A Pilot Randomized Controlled Trial of Resilience Coaching for Adolescents with Chronic Musculoskeletal Pain

项目总结 慢性肌肉骨骼疼痛(CMP)影响多达40%的儿童，主要是青少年，占 大多数新转诊到儿科风湿病。长期的生理和心理社会结果 患有慢性萎缩性侧索硬化症的青少年情况较差，医疗保健利用率增加，心理并存。 此外，目前治疗慢性萎缩性胃炎的治疗方案可获得性有限。弹性是一个动态的过程 在重大逆境中的积极适应或发展，例如生活在过度的慢性 疼痛。在压力管理中促进复原力(PRISM)是一种成功的复原力训练干预 患有严重疾病的青少年和青壮年。这项提案的初步数据显示， 青少年自我复原力与症状严重程度的相关性及可行性研究 以及在患有中医的青年中提供PRISM的可接受性。质量反馈普遍是积极的， 在干预中增加患者小组会议的一致建议。增加了一组患者 在干预措施召开之前，我们现在的目标是确定调整后的干预措施(促进复原力)的影响 青少年慢性肌肉骨骼疼痛的应激管理[PRISM-C]) 一项随机对照试验的结果。拟议项目的总体目标是：(1)确定 PRISM-C在青年慢性萎缩性胃炎人群中的疗效：(2)探讨干预的调节因素 青年最有可能受益于复原力培训，以及(3)评估实施成果并确定 参与PRISM-C的障碍和促进者。这项工作的发现将进一步加深我们对 心理社会因素在青春期中医减轻疾病负担和提高远期疗效中的作用 结果。研究结果将作为R01应用程序执行多中心随机试验的初步数据 PRISM-C治疗青少年慢性萎缩性胃炎对照试验拟议的职业发展奖解决了如何 改善获得跨学科治疗的机会和提高其疗效。非凡的资源和 费城儿童医院和宾夕法尼亚大学的机构支持，杰出 多学科指导团队和拟议的职业发展活动将使应聘者能够 实现她成为一名独立研究员和全国公认的儿科医生的长期目标 在儿科慢性疼痛、恢复力和行为健康干预方面具有专业知识的风湿科医生 改善患有慢性萎缩性麻痹的青少年的长期生理和心理社会结果的目标。

PROJECT SUMMARY Chronic musculoskeletal pain (CMP) affects as many as 4 in 10 children, mostly adolescents, and accounts for the majority of new referrals to pediatric rheumatology. Long-term physical and psychosocial outcomes for adolescents with CMP are poor with increased healthcare utilization and psychological co-morbidities. Additionally, current treatment regimens for CMP have limited accessibility. Resilience is a dynamic process of positive adaptation or development in the context of significant adversity, such as living with excessive chronic pain. Promoting Resilience in Stress Management (PRISM) is a successful resilience-training intervention for adolescents and young adults with serious illness. Preliminary data for this proposal demonstrate a moderate correlation between self-perceived resilience and symptom severity among adolescents as well as high feasibility and acceptability of PRISM delivery among youth with CMP. Qualitative feedback was universally positive with the consistent recommendation to add a patient group session to the intervention. With an added patient group session to the intervention, we now aim to ascertain the impact of the adapted intervention (Promoting Resilience in Stress Management (PRISM) for adolescent Chronic musculoskeletal pain [PRISM-C]) on pain-related clinical outcomes in a randomized controlled trial. The overall objectives of the proposed project are to (1) determine the efficacy of PRISM-C in a population of youth with CMP, (2) explore moderators of the intervention to identify youth most likely to benefit from resilience coaching, and (3) assess implementation outcomes and identify barriers and facilitators to engagement in PRISM-C. Findings from this work will further our understanding of psychosocial factors important in adolescent CMP in order to reduce disease burden and improve long-term outcomes. Study results will serve as preliminary data for an R01 application to perform a multicenter randomized controlled trial of PRISM-C for adolescents with CMP. The proposed Career Development Award addresses how to improve access to and efficacy of interdisciplinary treatments for CMP. The exceptional resources and institutional support at Children’s Hospital of Philadelphia and the University of Pennsylvania, outstanding multidisciplinary mentorship team, and proposed career development activities will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized pediatric rheumatologist with expertise in pediatric chronic pain, resilience, and behavioral health interventions with the goal of improving the long-term physical and psychosocial outcomes for adolescents with CMP.