Implementing a Cognitive/Exercise Therapy for Back Pain in The Community Setting

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DESCRIPTION (provided by applicant): Among older persons, chronic back pain (CBP) is a common, morbid, and costly disorder. Non-drug therapies for CBP including cognitive-behavioral and exercise treatments can be feasibly performed by older adults with CBP, have proven efficacy, but are seldom used by affected individuals. This gap between our current pain-management knowledge and limited use of the therapies by older persons with CBP provides strong support for efforts designed to test and implement strategies that facilitate adoption among individuals adversely affected by CBP. Given that prior research has documented significant racial disparities with respect to pain management, targeting at-risk racial/ethnic minorities appears particularly warranted at this time. The investigators have developed an age-appropriate intervention - i.e., an integrated, cognitive- behavioral and exercise therapy (CBET) protocol - for the treatment of CBP among older adults, and now seek to partner with future stakeholders to conduct pre-implementation testing in a community-based setting. The specific aims of this project are to use a community-based participatory research approach to refine our intervention prior to implementation by: (1) surveying community partners (i.e., prospective consumers of the intervention and directors of senior centers where the program will be administered) about their readiness to adopt a self-management program for CBP and perceived barriers to program adoption; and by (2) field testing the intervention in senior centers that serve three specific racial/ethnic groups: Hispanic American, African American, and non-Hispanic White Americans. Products of this research will include a field-tested and modified protocol, as well as stakeholder informed strategies for future program implementation. The long-term aim of this work is to develop an effective and sustainable implementation strategy for the above intervention, targeting community-dwelling older persons. The multi-disciplinary investigative team assembled for this project consists of individuals with complementary expertise in the areas of geriatric medicine and pain management (Dr. M. Carrington Reid), sociology and measurement of behavioral phenomena (Dr. Elaine Wethington), and geriatric physical therapy and instructional development and evaluation (Dr. Katherine Beissner), and are highly qualified to conduct the planned research.