Partners for Pain & Wellbeing Equity: A Randomized Trial of Community Supported Complementary and Integrative Health Self Management for Back Pain

项目摘要。背痛（BP），包括下背部和颈部疼痛，是最普遍和致残的疾病之一。 疼痛障碍大多数病例仍然管理不善，已知的社会生态因素对公平护理构成障碍 特别是在BP管理中的严重差异。这一点可以从布莱克和 西班牙裔美国人以及受教育程度和收入较低的人，一直经历着较差的结果。 重要的是，BP和其他慢性疾病一样，需要持续的自我管理。不幸的是，大多数提供的护理 通过卫生系统未能支持患者的自我保健，而是专注于昂贵和依赖提供者的治疗 几乎没有支持的研究证据。这些做法的持续使用与基于证据的BP指南相矛盾 建议采用侵入性较小的补充和综合健康（CIH）方法，以支持自我保健。 重要的是，我们的团队已经证明，CIH方法可以在非临床环境中安全有效地提供， 以面对面和视频会议的形式，可以克服造成差异的障碍。 长期目标是支持广泛实施基于证据的CIH方法， 以整个人为导向，为背痛患者提供自我护理，并且他们来自健康状况良好的人群 差异（BP-PEHD）。我们将使用一个两阶段的项目，该项目应用已建立的模型和框架， 长期的可持续性发展，可行性测试，并评估社区支持CIH自我的有效性， 管理计划，Partners 4Pain与主动控制，幸福的关键相比。该项目建立在我们的 团队在BP和CIH自我管理研究方面的广泛背景，并与社区和 具有广泛和多样化影响力的卫生组织，包括基督教青年会、基督教女青年会等。 I期（R61）将涉及随机可行性研究（n=40）的规划和准备，包括联合 开发和评估Partners 4Pain，这是一个由基于证据的CIH方法组成的自我管理计划 (e.g.疼痛教育、正念、认知行为/疼痛应对策略、锻炼）。 II期（R33）包括一项全面的多水平随机混合有效性实施试验（n=376）， 社区支持的自我管理计划，Partners 4Pain与主动控制相比，幸福的关键，两者都是 在第一阶段将进行优化和可行性测试。 通过与社区利益相关者共同开发可扩展的基于证据的CIH干预措施， 通过社区合作伙伴组织的广泛接触，我们将消除一个重要的障碍， 目前存在于昂贵和繁重的卫生保健系统中。这种方法具有更大规模的潜力 在一系列社区组织和环境中实施，改善公平获得资源的机会 这将支持BP患者在自己的疼痛护理中获得更大的代理权，从而改善健康和福祉。

PROJECT SUMMARY. Back pain (BP), including low back and neck pain, is one of the most prevalent and disabling pain disorders. Most cases remain poorly managed and known socio-ecological factors that pose barriers to equitable care have been especially under-addressed resulting in critical disparities in BP management. This is evidenced by Black and Hispanic Americans, and individuals with less education and income, consistently experiencing poorer outcomes. Importantly, BP, like other chronic conditions, requires ongoing self-management. Unfortunately, most care offered through health systems fails to support sufferers’ self-care, and instead focuses on costly and provider-dependent therapies with little supporting research evidence. The persistent use of these practices contradicts evidence-based BP guideline recommendations for less invasive complementary and integrative health (CIH) approaches which can support self-care. Importantly, our team has demonstrated CIH approaches can be safely and effectively delivered in non-clinical settings in both in person and video-conferencing formats which can overcome barriers contributing to disparities. The long-term objective is to bolster the widespread implementation of evidence-based CIH approaches that support whole person oriented, self-care for individuals with back pain and who are from populations that experience health disparities (BP-PEHD). We will use a two-phase project that applies established models and frameworks for facilitating long term sustainability to develop, feasibility test, and evaluate the effectiveness of a community supported CIH self- management program, Partners4Pain compared to an active control, Keys to Wellbeing. This project builds upon our team’s extensive background in BP and CIH self-management research and established partnerships with community and health organizations with broad and diverse reach including the YMCA, YWCA, and others. Phase I (R61) will involve planning and preparations leading to a randomized feasibility study (n=40) including co- development and assessment of Partners4Pain, a self-management program comprised of evidence based CIH approaches (e.g. pain education, mindfulness, cognitive behavioral/pain coping strategies, exercise). Phase II (R33) includes a full-scale multi-level randomized hybrid effectiveness implementation trial (n=376) of the community supported self-management program, Partners4Pain compared to the active control, Keys to Wellbeing, both of which will have been optimized and feasibility tested in Phase I. By co-developing scalable evidence based CIH interventions with community stakeholders that can be delivered in an accessible manner by community partner organizations with extensive reach, we will remove an important barrier that currently exists within the costly and burdensome health care systems. This approach has the potential for larger scale implementation across a range of community-based organizations and settings, improving equitable access to resources that will support BP sufferers’ ability to gain greater agency in their own pain care, leading to better health and wellbeing.