Feasibility of At Home Telehealth Yoga for Treating Chronic Pain

摘要：50%-75%的初级保健退伍军人报告经历了慢性疼痛(1，2)。慢性疼痛是 治疗耐药，药物治疗往往包括上瘾或过量用药的风险。认识到这一范围 对于这个问题，退伍军人管理局促进了补充和综合健康(CIH)，以便与 传统的疼痛治疗。瑜伽是一种流行的CIH方法，对许多类型的 慢性疼痛。最近的一篇文献综述得出的结论是，瑜伽作为一种锻炼方式的证据尤其有力。 治疗慢性肌肉骨骼类疼痛，这是最常见的慢性疼痛类型。因此， 这项建议的重点是瑜伽治疗慢性肌肉骨骼疼痛。退伍军人事务部帕洛阿尔托医疗保健 System使用两种方式为退伍军人提供临床瑜伽计划：传统的面对面瑜伽和诊所- 基于远程瑜伽，瑜伽教练使用实时互动与退伍军人医院的退伍军人进行交流 视频会议。我们的试点数据表明，基于诊所的电视瑜伽与面对面瑜伽一样安全有效 用于治疗慢性肌肉骨骼疼痛。然而，这种远程医疗模式不能克服障碍，例如 去诊所旅行的时间、费用和困难。最近，退伍军人管理局推出了一项新的基于网络的远程医疗 名为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交流 从家里通过一台平板电脑。VVC可用于小组或个人会话，具有巨大的潜力 因为她在家送治疗。其他研究小组早些时候试图开发在家使用的电视瑜伽 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 资源充足、可扩展且技术先进的系统。理想情况下，随机对照试验应该是 在治疗慢性肌肉骨骼疼痛方面，严格比较了居家电传瑜伽和亲身瑜伽。 在考虑这样的试验之前，我们需要评估和克服交付的技术障碍 使用VVC的居家电视瑜伽。该建议的第一阶段侧重于完善现有的瑜伽方案以使其成为 适用于通过VVC(n=20)提供的家庭电视瑜伽治疗肌肉骨骼疼痛。每个退伍军人都会 得到一台平板电脑，我们将使用迭代过程来确定和克服技术上的 这项技术带来的限制。这一阶段的成果将是为期12周的瑜伽干预。第二阶段 将展示一项涉及家庭电视瑜伽的随机对照试验的可行性 瑜伽方案是在第一阶段制定的。我们将招募患有慢性肌肉骨骼疼痛的退伍军人并将其随机分组 两个治疗组中的一个：亲身瑜伽和居家电瑜伽(n=15)。初步可行性 结果将包括招聘、保留、遵守协议的比率、参与者满意度、忠诚度 治疗交付和不良事件。我们还将评估测量心率变异性的可行性，因为 与瑜伽可能的作用机制有关的实验结果。结果将提供 更大规模随机对照试验的早期可行性数据。

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.