Mind Your Walk Intervention for Community-Based Management of Knee OA: A Feasibility Study

项目总结/摘要：本研究的总体目标是开发一种有效的步行- 基于干预，减少残疾，并保持膝关节骨关节炎患者的关节结构 （OA）。行走障碍导致膝关节OA患者早期死亡的风险增加。此外，人们 膝关节骨性关节炎患者行走时的运动模式会使软骨过载，并可能导致骨性关节炎的快速进展。 目前的步态再训练干预使用昂贵的设备，针对单个关节，或专注于仅减少关节损伤。 膝关节内收力矩此外，这些干预措施可能无法解决依从性、传播和 可扩展性，并且可能不利用移动的技术的普遍性。该项目旨在展示 一个创新的社区为基础的干预（“注意你的步行”），包括全身的可行性 基于生物力学原理的运动再训练，沿着有意识的身体意识技能， 膝关节OA我们的目标是利用这个项目的结果来支持一个更大的随机试验的设计 将这种干预与标准锻炼计划进行比较。为实现这一目标，本项目将重点关注： 证明招募、依从性和保持注意走路干预的可行性，2） 量化生物力学和功能结果的可变性，以及3）移动的健康的可用性测试 （mHealth）应用程序，用于监测依从性并保持对Mind Your Walk干预的参与。 影像学和症状性膝关节OA受试者（n=62）将参加可行性研究。另一 组（n=10）将参与mHealth应用程序的可用性测试。干预措施将在 在6个月内使用基于社区的小组会议。之后，受试者将自己练习， 再过6个月。注意力匹配的对照组将接受OA教育。除了可行性 数据，行走过程中的膝关节负荷将使用EMG驱动的膝关节模型和步态分析进行量化， 基线和6个月。使用加速度计和自我报告的疼痛记录每日体力活动， 基线和每3个月一次，为期1年。 主要研究者（PI）具有康复，生物力学和应用方面的专业知识， 定量成像PI的长期目标是领导一个跨学科的翻译肌肉骨骼 OA研究计划，重点是解开OA的生物力学途径，并使用 利用这些知识来制定有针对性的干预措施。该奖项将使申请人获得额外的培训 在临床试验的各个方面以及在膝关节OA中使用移动医疗技术。额外培训将侧重于 临床试验和纵向数据的高级生物统计学，以及领导力和团队科学。辅导 团队由风湿病学、临床试验、移动的健康技术领域的资深科学家组成， 生物统计学PI拥有强大的机构支持，该项目将加速PI向 独立研究者，并能够收集临床试验设计的关键数据。

PROJECT SUMMARY/ ABSTRACT: The overarching goal of this research is to develop an effective walking- based intervention that reduces disability and also maintains joint structure for people with knee osteoarthritis (OA). Walking disability leads to an increased risk of early death in people with knee OA. Furthermore, people with knee OA walk with movement patterns that overload the cartilage and may lead to rapid OA progression. Current gait retraining interventions use expensive devices, target a single joint, or focus on only reducing the knee adduction moment. Furthermore, these interventions may not address adherence, dissemination, and scalability, and may not utilize the ubiquity of mobile technology. This project proposed to demonstrate the feasibility of an innovative community based intervention (“Mind Your Walk”) that incorporates whole-body movement retraining based on biomechanical principles, along with mindful body-awareness skills, for people with knee OA. The goal is to use the results from this project to support the design of a larger randomized trial comparing this intervention with standard exercise programs. To achieve this goal, this project will focus on - 1) demonstrating feasibility of recruitment, adherence, and retention with the Mind Your Walk intervention, 2) quantifying the variability of biomechanical and functional outcomes, and 3) usability testing of a mobile health (mHealth) application for monitoring adherence and maintaining engagement for Mind Your Walk intervention. Subjects with radiographic and symptomatic knee OA (n=62) will participate in the feasibility study. Another group (n=10) will participate in usability testing of the mHealth application. The intervention will be delivered using community-based group sessions over 6-months. After that the subjects will practice on their own for another 6-months. The attention-matched control group will receive education on OA. In addition to feasibility data, knee loading during walking will be quantified using an EMG-Driven knee model and gait analyses at baseline and 6-months. Daily physical activity using accelerometers and self-reported pain will be recorded at baseline and every 3-months for a period of 1-year. The principal investigator (PI) has expertise in rehabilitation, biomechanics, and applications of quantitative imaging. The PI's long-term goal is to lead an inter-disciplinary translational musculoskeletal research program in OA; that is focused on unraveling the biomechanical pathways underlying OA, and using this knowledge to develop targeted interventions. This award will enable the applicant to gain additional training in all aspects of clinical trials and use of mHealth technologies in knee OA. Additional training will focus on advanced biostatistics for clinical trials and longitudinal data, and on leadership and team science. The mentoring team comprises of established senior scientists in rheumatology, clinical trials, mobile health technologies, and biostatistics. The PI has strong Institutional support, and this project will accelerate the PI's transition to an independent investigator, and enable collection of critical data for design of the clinical trial.