可以改善膝骨性关节炎(OA)患者的疼痛和功能，减少肥胖，并防止心脏病、糖尿病和慢性肺部疾病的发生和发展。美国人类与健康服务部(DHHS)的指导方针建议成年人每周进行150分钟的适度体育活动。然而，在普通人群中，对PA指南的依从性很差，特别是在膝骨性关节炎患者中。全膝关节置换术(TKR)广泛应用于有症状的晚期膝骨性关节炎患者。虽然绝大多数接受TKR的人都经历了相当大的疼痛减轻和功能能力的改善，但很少有人利用这个机会变得更活跃。由于体力活动与生活质量以及许多慢性疾病的预防和改善有直接关系，许多接受TKR的人并没有从手术中获得最大好处。这项建议的重点是进行一项概念验证RCT，以确定基于行为经济学的干预的有效性和成本效益，该干预将促进参与体力活动，并在不断增长的TKR接受者中改善对PA指南的遵守。我们提出了一个创新的假设，即TKR之后的一段时间是从根本上改变人们对PA的态度和信念的机会之窗，有形的经济激励将有效地诱导行为改变，并有助于遵守PA指南。我们提出“膝关节手术后体力活动奖赏研究(SPAKS)”的具体目标如下：1.设计并进行一项概念验证RCT，以建立建立在此基础上的个性化干预的可行性和有效性 行为经济学原理--与护理标准相比--在改善TKR患者的体力活动方面。2.评估这种行为经济学干预改善TKR患者体力活动的成本和成本-效果。这项概念验证试验将作为规划多中心随机对照试验和开发基础设施的基础，以促进基于奖励的计划，以鼓励促进健康的行为。除了评估效力外，我们还将制定一个框架，以评估大规模实施这类干预措施的价值和预算影响。

DESCRIPTION (provided by applicant): Physical activity (PA) has been shown to improve pain and function in persons with knee osteoarthritis (OA), reduce obesity, and prevent the onset and progression of heart disease, diabetes, and chronic pulmonary disease. The US Department of Human and Health Services (DHHS) guidelines recommend that adults engage in >150 minutes of moderate physical activity per week. However, adherence to PA guidelines is poor in the general population, particularly in persons with knee OA. Total knee replacement (TKR) is widely used in patients with symptomatic, advanced knee OA. While the vast majority of persons undergoing TKR experience considerable reduction in pain and improvement in functional capacity, far fewer take this opportunity to become more physically active. Since physical activity has a direct relationship with quality of life and with prevention and amelioratin of many chronic conditions, many TKR recipients do not derive maximum benefits from the procedure. The focus of this proposal is to conduct a proof of concept RCT to establish the efficacy and cost-effectiveness of a behavioral economics-based intervention that would facilitate engagement in physical activity and improve adherence to PA guidelines in the growing population of TKR recipients. We address the innovative hypothesis that the period following TKR presents a window of opportunity to fundamentally change attitudes and beliefs regarding PA, and that tangible economic incentives will effectively induce behavior change and facilitate adherence to PA guidelines. We propose 'Study of Physical Activity Rewards after Knee Surgery (SPARKS)' with the following specific aims: 1. To design and conduct a proof-of- concept RCT to establish the feasibility and efficacy of a personalized intervention built upon the principles of behavioral economics - as compared with standard of care - in improving physical activity among patients who have undergone TKR. 2. To estimate the costs and cost-effectiveness of this behavioral economics intervention to improve physical activity in persons who have undergone TKR. This proof of concept trial will serve as a building block for planning a multicenter RCT and developing an infrastructure to facilitate rewards-based programs to encourage health-promoting behavior. In addition to assessing efficacy we will develop a framework to evaluate the value and budgetary impact of implementing such interventions on a large scale.