Feasibility of At Home Telehealth Yoga for Treating Chronic Pain

在家远程保健瑜伽治疗慢性疼痛的可行性

• 批准号: 10184910
• 负责人: Peter J. Bayley
• 金额: $ 35.11万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10184910
• 关键词: Address; Adherence; Adult; Adverse event; Ambulatory Care Facilities; American College of Physicians; Benchmarking; Caring; Cellular Phone; Chronic; Clinic; Clinical; Cognitive Therapy; Complementary Health; Dangerousness; Data; Devices; Elements; Enrollment; Family; Feasibility Studies; Feedback; Health; Health Personnel; Healthcare Systems; Home environment; Individual; Information Systems; Instruction; Integrative Medicine; Internet; Intervention; Link; Low income; Measurement; Measures; Medical; Modality; Modeling; Musculoskeletal; Musculoskeletal Pain; Online Systems; Opioid; Outcome; Outcome Measure; Overdose; Pain; Pain management; Participant; Patient Outcomes Assessments; Patients; Persons; Pharmaceutical Preparations; Pharmacology; Phase; Primary Health Care; Process; Protocols documentation; Provider; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Resistance; Resources; Review Literature; Risk; Running; Rural; Serious Adverse Event; Structure; Tablet Computer; Tablets; Technology; Time; Transportation; Travel; United States; United States National Institutes of Health; Veterans; Weather; Yoga; addiction; advanced system; barrier to care; base; chronic musculoskeletal pain; chronic pain; chronic pain management; cohort; cost; economic cost; effective therapy; efficacy testing; experience; heart rate variability; innovation; instructor; novel; programs; recruit; retention rate; satisfaction; societal costs; symposium; telehealth; telehealth systems; treatment group

Abstract: Between 50-75% of veterans in primary care report experiencing chronic pain (1, 2). Chronic pain is treatment-resistant, and medications often include the risk of addiction or overdose. In recognition of the scope of this problem, the VA has promoted complementary and integrative health (CIH) for use in conjunction with conventional pain treatments. Yoga is a popular CIH approach and is effective in treating many types of chronic pain. A recent literature review (3) concluded that evidence is particularly strong for yoga as a treatment for chronic musculoskeletal-type pain, which is the most common type of chronic pain. Accordingly, this proposal focuses on yoga treatment for chronic musculoskeletal pain. The VA Palo Alto Health Care System runs a clinical yoga program for veterans using two modalities; traditional in-person yoga, and clinic- based teleyoga in which a yoga instructor communicates with veterans at VA clinics using real-time interactive video conferencing. Our pilot data suggest that clinic-based teleyoga is as safe and effective as in-person yoga for treating chronic musculoskeletal pain. However, this telehealth model does not overcome barriers such as the time, cost and difficulty of travel to a clinic. Very recently, the VA launched a new web-based telehealth system called VA Video Connect (VVC), which allows veterans to communicate with their health care providers from home via a tablet computer. VVC can be used for group or individual sessions and has immense potential for delivering treatments at home. Earlier attempts by other research groups to develop at-home teleyoga have been met with technical problems. VVC offers an exciting opportunity to overcome these problems using a well-resourced, scalable, and technically advanced system. Ideally, a randomized controlled trial would be performed to rigorously compare at-home teleyoga to in-person yoga for treating chronic musculoskeletal pain. Before such a trial can be considered, we need to evaluate and overcome the technical barriers of delivering at-home teleyoga using VVC. Phase 1 of this proposal focuses on refining an existing yoga protocol to make it suitable for treating musculoskeletal pain using at-home teleyoga delivered via VVC (n=20). Each veteran will be given a tablet computer and we will use an iterative process to identify and overcome the technical limitations imposed by the technology. The product of this phase will be a 12-week yoga intervention. Phase 2 will demonstrate the feasibility of conducting a randomized controlled trial involving at-home teleyoga using the yoga protocol developed in Phase 1. We will enroll and randomize veterans with chronic musculoskeletal pain to one of two treatment groups: in-person yoga and at-home teleyoga (n=15 per group). Primary feasibility outcomes will include rates of recruitment, retention, protocol adherence, participant satisfaction, fidelity of treatment delivery, and adverse events. We will also assess the feasibility of measuring heart rate variability as an experimental outcome that is related to the putative mechanism of action of yoga. The results will provide early stage feasibility data for a larger randomized controlled trial.

摘要：初级保健中 50-75% 的退伍军人表示患有慢性疼痛 (1, 2)。慢性疼痛是 治疗耐药，并且药物通常包括成瘾或过量的风险。承认范围 为了解决这个问题，退伍军人管理局提倡补充和综合健康（CIH），与 常规疼痛治疗。瑜伽是一种流行的 CIH 方法，可有效治疗多种类型的疾病 慢性疼痛。最近的一篇文献综述 (3) 得出结论，有证据表明瑜伽作为一种 治疗慢性肌肉骨骼型疼痛，这是最常见的慢性疼痛类型。因此， 该提案的重点是瑜伽治疗慢性肌肉骨骼疼痛。 VA 帕洛阿尔托医疗保健 System 使用两种方式为退伍军人开展临床瑜伽项目：传统的面对面瑜伽和诊所- 基于远程瑜伽，瑜伽教练通过实时互动与退伍军人管理局诊所的退伍军人进行交流 视频会议。我们的试点数据表明，基于诊所的远程瑜伽与现场瑜伽一样安全有效 用于治疗慢性肌肉骨骼疼痛。然而，这种远程医疗模式并没有克服以下障碍： 前往诊所的时间、费用和难度。最近，VA 推出了新的基于网络的远程医疗 称为 VA Video Connect (VVC) 的系统，允许退伍军人与他们的医疗保健提供者进行沟通 在家中通过平板电脑。 VVC 可用于团体或个人会议，潜力巨大 用于在家提供治疗。其他研究小组早期尝试开发家庭远程瑜伽 遇到了技术问题。 VVC 提供了一个令人兴奋的机会来克服这些问题 资源丰富、可扩展且技术先进的系统。理想情况下，随机对照试验是 旨在严格比较家庭远程瑜伽和面对面瑜伽治疗慢性肌肉骨骼疼痛的效果。 在考虑这样的试验之前，我们需要评估并克服交付的技术障碍 使用 VVC 在家进行远程瑜伽。该提案的第一阶段重点是完善现有的瑜伽协议，使其成为 适合使用通过 VVC 提供的家庭远程瑜伽治疗肌肉骨骼疼痛 (n=20)。每个退伍军人都会 给我们一台平板电脑，我们将使用迭代过程来识别和克服技术问题 技术施加的限制。这一阶段的产品将是为期 12 周的瑜伽干预。第二阶段 将证明使用以下方法进行涉及家庭远程瑜伽的随机对照试验的可行性 第一阶段制定的瑜伽方案。我们将招募患有慢性肌肉骨骼疼痛的退伍军人并随机分组 参加两个治疗组之一：面对面瑜伽和家庭远程瑜伽（每组 n=15）。初步可行性 结果将包括招募率、保留率、协议遵守率、参与者满意度、忠诚度 治疗实施和不良事件。我们还将评估测量心率变异性的可行性 与瑜伽的假定作用机制相关的实验结果。结果将提供 大型随机对照试验的早期可行性数据。