Optimizing Physical Activity Outcomes for Veterans After Total Knee Arthroplasty

优化全膝关节置换术后退伍军人的身体活动结果

• 批准号: 10329916
• 负责人: Cory L Christiansen
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10329916
• 关键词: Accelerometer; Acute; Address; Behavior; Chronic; Clinical; Control Groups; Data; Degenerative Disorder; Degenerative polyarthritis; Education; Feedback; Health; Health Status; Health Surveys; Healthcare; Healthcare Systems; Home; Impairment; Intervention; Knee; Knowledge; Life; Link; Measures; Methods; Monitor; Operative Surgical Procedures; Outcome; Pain; Patient Self-Report; Performance; Physical Function; Physical activity; Postoperative Period; Problem Solving; Psychosocial Factor; Randomized Controlled Trials; Rehabilitation therapy; Resources; Rural; Self Efficacy; Services; Social support; Standardization; Technology; Testing; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Walking; Western Ontario and McMaster Universities Arthritis Index; base; behavior change; clinical implementation; comorbidity; cost; disability; evidence base; fear of falling; functional outcomes; health care service utilization; improved; indexing; innovation; intervention cost; knee replacement arthroplasty; meetings; military veteran; novel; physical therapist; physically handicapped; primary endpoint; primary outcome; randomized trial; rehabilitation paradigm; rehabilitation strategy; secondary outcome; telerehabilitation; trend; wearable sensor technology

More than 700,000 total knee arthroplasty surgeries are performed annually to alleviate pain and disability associated with osteoarthritis; a chronic, degenerative condition present in 43% of Veterans using VA services. Although total knee arthroplasty intervention improves pain and self-reported physical function, objective physical activity remains low and nearly unchanged from pre-surgery levels up to one year after rehabilitation. These data suggest that current conventional rehabilitation, primarily directed towards acute post-operative impairment, does not address the key-underlying problem of persistent physical activity behaviors after total knee arthroplasty. The negative health consequences of low physical activity are well documented. Therefore, the primary aim of this randomized controlled trial is to assess the efficacy of physical activity behavior-change telerehabilitation as an adjunct to contemporary rehabilitation for increasing physical activity behavior following total knee arthroplasty. The novel, low-cost intervention incorporates evidence-based behavior-change methods and telerehabilitation technology. Outcomes will be assessed immediately before total knee arthroplasty, at rehabilitation midpoint, end of rehabilitation (primary end point), and 24 weeks after rehabilitation. The primary outcome will be accelerometer-assessed average daily step count. Secondary outcomes include: average daily time spent in standing and walking activity, self-reported physical activity (Life Space Assessment), performance-based physical function (30-Second Chair-Stand Test, Timed Up-and-Go, Six-Minute Walk Test), self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index and Veterans 12-Item Health Survey), healthcare utilization and secondary health problems. The distinct and unique rehabilitation paradigm used in this study addresses the problem of chronic poor physical activity following total knee arthroplasty. The proposed intervention also adds value to current VA telerehabilitation technology by improving rehabilitation accessibility. The products of this trial will advance rehabilitation knowledge and provide necessary evidence for the clinical implementation of physical activity behavior-change telerehabilitation for the large population of Veterans recovering from total knee arthroplasty.

每年进行超过700,000次总膝关节置换术手术以减轻疼痛和残疾 与骨关节炎有关；使用VA服务的退伍军人中有43％的退伍军人出现了一种慢性，退行性的状况。 尽管总膝关节置换术会改善疼痛和自我报告的身体功能，但客观 体育锻炼保持较低，康复后一年后的手术前水平几乎没有变化。 这些数据表明，当前的常规康复主要是针对急性术后的 损害，无法解决持续的体育活动行为的关键问题 膝关节置换术。低体育活动的负面健康后果已得到充分记录。所以， 这项随机对照试验的主要目的是评估体育活动行为改变的功效 远离居民作为当代康复的辅助，以增加体育活动行为 总膝关节置换术。小说，低成本干预融合了基于证据的行为变化 方法和居室技术。结果将在总膝盖之前立即进行评估 关节置换术，在康复中点，康复终点（主要终点），后24周 康复。主要结果将是加速度计的平均每日步数。次要 结果包括：站立和步行活动，自我报告的体育活动（生活）的平均每日时间 空间评估），基于性能的身体功能（30秒的椅子架测试，定时和行程， 六分钟的步行测试），自我报告的身体功能（西安大略省和麦克马斯特大学 骨关节炎指数和退伍军人12项健康调查），医疗保健利用和中等健康 问题。本研究中使用的独特而独特的康复范式解决了慢性的问题 全膝关节置换术后的身体活动不佳。拟议的干预还增加了当前VA的价值 通过改善康复可访问性，远程访问技术。该试验的产品将推进 康复知识并为体育锻炼的临床实施提供必要的证据 从总膝关节性置换术中恢复的大量退伍军人的行为改变远程居民。