Integrated Care for Depression and Chronic Back Pain

描述（由申请人提供）：研究目标：我们的长期目标是改善共病抑郁症和慢性疼痛患者的功能，症状和护理结果的成本。 该提案寻求支持对抑郁症和慢性背痛进行综合干预的试点研究。 拟议的试点研究将实现以下具体目标： 目的1：为慢性背痛合并抑郁症患者提供综合干预。 本研究将发展一个整合的，生物心理社会干预慢性背痛患者的抑郁症。 综合干预结合了针对重度抑郁症的经证实的干预措施（问题解决疗法和/或抗抑郁药物，取决于患者的偏好），以及针对慢性背痛的简短认知行为干预措施，这些干预措施也已证明有效。 目标2：开发诱导和评估干预保真度的方法。 我们将通过多种方法（提供者评级、患者评级、患者日志和独立录音带评级）评估综合干预的交付、接收和实施。 我们将评估独立评级的录音带，从不同来源获得的保真度措施的收敛效度，以及干预保真度的不同组成部分的相关性的评级者间的可靠性。 目的3：对抑郁性慢性背痛患者进行综合干预的试点试验。 我们将对50名干预患者和50名常规对照患者进行综合干预的试点测试。 试点RCT将评估筛选完成率和合格率;随机分配到干预组的患者参与综合干预;提供者提供和患者接受干预的保真度;通过测量患者对药理学和行为治疗的依从性评估的患者实施干预的水平;参与初级保健医生对综合干预的可接受性;以及6个月时疼痛、抑郁和功能结局的干预效应量。 我们将评估抑郁症和慢性背痛的综合管理相对于仅对背痛进行短暂认知行为干预的增量效益（通过将干预患者与仅接受慢性背痛认知行为干预的历史对照进行比较）。

DESCRIPTION (provided by applicant): Research Goal: Our long-term goal is to improve the functional, symptom and cost of care outcomes among patients with co-morbid depression and chronic pain. This proposal seeks support for a pilot study of an integrated intervention for depression and chronic back pain. The proposed pilot study will accomplish the following specific aims: Aim 1: Develop an integrated intervention for chronic back pain patients with major depression. This research will develop an integrated, biopsychosocial intervention for chronic back pain patients with major depression. The integrated intervention incorporates proven interventions for major depression (Problem-Solving Therapy and/or antidepressant medications depending on patient preferences) with brief cognitive-behavioral interventions for chronic back pain, also of proven effectiveness. Aim 2: Develop methods for inducing and assessing intervention fidelity. We will assess the delivery, receipt and enactment of the integrated intervention with multiple methods (provider ratings, patient ratings, patient logs, and independent ratings of audiotapes). We will assess the inter-rater reliability of independent ratings of audiotapes, the convergent validity of fidelity measures obtained from different sources, and the correlation of different components of intervention fidelity. Aim 3: Conduct a pilot test of the integrated intervention for depressed chronic back pain patients. We will conduct a pilot test of the integrated intervention with 50 intervention and 50 care as usual control patients. The pilot RCT will assess screening completion and eligibility rates; participation in the integrated intervention among patients randomly assigned to the intervention arm; the fidelity of provider delivery and patient receipt of the intervention; levels of patient enactment of the intervention as assessed by measures of patient adherence with pharmacologic and behavioral treatments; acceptability of the integrated intervention to participating primary care physicians; and intervention effect size at 6 months for pain, depression and functional outcomes. We will assess the incremental benefit of integrated management of depression and chronic back pain relative to brief cognitive-behavioral intervention for back pain alone (through comparison of intervention patients to historical controls receiving only a cognitive-behavioral intervention for chronic back pain).