Caring for older veterans with chronic low back pain using a geriatric syndrome approach: Rationale and methods for the aging back clinics (ABC) trial.
Caring for older veterans with chronic low back pain using a geriatric syndrome approach: Rationale and methods for the aging back clinics (ABC) trial.
复制标题
使用老年综合征方法护理患有慢性腰痛的老年退伍军人：老年背部诊所 (ABC) 试验的基本原理和方法。
DOI：
10.1016/j.cct.2020.106077
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发表时间：
2020
影响因子：
2.2
通讯作者：
Perera,Subashan
中科院分区：
文献类型：
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作者：
Weiner,DebraK;Gentili,Angela;Fang,MeikaA;Garay,Edward;Annaswamy,Thiru;Castle,Steven;Joseph,Lenore;Lawson,Laura;Lee,CathyC;Makris,UnaE;Rossi,MichelleI;Thorn,Beverly;Clemens,Kimberly;Newman,Dave;Perera,Subashan
正在进行的试验的目的是改善对患有慢性腰痛（CLBP，即，腰痛≥6个月，≥半天）。目前的CLBP护理受到过度脊柱集中或非特异性规定的限制，这两种方法经常导致疼痛的次优减轻和功能的改善。通过先前的研究，我们为以患者为中心的方法治疗老年CLBP退伍军人奠定了基础，其中脊柱是脆弱性的来源，但不是唯一的治疗目标。该方法认为CLBP是一种老年综合征，是多个贡献者表达的最终共同途径，而不是脊柱疾病。我们在这里描述了一项随机对照试验的原理和设计，以测试老年退伍军人为中心的方法来CLBP护理的有效性，在“老化背部诊所（ABC）”与社区护理（UC）相比。330名年龄在65-89岁的CLBP退伍军人将被随机分配到ABC或UC组，并在随机分配后随访12个月。我们将在6个月和12个月时使用奥斯韦斯特里残疾指数评估ABC对疼痛相关残疾的主要结局的影响，以及对疼痛强度、健康相关生活质量、平衡信心、移动性和医疗保健利用的次要结局的影响。如果证明有效，在ABC中测试的方法有可能通过改善数百万人的生活质量，降低发病率和节省大量医疗费用来改变CLBP老年人的护理。
The purpose of the ongoing trial is to improve care of older Veterans with chronic low back pain (CLBP, i.e., low back pain for ≥6 months on ≥ half the days). Current CLBP care is limited by being either overly spine-focused or non-specifically prescribed and both approaches frequently lead to suboptimal reduction in pain and improvement in function. Through prior studies we have laid the foundation for a patient-centered approach to care for older Veterans with CLBP in which the spine is a source of vulnerability but not the sole treatment target. The approach considers CLBP a geriatric syndrome, a final common pathway for the expression of multiple contributors rather than a disease of the spine. We describe here the rationale and design of a randomized controlled trial to test the efficacy of an older Veteran-centered approach to CLBP care in “Aging Back Clinics (ABCs)” compared with Usual Care (UC). Three hundred thirty Veterans age 65–89 with CLBP will be randomized to ABCs or UC and followed for 12 months after randomization. We will assess the impact of ABCs on our primary outcome of pain-associated disability with the Oswestry Disability Index at 6 and 12 months, and secondary outcomes of pain intensity, health-related quality of life, balance confidence, mobility and healthcare utilization. If shown efficacious, the approach tested in ABCs has the potential to transform the care of older adults with CLBP by improving the quality of life for millions, reducing morbidity and saving substantial healthcare costs.