Developing a Novel Clinical Care Model for Chronic Patellar Tendinopathy Utilizing Whole Person Healthcare

利用全人医疗保健开发慢性髌腱病的新型临床护理模式

• 批准号: 10739428
• 负责人: Laura Stanley Pietrosimone
• 金额: $ 15.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-10 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739428
• 关键词: Address; Adopted; Behavioral; Benchmarking; Biofeedback; Biological; Biomechanics; Cancer Burden; Caring; Case Series; Chronic; Chronic Disease; Clinical; Clinical Management; Clinical Research; Clinical Trials; Comprehensive Health Care; Data; Development; Diabetes Mellitus; Economic Burden; Enrollment; Etiology; Exercise; Fostering; Frequencies; Funding; Future; Goals; Health; Healthcare; Heart Diseases; Individual; Intervention; Interview; K-Series Research Career Programs; Knee; Knowledge; Lead; Literature; Manuals; Measurement; Measures; Mechanics; Mental Health; Mentors; Methodology; Methods; Military Personnel; Mission; Modeling; Movement; Musculoskeletal; Musculoskeletal Pain; Outcome; Outcomes Research; Pain; Pathway interactions; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Personal Satisfaction; Physical Function; Physical activity; Procedures; Protocols documentation; Public Health; Quality of life; Randomized, Controlled Trials; Rehabilitation therapy; Research; Safety; Standardization; Structure; Symptoms; Techniques; Tendinopathy; Tendon structure; Testing; Therapeutic Intervention; Tissues; Training; Treatment outcome; United States National Institutes of Health; Work; acceptability and feasibility; appropriate dose; biopsychosocial; career; chronic care model; chronic musculoskeletal pain; clinical care; design; disability; effective intervention; efficacy evaluation; evidence base; experience; high risk; improved; innovation; intervention refinement; model design; multimodality; novel; patellar tendon; patient engagement; patient oriented; patient population; personalized care; physical conditioning; pragmatic trial; primary outcome; programs; progressive care; psychologic; psychological distress; randomized, clinical trials; randomized, controlled study; recruit; retention rate; secondary outcome; social; standard of care; therapy development; tool; traditional care; treatment group; treatment strategy; wearable sensor technology; whole health; years lived with disability

Abstract Individuals with chronic MSK pain conditions who experience disability-related limitations in physical activity participation are at higher risk for poor physical and mental health outcomes. Chronic patellar tendinopathy is a highly prevalent chronic MSK condition that severely limits performance, physical activity, self-perceived function, and quality of life. Whole person health (WPH) is a comprehensive framework that considers interconnected domains (biological, behavioral, social, environmental) that foster health, and is designed to facilitate multicomponent therapeutic interventions. The applicant’s long-term career objective is to establish a funded research program that develops and evaluates a WPH model to decrease disability and improve quality of life for individuals with for chronic musculoskeletal pain conditions. Current standard of clinical care for patients with chronic patellar tendinopathy take a unifocal approach, emphasizing local tendon pain and capacity, does not incorporate other factors (psychological, social, environmental) that may contribute to the patient’s overall health. The overall objective of this study for this career development award is to develop a WHP framework that is responsive to the critical gaps in the literature and will inform future intervention approaches for patellar tendinopathy. The approach will expand the standard of care progressive loading exercise treatment (PLE) utilizing individualized biofeedback augmented movement retraining and behavioral graded exposure techniques to develop and refine a novel patellar tendon WPH intervention (WPH), and evaluate feasibility, acceptability, and responsiveness of key biopsychosocial outcomes (landing mechanics, psychological distress, tendon stiffness). The central hypothesis of this study is that individuals with chronic patellar tendinopathy who utilize novel WPH for patellar tendinopathy rehabilitation will demonstrate improvements in self-reported function, landing biomechanics, and tissue capacity. The hypothesis will be tested through three specific aims: 1) refine WPH intervention protocols through a small case series study using mixed-methods approach, 2) establish feasibility and acceptability benchmarks, and 3) determine safety and responsiveness of WPH compared to PLE on primary outcome of (a) patient self-reported function and psychological distress, and secondary outcomes of (b) landing biomechanics and (c) patellar tendon stiffness through a pilot randomized controlled study. The proposed work is innovative, in that: 1) it will be the first study to utilize a WPH framework compared to standard of care and evaluate a novel combination of outcomes for the treatment of chronic tendinopathy. The study is significant as it addresses an important gap in knowledge, moving beyond outdated traditional care models to create novel clinical care model designed to mitigate the debilitating effects of tendon pain on quality of life. Doing so takes a substantial step forward to enhance patient-oriented long-term outcomes for individuals with chronic musculoskeletal pain conditions.

抽象的 患有慢性 MSK 疼痛且身体活动受到残疾相关限制的个体 慢性髌腱病是一种导致身体和心理健康状况不佳的风险。 高度普遍的慢性 MSK 病症，严重限制表现、体力活动、自我认知 整体健康（WPH）是一个考虑到功能和生活质量的综合框架。 促进健康的相互关联的领域（生物、行为、社会、环境），旨在 促进多成分治疗干预措施。申请人的长期职业目标是建立。 一项资助的研究计划，开发和评估 WPH 模型以减少残疾并改善 慢性肌肉骨骼疼痛患者的生活质量当前的临床护理标准。 对于慢性髌腱病患者，采取单焦点治疗方法，强调局部肌腱疼痛和 能力，不包含可能有助于的其他因素（心理，社会，环境） 这项职业发展奖研究的总体目标是制定一个患者的整体健康状况。 WHP 框架对文献中的关键差距做出了回应，并将为未来的干预提供信息 该方法将扩大渐进式负荷的护理标准。 利用个体化生物反馈增强运动再训练和行为的运动治疗（PLE） 分级暴露技术来开发和完善新型髌腱干预（WPH），以及 评估关键生物心理社会结果（着陆力学、 心理困扰、肌腱僵硬）这项研究的中心假设是患有慢性疾病的个体。 使用新型 WPH 进行髌腱病康复的髌腱病患者将证明 自我报告的功能、着陆生物力学和组织能力的改善。 通过三个具体目标进行测试：1）通过小型病例系列研究完善 WPH 干预方案 使用混合方法，2) 建立可行性和可接受性基准，3) 确定安全性 与 PLE 相比，WPH 对以下主要结果的反应：(a) 患者自我报告的功能和 心理困扰，以及 (b) 着陆生物力学和 (c) 髌腱僵硬的次要结果 通过一项试点随机对照研究，拟议的工作具有创新性，因为：1）这将是第一个。 研究利用 WPH 框架与护理标准进行比较并评估新的结果组合 这项研究对于治疗慢性肌腱病具有重要意义，因为它解决了这一领域的一个重要空白。 知识，超越过时的传统护理模式，创建新颖的临床护理模式，旨在 减轻肌腱疼痛对生活质量的破坏性影响是向前迈出的一大步。 增强慢性肌肉骨骼疼痛患者以患者为中心的长期结果。