Computer-guided Action Planning to Support Physical Activity (CAPPA) for Employees with Chronic Knee Symptoms

项目摘要 社会需要有效的非手术疗法来管理慢性膝关节症状（CKS） 膝关节骨关节炎（KOA）。CKS与疼痛、丧失独立性、 和死亡率的增加。CKS的比率正在增加，这是由衰老、肥胖和久坐所推动的。 社会由于CKS首先出现在工作年龄的成年人中，因此它是导致工作残疾的主要原因 和工作生产力损失。超过1300万45岁及以上的美国成年人有症状 KOA和CKS，1和三分之一的工作成年人（45-64岁）患有关节炎。 超过一半的KOA患者有严重残疾，将接受全膝关节置换术（TKR）。可悲的是， CKS患者在等待TKR期间进行低效率治疗，部分原因是 参与常规体力活动（PA）的行为挑战。身体活动有 已被证明可以缓解疼痛，改善功能，并防止个人独立性的丧失 在KOA疾病谱中。尽管它的价值，PA水平仍然很低的成年人， CKS和工作场所的成年人。低PA与高医疗保健支出和损失有关， 工人的生产力，为雇主支持巴勒斯坦权力机构的倡议创造了激励。许多工作场所 然而，已经接受了健康计划，以支持员工改善健康状况， 与没有CKS的同事相比，CKS员工的PA率较低。 先前的研究发现，Fitbit跟踪可以改善一些CKS患者的行为 但其他人则受益于更密集的辅导形式。所需的指导量 仍然未知。员工利益相关者要求低资源形式的辅导 通过工作场所。有可能使用一个 可接受的低资源教练策略。该计划的目标是测试一个简短的，可扩展的 PA辅导干预，可以帮助CKS员工获得和保持健康的PA 在中西部的两个工作场所的行为。CAPPA是一项为期12周的随机对照试验， 试验将1）使用计算机指导的行动计划行为干预来支持 员工制定个人健康行动计划，2）使用从个人传输的数据 健身追踪器（Fitbit），以支持教练和员工了解PA性能，以及3） 告知没有显著增加PA的参与者的最佳逐步增加时间。Cappa 将把PA反馈放在运动仪表板中，以支持研究参与者。CAPPA 干预将使用每个参与者的首选通信模式（文本、语音呼叫或视频 聊天），以达到和维持健康的PA行为在蓝十字蓝盾伊利诺伊州和 倡导奥罗拉健康。PA、疼痛和身体功能的随访措施计划在 治疗完成后和研究完成后3个月。 具体目标是：（1）评估干预措施的有效性，以客观地增加- 2）检查测量的身体活动的可行性，可接受性和可持续性， 针对各工作场所的CAPPA干预，以及3）告知 参与者中的未来阶梯式干预不会显著增加他们的身体状况。 活动这项研究利用了联合国儿童基金会的临床和技术专长， 西北大学流变学研究小组的身体活动成员， 西北大学关节炎中心加速度计单位，马奎特大学的行为， 参与和健康技术评估实验室和普适计算实验室，蓝色 十字蓝盾伊利诺伊州公司，并倡导极光健康。如果CAPPA可行， 显示初步有效性，随后将进行多中心随机对照试验/U 01提案 证明CAPPA干预在较大工作场所人群中的有效性。这 研究可能会对改善这些患者的症状和生活质量产生巨大影响。 与CKS和早期KOA。如果在伊利诺斯州的蓝十字蓝盾医院治疗成功， 倡导极光健康，他们可以在他们提供的服务，以其他就业 组织的

PROJECT SUMMARY Society needs effective non-operative therapies to manage chronic knee symptoms (CKS) resulting from knee osteoarthritis (KOA). CKS is associated with pain, loss of independence, and increased mortality. Rates of CKS are increasing, fueled by an aging, obese, and sedentary society. Because CKS first presents in working age adults, it is a major cause of work disability and work productivity loss. Over 13 million US adults 45 years and older have symptomatic KOA and CKS,1 and one-third of working adults (45-64 years) have arthritis.2-4 Of those with KOA, over half have severe disability and will have a total knee replacement (TKR). Sadly, persons with CKS engage in treatments with low effectiveness while waiting for TKR, in part due to the behavioral challenges of engaging in regular physical activity(PA). Physical activity has been shown to relieve pain, improve function, and prevent losses in independence in individuals across the KOA disease spectrum. Despite its value, PA levels remain low among adults with CKS and for adults in the workplace. Low PA is linked to high healthcare spending and losses in worker productivity creating an incentive for employer-support PA initiatives. Many workplaces have embraced wellness programs to support employees in improving their health, however employees with CKS struggle with lower rates of PA than their peers without CKS. Previous research has found that Fitbit tracking can improve behavior for some with CKS but others benefit from more intensive forms of coaching. The exact amount of coaching needed remains unknown. Employee stakeholders have asked for low resource forms of coaching available through the workplace. The potential exists to support employees with CKS using an acceptable, low-resource coaching strategy. The goal of this program is to test a brief, scalable PA coaching intervention that can assist employees with CKS attain and maintain healthy PA behavior in two worksites in the Midwest. CAPPA is a 12-week pilot randomized controlled trial that will 1) use computer-guided action-planning behavioral intervention to support employees in making PA action plans for their health, 2) use data transmitted from a personal fitness tracker (Fitbit) to support coach and employee knowledge about PA performance, and 3) Inform on optimal step up times for participants who do not substantially increase PA. CAPPA will put PA feedback in a Movement Dashboard to support study participants. The CAPPA intervention will use each participant’s preferred communication mode (text, voice call, or video chat) to attain and sustain healthy PA behavior at Blue Cross Blue Shield of Illinois and Advocate Aurora Health. Follow-up measures of PA, pain and physical function are planned at treatment completion and three months following study completion. Specific aims are to: 1) Estimate the efficacy of the intervention to increase objectively- measured physical activity, 2) Examine the feasibility, acceptability and sustainability of the CAPPA intervention for the respective workplaces, and 3) Inform the initial step up time for future stepped interventions among participants not substantially increasing their physical activity. This study leverages the combined clinical and technologic expertise of the members of the Physical Activity in Rheumatology Research group at Northwestern University, Northwestern’s Arthritis Center Accelerometer unit, Marquette University’s Behavior, Engagement and Health Technology Assessment Lab and Ubiquitous Computing Lab, the Blue Cross Blue Shield of Illinois Corporation, and Advocate Aurora Health. If CAPPA is feasible and shows preliminary effectiveness, a multi-site randomized controlled trial/U01 proposal will follow to demonstrate the effectiveness of the CAPPA intervention in larger worksite populations. This research could have a tremendous impact on improving symptoms and quality of life for those with CKS and early KOA. If treatments are successful at Blue Cross Blue Shield of Illinois and Advocate Aurora Health they may be employed in the services they provide to other organizations.