I CARE for Vets: InCreasing Activity & REcovery for Veterans with PTSD

我关心退伍军人：增加活动

• 批准号: 10013894
• 负责人: Wei Duan-Porter
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013894
• 关键词: Address; Adult; Attitude; Behavior Control; Behavioral; Belief; Body Weight decreased; Cardiovascular Diseases; Caring; Chronic; Clinic; Clinical; Clinical Services; Communication; Data; Data Collection; Development; Diabetes Mellitus; Enrollment; Exercise; Exercise Therapy; Fatigue; Funding; Future; Goals; Health; Health Technology; Health behavior; Heart Diseases; High Prevalence; Home environment; Household; Impairment; Individual; Intervention; Interview; Knowledge; Lead; Life Style; Manuals; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Mission; Modeling; Obesity; Outcome; Pain; Participant; Patient Recruitments; Patients; Persistent pain; Persons; Physical Function; Physical activity; Pilot Projects; Population; Post-Traumatic Stress Disorders; Primary Health Care; Procedures; Process; Process Assessment; Protocols documentation; Quality of life; Randomized Controlled Trials; Recovery; Reporting; Research; Research Personnel; Research Project Grants; Risk; Self Efficacy; Sleep; Structure; Symptoms; Techniques; Telephone; Testing; Time; Training; United States National Institutes of Health; Veterans; Visit; Walking; Work; base; chronic pain; clinical care; comorbidity; depressive symptoms; effective intervention; effectiveness trial; exercise intervention; experience; flexibility; functional restoration; health administration; improved; improved functioning; innovation; mHealth; mortality; motivational enhancement therapy; novel; outpatient programs; physical therapist; post intervention; programs; randomized trial; recruit; sleep quality; social; synergism; therapy development; usability

Veterans with posttraumatic stress disorder (PTSD) have poor physical functioning and there are no existing interventions that effectively address this problem. Our long-term goal is to develop and implement effective interventions to improve physical functioning and reduce risk for adverse health outcomes for Veterans with PTSD. The overall objectives of the proposed project are to develop and pilot test a novel intervention aimed at initiating and maintaining higher levels of physical activity for Veterans with PTSD. This new intervention will address attitudinal and behavioral barriers to increasing physical activity for Veterans with PTSD. Particularly relevant barriers for those with PTSD may include low perceived behavioral control for making positive long- term lifestyle changes and personal attitudes about the harms (vs. benefits) of physical activity. The proposed work will meet two specific aims: 1) Adapt graded exercise therapy (GET) and incorporate motivational interviewing and mobile health technology (mHealth) to increase physical activity for Veterans with PTSD; and 2) conduct a pilot study to examine the feasibility and acceptability of the intervention for a future randomized controlled trial. To achieve Aim 1, we will develop treatment manuals, training procedures for interventionists, and processes for assessment of intervention fidelity. The intervention will use GET to increase perceived behavioral control by enhancing knowledge about appropriate activities and helping participants set appropriate and attainable daily goals for physical activity. We will also incorporate motivational interviewing techniques and mHealth to enhance positive personal attitudes about physical activity. We will work with our Veteran Engagement Panel for PTSD to refine topics and communication materials. In Aim 2, we will enroll 3 groups of 6-8 participants (18-24 total) and use a concurrent mixed-methods approach to rapidly assess feasibility and acceptability. Quantitative measures will include recruitment (proportion enrolled out of total eligible); attendance (proportion who attend 75% of in-person visits); and retention (proportion who complete post-intervention data collection). Qualitative assessment will consist of semi-structured interviews on acceptability of intervention components (eg, format and topics of in-person visits, usability of mHealth), and barriers and facilitators to attendance. At baseline, during, and post-intervention, we will also measure overall and physical functioning, and collect data on other clinical variables (PTSD symptoms, depressive symptoms, pain, fatigue, and sleep quality) to inform a future effectiveness trial. The proposed work is innovative because it is a novel combination of GET, motivational interviewing, and mHealth to increase physical activity. It will also be the first intervention to focus on changing physical activity as a means to improving physical functioning for individuals with PTSD. Successful experiences with this program may also help participants build confidence about their general ability to make positive changes related to health, thus increasing the likelihood they will engage in (and adhere to) mental health treatments. If such synergy is ultimately demonstrated, it will open a new direction for VA RR&D and VHA clinical care by indicating that interventions focusing on physical functioning should be more closely integrated with mental health services. Additionally, this project will be one of the first to collaborate with our Veteran Engagement Panel on PTSD research. The format of our panel is adapted from and builds upon previous models of patient stakeholder engagement. Our model addresses many of the barriers to effective stakeholder engagement, including challenges to timely recruitment of patients with relevant experiences, and lack of facilitation expertise among investigators. Completion of this project will help establish the utility of our model of Veteran stakeholder engagement for rapidly developing effective interventions with improved feasibility and acceptability. Thus, this work will enable incorporation of Veteran engagement in future VA research projects.

患有创伤后应激障碍（PTSD）的退伍军人身体机能较差，没有 现有的干预措施可以有效解决这一问题。我们的长期目标是制定和实施 有效的干预措施可改善退伍军人的身体机能并降低不良健康结果的风险 患有创伤后应激障碍。拟议项目的总体目标是开发和试点测试一种新颖的干预措施 旨在为患有创伤后应激障碍（PTSD）的退伍军人启动并维持较高水平的身体活动。这项新的干预措施 将解决患有创伤后应激障碍 (PTSD) 的退伍军人增加体育活动的态度和行为障碍。特别 对于患有创伤后应激障碍（PTSD）的人来说，相关障碍可能包括感知行为控制能力低，无法做出积极的长期行为。 术语生活方式的改变和个人对体育活动的危害（与益处）的态度。 拟议的工作将实现两个具体目标：1）适应分级运动疗法（GET）和 结合动机访谈和移动健康技术（mHealth）来增加体力活动 患有创伤后应激障碍 (PTSD) 的退伍军人； 2）进行试点研究以检验干预措施的可行性和可接受性 用于未来的随机对照试验。为了实现目标 1，我们将制定治疗手册、培训 干预者的程序以及干预保真度的评估过程。干预将使用 GET 通过增强有关适当活动的知识和帮助来增强感知行为控制 参与者设定适当且可实现的日常身体活动目标。我们还将融入激励 访谈技巧和移动健康，以增强个人对身体活动的积极态度。我们将工作 与我们的 PTSD 退伍军人参与小组一起完善主题和沟通材料。在目标 2 中，我们将 招募 3 组，每组 6-8 名参与者（总共 18-24 人），并使用并行混合方法快速评估 可行性和可接受性。定量措施将包括招生（入学人数占总人数的比例） 有资格的）;出席率（参加现场访问的比例为 75%）；和保留率（完成任务的比例） 干预后数据收集）。定性评估将包括半结构化访谈 干预措施的可接受性（例如，亲自就诊的形式和主题、移动医疗的可用性），以及 出席的障碍和促进因素。在基线、干预期间和干预后，我们还将衡量总体情况 和身体机能，并收集其他临床变量的数据（创伤后应激障碍症状、抑郁症状、 疼痛、疲劳和睡眠质量），为未来的有效性试验提供信息。 拟议的工作具有创新性，因为它是 GET、动机访谈、 和移动医疗以增加体力活动。这也将是第一个专注于改变身体活动的干预措施 作为改善 PTSD 患者身体机能的一种手段。这方面的成功经验 计划还可以帮助参与者建立对自己做出积极改变的总体能力的信心 健康，从而增加他们参与（并坚持）心理健康治疗的可能性。如果这样的话 最终证明协同作用，它将为 VA RR&D 和 VHA 临床护理开辟新方向 注重身体机能的干预措施应与心理健康服务更紧密地结合起来。 此外，该项目将是首批与我们的 PTSD 退伍军人参与小组合作的项目之一 研究。我们小组的格式改编自并建立在以前的患者利益相关者模型的基础上 订婚。我们的模型解决了利益相关者有效参与的许多障碍，包括 及时招募具有相关经验的患者面临的挑战，以及缺乏协助专业知识 调查人员。该项目的完成将有助于建立我们的资深利益相关者模型的效用 参与快速制定有效的干预措施，提高可行性和可接受性。因此，这个 这项工作将使退伍军人参与未来的退伍军人事务部研究项目。