Optimizing Mobility in Elders with Knee Osteoarthritis: Gait and Power Training

描述(申请人提供)：膝骨性关节炎(OA)占活动受限的很大比例，是日益增长的老年人面临的最具致残性的问题之一。这项研究的长期目标是减少患有有症状的膝骨性关节炎的老年人的残疾。训练的特殊性原则表明，接近目标功能活动的练习在提高该活动中的体能表现方面是最有效的。基于这一原则，本项目的具体目标是设计一种针对患者的步态训练干预措施，通过分析代偿性关节瞬间和能量消耗，然后评估这种步态训练干预措施和特定于活动能力的训练计划在改善老年有症状的膝骨性关节炎患者活动限制、残疾和生活质量方面的效果。这将通过在随机对照试验中评估每种干预措施对病理学(单层CT的肌肉成分)、损伤(肌肉力量)和功能限制(站立和行走)的影响来实现。力量训练干预是一种加权背心计划，以前曾被证明可以改善社区居住的老年人的功能活动能力。下一个合乎逻辑的步骤是将这项研究扩展到膝骨性关节炎患者。了解每一种干预措施在下肢肌肉中发生的变化，将指导未来的治疗干预，并确定哪些受试者可能需要额外的关注。成功的完成将为保持或改善活动能力的康复提供信息，并探索其作用机制。该项目是作为职业发展计划的一部分提出的。这位候选人的长期职业目标是维持一个独立的、以患者为导向的研究计划，该计划将指导治疗，最大限度地减少患有膝骨性关节炎的老年人的活动限制和残疾。建议的导师、教学和专业经验将提供肌肉成分、力量和力量的评估、生物力学运动分析和体能测试的使用以及研究方法和负责任的行为技能方面的培训。候选人是爱荷华大学(Ul)整形外科和康复系的助理教授。该部门以及乌尔医学院、乌尔老龄中心和普通临床研究中心都坚定地致力于支持候选人和研究，以造福老年人。这一重大承诺将提高培训和研究效率，使候选人能够成为一名独立的调查员，促进老年人的身体机能。

DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) accounts for a significant proportion of mobility limitations and is one of the most disabling problems facing the growing population of older adults. The long-term objective of this research is to reduce disablement of older adults with symptomatic knee OA. The principle of specificity of training indicates that exercises that closely approximate the goal functional activity are most effective in improving physical performance during that activity. Based on this principle, the specific aims of this project are to design a patient-specific gait training intervention using analysis of compensatory joint moments and energy expenditure, and then to assess the effect of this gait training intervention and a mobility-specific power training program on improving mobility limitations, disability and quality of life in older adults with symptomatic knee OA. This will be accomplished through assessing the effects on pathology (muscle composition by single slice CT), impairments (muscle power), and functional limitations (standing and walking) with each intervention in a randomized controlled trial. The power training intervention is a weighted vest program, previously shown to improve functional mobility among community dwelling older adults. The next logical step is to extend this research to individuals with knee OA. Understanding the changes that occur in lower limb muscle with each of these interventions will guide future therapeutic interventions and characterize which subjects may need additional attention. Successful completion will inform rehabilitation for maintaining or improving mobility as well as explore the mechanism of effect. This project is proposed as part of a career development plan. The candidate's long-term career goal is to sustain an independent patient-oriented research program that will guide therapy for minimizing mobility limitations and disability in older adults with knee OA. The mentorship, didactic, and professional experiences proposed will provide training in assessment of muscle composition, strength and power, use of biomechanical motion analysis and physical performance testing, and skills in research methodologies and responsible conduct. The candidate is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at the University of Iowa (Ul). This department, as well as the Ul College of Medicine, the Ul Center on Aging, and the General Clinical Research Center are strongly committed to supporting the candidate and research to benefit older adults. This substantial commitment will enhance training and research productivity, enabling the candidate to become an independent investigator who will advance physical function in older adults.