mHealth-based Just-In-Time Adaptive Intervention to Improve Physical Activity Levels of Individuals with Spinal Cord Injury

项目摘要 在美国，超过290，000名脊髓损伤（SCI）患者缺乏定期的身体活动（PA）。 美国是一个持续的健康危机。这种缺乏活动可能会产生破坏性的后果， SCI患者体内PA水平低会增加心血管疾病、糖尿病和 肺病。此外，SCI患者的PA水平低与继发性 例如疼痛、疲劳、体重增加和失调。定期PA和基于运动的 在SCI患者中，干预措施与改善的结果和更健康的生活方式有关。传感器- 基于活动监测器可以通过量化轮椅运动来评估PA和锻炼干预， 个体的运动和生理变化。然而，这些监视器不提供实时的， 量身定制的反馈和建议，可能有助于SCI患者提高他们的PA水平 社区该提案的首要目标是评估一种传感器启用的，及时的自适应 干预（JITAI）策略，以增加和维持社区SCI患者的PA水平。 本研究的长期目标是将移动的健康JITAI与现有PA干预有效整合 激励SCI患者改变健康相关行为的计划。其主要目的是 我的建议是扩大我们的试点工作，以评估集成的JITAI与基于网络的14周PA 国家健康、体育活动和残疾中心的干预计划（目标1）。我们 假设基于网络的PA干预计划与JITAI的整合将导致显著的 在14周内，与单独的标准的基于我们的PA干预计划相比，PA水平更高。一 本研究的第二个目标是扩展使用商业可穿戴技术的现有算法， 稳健地检测PA行为，以便于提供量身定制的即时可操作反馈和PA 对SCI患者的建议（目标3和4）。 JITAI的集成，由于基于传感器， PA的评估，标准的基于网络的PA干预计划将通过临床试验进行测试， 结合了随机对照试验和微随机试验。我们的团队包括调查人员， SCI研究、移动的健康、PA跟踪和行为改变干预方面的专业知识。拟议 这项研究将产生关于JITAI以及JITAI与更传统的基于网络的PA相结合的新见解 干预计划，这将有助于研究人员为患有 社区中的残疾人，可以改善他们的健康和生活质量。

Project Summary The lack of regular physical activity (PA) in over 290,000 individuals with spinal cord injury (SCI) in the United States (US) is an ongoing health crisis. This lack of activity has potentially devastating consequences because low levels of PA in people with SCI elevates the risk of mortality due to cardiovascular diseases, diabetes, and lung disease. Furthermore, low levels of PA in individuals with SCI have been associated with secondary conditions such as pain, fatigue, weight gain, and deconditioning. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Sensor- based activity monitors can assess PA and exercise interventions by quantifying wheelchair movement, movement of the individual, and physiological changes. However, these monitors do not provide real-time, tailored feedback and recommendations that might help individuals with SCI increase their PA levels in the community. The overarching goal of this proposal is to evaluate a sensor-enabled, just-in-time adaptive intervention (JITAI) strategy to increase and sustain PA levels among individuals with SCI in their communities. The long-term goal of this research is to effectively integrate a mobile health JITAI with existing PA intervention programs to motivate health-related behavior change in individuals with SCI. A primary objective of this proposal is to extend our pilot work to evaluate the integration of a JITAI with a web-based 14-week PA intervention program from the National Center on Health, Physical Activity and Disability (Aim 1). We hypothesize that the integration of web-based PA intervention program with JITAI will result in significantly higher PA levels over 14 weeks compared to the standard we-based PA intervention program alone. A secondary objective of this study is to extend existing algorithms that use commercial wearable technology to robustly detect PA behaviors to facilitate the delivery of tailored just-in-time actionable feedback and PA recommendations for individuals with SCI (Aims 3 and 4). The integration of the JITAI, which provides feedback and PA recommendations due to sensor-based assessments of PA, with the standard web-based PA intervention program will be tested via a clinical trial that combines a randomized controlled trial and a micro-randomized trial. Our team includes investigators with expertise in SCI research, mobile health, PA tracking, and behavioral change interventions. The proposed study will yield novel insights about JITAIs and JITAIs combined with more traditional, web-based PA intervention programs, which will help researchers design engaging PA interventions for individuals with disability in the community that may improve their health and quality of life.