Reducing Sedentary Time Using an Innovative mHealth Intervention Among Total Knee Replacement Patients

项目总结/摘要 每年接受全膝关节置换术（TKR）的人数持续增加。而 TKR可有效改善疼痛和功能，但随后的体力活动改善无效 共同因此，患者一天中的大部分时间都在久坐不动，这可能会使他们处于 功能差和残疾的风险较高，手术的总体成功率较低 治疗干预久坐不动的时间，而不是身体活动，可能是更可行的第一步 改变这一人群中与活动相关的行为的方法。因此，这一创新的目的 临床试验是将TKR用作实施久坐减少干预的可教时刻。 我们建议使用即时移动的健康（mHealth）干预，以减少久坐时间， TKR患者。将招募计划接受TKR的患者（n=92）在手术前参与，然后 术后4周随机分为（1）NEAT！2或（2）控制。太棒了！2名参与者将使用 太棒了！2（非运动活动产热版本2）智能手机应用程序，直至术后3个月。的 太棒了！2应用程序旨在提供振动和/或可听音，以中断长时间的静坐 从智能手机的内部加速度计检测。更进一步，NEAT！2例已根据TKA进行调整 患者输入和程序偏好。太棒了！2名参与者将在下午4点至 手术后12周。对照组参与者将收到一个教育控制应用程序，并接受不干预 呼吁评估一般恢复。这两个群体将在每月3至6时之间收到维护电话 个月将在术前以及治疗结束时（TKR后3个月）收集数据， 维持评估（TKR后6个月）。主要目的是检查NEAT的效果！2 在治疗结束（3个月）和维持（6个月）时干预久坐时间。次要目的 包括检查NEAT的效果！2对身体功能、身体活动和疼痛的干预， 以及检查坚持NEAT！2、结果的变化。 这项拟议的研究将审查减少久坐时间的创新方法， 针对TKR后成年人的身体活动，并确定远程交付的mHealth久坐 减少干预可以减少久坐时间。该研究是创新性的整合一个即时 减少TKR患者“可教时刻”久坐时间的技术方法。的 这项研究的结果将建立在我们以前和目前的工作，以改善TKA后的健康行为， 确定潜在有效和可扩展的策略，以改善长期的身体活动行为， TKR后患者的身体功能。

Project Summary/Abstract The number of individuals undergoing total knee replacement (TKR) each year continues to rise. While TKR is effective for improving pain and function, subsequent improvements in physical activity are not common. As a result, patients spend most of their day engaged in sedentary behavior, which may put them at higher risk of experiencing poor function and disability, as well as lower the overall success of the surgical treatment. Intervening on sedentary time, rather than physical activity, may be a more feasible first-step approach for modifying activity-related behaviors in this population. Therefore, the purpose of this innovative clinical trial is to use TKR as a teachable moment for implementing a sedentary reduction intervention. We propose to use a just-in-time mobile health (mHealth) intervention to reduce sedentary time among TKR patients. Patients (n=92) scheduled for TKR will be recruited to participate prior to surgery and then randomized at 4 weeks after surgery to either (1) NEAT!2 or (2) Control. NEAT!2 participants will use the NEAT!2 (Non-Exercise Activity Thermogenesis version 2) smartphone app until 3 months after surgery. The NEAT!2 app is designed to provide a vibration and/or audible tone to interrupt prolonged bouts of sitting detected from the smartphone’s internal accelerometer. Further, NEAT!2 has been adapted based on TKA patient input and program preference. NEAT!2 participants will receive biweekly coaching calls between 4 and 12 weeks after surgery. Control participants will receive an education control app and receive non-intervention calls to assess general recovery. Both groups will receive monthly maintenance calls between 3 and 6 months. Data collection will occur pre-operatively, as well as at the end of treatment (3 months after TKR) and the maintenance assessment (6 months after TKR). The primary aim is to examine the effects of the NEAT!2 intervention on sedentary time at end of treatment (3 months) and maintenance (6 months). Secondary aims include examining the effects of the NEAT!2 intervention on physical function, physical activity, and pain as well as examining the dose response relationship between adherence to NEAT!2 and changes in outcomes. The proposed study will examine the innovative approach of decreasing sedentary time prior to targeting physical activity in adults after TKR and determine if a remotely-delivered, mHealth sedentary reduction intervention can decrease sedentary time. The study is innovative for integrating a just-in-time technology-based approach to reduce sedentary time during a “teachable moment” for TKR patients. The results of this study will build on our previous and current work to improve health behaviors after TKA and help to identify potentially effective and scalable strategies to improve long-term physical activity behaviors and physical function in patients after TKR.