Jacobs Cale A, Mace Ryan A, Greenberg Jonathan, Popok Paula J, Reichman Mira, Lattermann Christian, Burris Jessica L, Macklin Eric A, Vranceanu Ana-Maria
Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 740 S. Limestone, Suite K401, Lexington, 40536-0284, KY, USA.
Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, 02114, MA, USA.
Contemp Clin Trials Commun. 2021 Jan 28;21:100720. doi: 10.1016/j.conctc.2021.100720. eCollection 2021 Mar.
Knee osteoarthritis (OA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Mind-body interventions to lessen depressive symptoms and increase physical activity offer the ability to target biological, mechanical and psychological mechanisms of OA progression. Our long-term goals are to evaluate the mechanisms by which the Relaxation Response Resiliency Program (3RP) delivered via secure telehealth, and adapted for patients with depression, obesity and knee OA (GetActive-OA) promotes increases in physical activity and improved knee health. We hypothesize that the synergistic interaction between mindfulness, adaptive thinking, positive psychology and healthy living skills of the GetActive-OA will slow the progression of symptomatic knee OA by reducing pro-inflammatory cytokine expression and promoting optimal mechanical loading of the cartilage. Here we present the protocol for a mixed methods study that will adapt the 3RP for the needs of knee OA patients with depression and obesity with a focus on increasing physical activity (GetActive-OA), and iteratively maximize the feasibility, credibility and acceptability of the programs and research procedures.
膝关节骨关节炎（OA）是美国最常见的关节疾病，也是导致残疾的主要原因。抑郁症和肥胖症在膝关节OA患者中高度共病，肥胖与抑郁症的合并与身体活动减少、疼痛和残疾程度加重以及软骨退化加速有关。抑郁症、肥胖症和OA相互加剧，并且具有涉及全身炎症和促炎细胞因子的共同病理生理学，反映了一种复杂的身心相互作用。目前针对膝关节OA的治疗与安慰剂相比几乎没有益处，并且没有强调针对潜在病理生理学的身心实践或身体活动。减轻抑郁症状并增加身体活动的身心干预能够针对OA进展的生物学、力学和心理机制。我们的长期目标是评估通过安全远程医疗提供并针对抑郁症、肥胖症和膝关节OA患者进行调整的放松反应恢复力计划（3RP）促进身体活动增加和改善膝关节健康的机制。我们假设，GetActive-OA的正念、适应性思维、积极心理学和健康生活技能之间的协同相互作用将通过减少促炎细胞因子表达和促进软骨的最佳机械负荷来减缓症状性膝关节OA的进展。在此，我们展示了一项混合方法研究的方案，该研究将根据抑郁症和肥胖症膝关节OA患者的需求调整3RP，重点是增加身体活动（GetActive-OA），并迭代地最大化该计划和研究程序的可行性、可信度和可接受性。
