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: 10067376
• 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 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10067376
• 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 例全膝关节置换手术，以减轻疼痛和残疾 与骨关节炎有关； 43% 使用 VA 服务的退伍军人患有慢性退行性疾病。 尽管全膝关节置换术干预可改善疼痛和自我报告的身体功能，但客观 康复后一年内，身体活动量仍然很低，并且与手术前水平几乎没有变化。 这些数据表明，目前的常规康复主要针对术后急性期 损害，并没有解决总体后持续身体活动行为的关键根本问题 膝关节置换术。低体力活动对健康的负面影响是有据可查的。所以， 这项随机对照试验的主要目的是评估身体活动行为改变的功效 远程康复作为当代康复的辅助手段，用于增加以下身体活动行为 全膝关节置换术。这种新颖的低成本干预措施结合了基于证据的行为改变 方法和远程康复技术。结果将在全膝关节置换术之前立即进行评估 关节置换术，康复中点、康复结束（主要终点）以及术后 24 周 康复。主要结果将是加速计评估的平均每日步数。中学 结果包括：平均每天站立和行走活动所花费的时间、自我报告的身体活动（生活 空间评估）、基于表现的身体功能（30 秒椅子站立测试、定时起立、 六分钟步行测试），自我报告身体机能（西安大略大学和麦克马斯特大学 骨关节炎指数和退伍军人 12 项健康调查）、医疗保健利用率和二级健康 问题。本研究中使用的独特康复模式解决了慢性病的问题 全膝关节置换术后体力活动不良。拟议的干预措施还为当前的 VA 增加了价值 通过提高康复可达性来实现远程康复技术。本次试验产品将推进 康复知识，为临床实施体育活动提供必要的依据 为大批从全膝关节置换术中恢复的退伍军人提供行为改变远程康复。