Study of Physical Activity Rewards after Knee Surgery (SPARKS)

描述（由申请人提供）：体力活动（PA）已被证明可改善膝关节骨关节炎（OA）患者的疼痛和功能，减少肥胖，预防心脏病、糖尿病和慢性肺病的发作和进展。美国人类和卫生服务部（DHHS）的指南建议成年人每周进行>150分钟的中等体力活动。然而，一般人群对PA指南的依从性较差，尤其是膝关节OA患者。全膝关节置换术（TKR）广泛用于症状性晚期膝关节OA患者。虽然绝大多数接受全膝关节置换术的患者疼痛明显减轻，功能能力得到改善，但很少有人借此机会进行更多的体力活动。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，因此许多TKR接受者并未从手术中获得最大益处。该提案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措施的疗效和成本效益，该干预措施将促进参与体力活动，并提高日益增长的TKR接受者人群对PA指南的依从性。我们解决的创新假设，TKR后的时期提供了一个窗口的机会，从根本上改变态度和信念，对PA，有形的经济激励措施将有效地诱导行为改变，促进遵守PA的指导方针。我们提出了“膝关节手术后身体活动奖励研究（SPARKS）”，具体目标如下：1。设计并实施一项概念验证RCT，以确定基于以下内容的个性化干预的可行性和有效性： 行为经济学原理-与标准治疗相比-在改善接受TKR患者的体力活动方面。2.评估这种行为经济学干预的成本和成本效益，以改善接受TKR的患者的体力活动。这项概念验证试验将作为计划多中心RCT和开发基础设施的基础，以促进基于奖励的计划，鼓励健康促进行为。除了评估功效外，我们还将制定一个框架，以评估大规模实施此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.