A Pragmatic Trial to Determine the Benefit of Behaviorally Enhanced Exercise Incentives and Corticosteroid Injections in Osteoarthritis of the Knee

确定行为强化运动激励和皮质类固醇注射对膝骨关节炎的益处的务实试验

• 批准号: 10508504
• 负责人: JOSHUA F. BAKER
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10508504
• 关键词: Accelerometer; Address; Adrenal Cortex Hormones; Analgesics; Area; Arthritis; Behavioral; Biological; Cartilage; Chronic; Clinic Visits; Clinical; Clinical Trials; Clinical effectiveness; Collaborations; Country; Crossover Design; Data; Discipline; Disease Progression; Double-Blind Method; Effectiveness of Interventions; Elements; Ensure; Exercise; Exercise Therapy; Fatigue; Feasibility Studies; Functional disorder; Funding; Goals; Health; Incentives; Inflammatory Arthritis; Infrastructure; Injections; Intervention; Knee Osteoarthritis; Knowledge; Lead; Lidocaine; Magnetic Resonance Imaging; Measures; Mediating; Medical; Metabolic; Morbidity - disease rate; Network Infrastructure; Obesity; Outcome; Outcome Assessment; Pain; Participant; Patient Outcomes Assessments; Patient Self-Report; Patients; Physical Function; Physical activity; Pilot Projects; Play; Population; Provider; Quality of life; Randomized; Randomized Clinical Trials; Replacement Arthroplasty; Reporting; Research Design; Research Personnel; Resources; Safety; Saline; Subgroup; Symptoms; Technology; Testing; Thick; Time; Veterans; base; behavior change; behavioral economics; cost; design; disability; effective therapy; experience; improved; improved functioning; innovation; mobile application; mortality; organizational structure; osteoarthritis pain; pain reduction; pragmatic trial; randomized trial; recruit; rehabilitation research; response; satisfaction; side effect; smartphone Application; social

Knee osteoarthritis (KOA) is one of the most prevalent and disabling conditions among veterans and accounts for high morbidity and high costs for the VA. Importantly, chronic reductions in physical activity in patients with KOA may worsen pain, physical function, and exacerbate the metabolic consequences of obesity. The current proposal aims to address two important knowledge gaps in the management of KOA in order to improve pain and function. Promoting physical activity has been shown to be helpful in reducing pain and improving function in KOA, however, reliable ways to change behavior that can be easily employed are lacking. Our group has shown that social incentives derived from concepts from the field of behavioral economics to promote behavioral change and increase physical activity can be both practical and effective in other settings. The efficacy and safety of incentivizing physical activity using these approaches has not been studied in patients with KOA. Furthermore, whether adjunct therapies such as corticosteroid injections may be a helpful to reduce pain and disability and increase physical activity is unknown and is an additional knowledge gap addressed by the current proposal. Despite widespread use, definitive data to quantifying the benefit, if any, of corticosteroid injections are lacking. A large randomized trial tested the effects of corticosteroids injections every 3 months for a period of 2 years on patient reported pain. This study demonstrated no improvement in pain compared to saline and a small decline in cartilage thickness on MRI in the corticosteroid group. These data might suggest that corticosteroid injections result in more harm than good, however, there are critical weaknesses to this study including that pain and function were only assessed at 3-month intervals, while previous trials have suggested that peak benefit is expected at 4-8 weeks. We propose to fill these important knowledge gaps with an innovative and efficient pragmatic study. The aims are (1) To determine whether an incentive based on behaviorally-enhanced gamification can improve physical activity among patients with KOA and reduce self-reported pain and disability, and (2) to determine if corticosteroid injections can reduce pain and disability in patients with KOA when compared to lidocaine only. This double-blinded randomized clinical trial of 220 patients using a factorial and crossover design will leverage unique resources available through the Penn Center for Innovation to capture important patient-reported outcomes. We will randomize participants to receive social incentives with gamification to promote increases in physical activity. Each patient will also receive both corticosteroids and saline in random order. We will utilize innovative mobile applications for smart phones and wearable activity trackers through the Way-to-HealthTM platform and assess, in real time, the impact of the interventions on patient-reported function and pain as well as physical activity. The technology will allow for the recording of outcomes as they occur, thereby avoiding information bias due to poor recall. The study will determine the benefit of social incentivization to promote increases in physical activity in patients with KOA and to determine the efficacy of corticosteroid injections for improving function, increasing physical activity, and reducing pain. Our RR&D funded pilot study demonstrated high feasibility and provided important preliminary data to accurately power the larger study. The study includes experts across multiple disciplines and also leverages existing networks and infrastructure that will ensure feasibility through a strong organizational structure and close collaboration between investigators.

膝骨关节炎 (KOA) 是退伍军人和军人中最常见和最致残的疾病之一 VA 的高发病率和高成本。重要的是，长期减少体力活动的患者 KOA 可能会加重疼痛、身体功能，并加剧肥胖的代谢后果。目前的 该提案旨在解决 KOA 管理中的两个重要知识差距，以改善疼痛 和功能。促进身体活动已被证明有助于减轻疼痛和改善功能 然而，在 KOA 中，缺乏可以轻松采用的改变行为的可靠方法。我们组有 研究表明，源自行为经济学领域概念的社会激励可以促进 在其他环境中，行为改变和增加体力活动既实用又有效。这 尚未在患者中研究使用这些方法激励身体活动的有效性和安全性 与KOA。此外，皮质类固醇注射等辅助疗法是否有助于减少 疼痛和残疾以及增加体力活动是未知的，并且是一个额外的知识差距 当前的提案。尽管广泛使用，但量化皮质类固醇的益处（如果有）的明确数据 缺乏注射。一项大型随机试验测试了每 3 个月注射一次皮质类固醇的效果 患者报告疼痛长达 2 年。这项研究表明，与相比，疼痛没有改善 盐水和皮质类固醇组的 MRI 软骨厚度略有下降。这些数据可能表明 皮质类固醇注射弊大于利，然而，这存在严重的弱点 研究包括仅每隔 3 个月评估一次疼痛和功能，而之前的试验 预计受益高峰期为 4-8 周。我们建议填补这些重要的知识空白 创新、高效、务实的研究。目的是 (1) 确定激励措施是否基于 行为增强的游戏化可以改善 KOA 患者的体力活动 减少自我报告的疼痛和残疾，以及（2）确定皮质类固醇注射是否可以减少 与仅使用利多卡因相比，KOA 患者的疼痛和残疾情况。本次双盲 使用析因和交叉设计对 220 名患者进行的随机临床试验将利用独特的资源 可通过宾夕法尼亚州创新中心获取重要的患者报告结果。我们将 通过游戏化随机分配参与者接受社会激励，以促进体育活动的增加。 每个患者还将按随机顺序接受皮质类固醇和盐水。我们将利用创新的移动设备 通过 Way-to HealthTM 平台开发智能手机和可穿戴活动追踪器的应用程序并评估， 实时显示干预措施对患者报告的功能、疼痛以及身体活动的影响。 该技术将允许记录发生的结果，从而避免由于信息偏差 记性不好。该研究将确定社会激励对促进体力增加的好处 评估 KOA 患者的活动情况并确定皮质类固醇注射对于改善功能的功效， 增加体力活动，减少疼痛。我们的 RR&D 资助的试点研究证明了高度的可行性和 提供了重要的初步数据，以准确地支持更大规模的研究。该研究包括各个领域的专家 多个学科，并利用现有网络和基础设施，通过 强大的组织结构和调查人员之间的密切合作。