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

描述（由申请人提供）：在老年人中，慢性背痛（CBP）是一种常见的、病态的、昂贵的疾病。非药物治疗CBP包括认知行为和运动治疗，对老年CBP患者可行，已证明有效，但很少用于受影响的个体。我们目前的疼痛管理知识与老年CBP患者有限的治疗使用之间的差距，为旨在测试和实施促进CBP不良影响个体采用策略的努力提供了强有力的支持。鉴于先前的研究已经证明了在疼痛管理方面存在显著的种族差异，针对有风险的种族/少数民族似乎在这个时候特别有必要。研究人员已经开发了一种适合年龄的干预措施，即一种综合的认知行为和运动疗法（CBET）方案，用于治疗老年人的CBP，现在正在寻求与未来的利益相关者合作，在社区环境中进行实施前的测试。该项目的具体目标是在实施之前使用基于社区的参与性研究方法来完善我们的干预措施：(1)调查社区合作伙伴（即干预措施的潜在消费者和将管理该计划的老年中心的主任），了解他们是否准备采用CBP自我管理计划，以及采用计划的感知障碍；(2)在老年人中心实地测试干预措施，这些中心服务于三个特定的种族/民族群体：西班牙裔美国人、非洲裔美国人和非西班牙裔美国白人。这项研究的成果将包括实地测试和修改的协议，以及未来项目实施的利益相关者知情战略。这项工作的长期目标是为上述干预措施制定一项有效和可持续的实施战略，目标是社区居住的老年人。为这个项目组建的多学科调查小组由在老年医学和疼痛管理（M. Carrington Reid博士）、社会学和行为现象测量（Elaine Wethington博士）、老年物理治疗和教学发展与评估（Katherine Beissner博士）领域具有互补专业知识的个人组成，他们非常有资格进行计划中的研究。

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.