CAM Referral and Outcomes: Chronic Low Back Pain in Urban and Rural Primary Care

CAM 转诊和结果：城乡初级保健中的慢性腰痛

• 批准号: 7928721
• 负责人: William Gibbs Elder
• 金额: $ 21.82万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928721
• 关键词: Address; Adoption; Back Pain; Caring; Characteristics; Chronic low back pain; Client satisfaction; Clinical; Collaborations; Communication; Communities; Community Medicine; Complementary and alternative medicine; Decision Making; Education; Effectiveness; Family; Family Physicians; Foundations; Goals; Grant; Health Personnel; Health Services; Kentucky; Licensing; Life; Long-Term Effects; Massage; Medical; Methodology; Modality; Muscle relaxation phase; National Center for Complementary and Alternative Medicine; Opiates; Outcome; Pain; Patients; Pharmaceutical Preparations; Physicians; Practice based research; Preparation; Primary Care Physician; Primary Health Care; Recommendation; Relaxation Therapy; Reporting; Research; Rural; Students; Surveys; Testing; Therapeutic; Time; Training; Universities; addiction; base; clinical practice; control trial; conventional therapy; cost; disability; effective therapy; health related quality of life; improved; lectures; member; patient oriented; practice-based research network; programs; public health relevance; rural area; willingness

DESCRIPTION (provided by applicant): Kentucky ranks 2nd in disability among states, with chronic low back pain (CLBP) as a major disability, especially in our rural areas. In the last few years the medical use of opiate medications has significantly increased. Their use has complicated treatment greatly, with addiction rates and misuse skyrocketing. Kentucky and U.S. health care providers need alternative and effective treatments. Following NCCAM strategic research recommendations, this study will investigate health services outcomes of complementary and alternative medicine (CAM) therapies in an existing primary care practice-based research network (PBRN). The Kentucky Ambulatory Network (KAN) is the partnering PBRN. Patients with CLBP are often willing to try therapeutic options outside the conventional medical spectrum. Massage and relaxation therapies have demonstrated fairly good efficacy in controlled trials but their effectiveness in the "real world" of primary care is only beginning to be evaluated. The long-term goal of the proposed project builds on the foundation of these two established therapies to improve treatment of chronic low back pain (CLBP) in primary care practices. Two alternative (CAM) therapies, progressive muscle relaxation (PMR) and clinical massage therapy (CMT), will be studied. The short-term objectives of the proposed project are to: (1) examine outcomes of CAM for patients with CLBP referred from primary care practices, and (2) better understand physician decision-making to recommend CAM therapy for CLBP. Specific Aim 1 will evaluate improvement in health-related outcomes for patients with CLBP when referred to PMR or CMT from primary care. Specific Aim 2 will explore selected factors in primary care physicians' decisions to recommend CAM therapy to these patients. The proposed study is unique in that it addresses "real life" clinical situations and decision-making in both urban and rural clinical practices within an existing PBRN. Should such CAM referral prove successful for ameliorating CLBP, it would provide relatively low cost, non-addictive treatment options for inclusion in the repertoire of primary care physicians. PUBLIC HEALTH RELEVANCE: The "CAM Referral and Outcomes: Chronic Low Back Pain in Urban and Rural Primary Care" project will investigate clinical and patient-oriented outcomes of CAM therapies in an existing practice-based research network (PBRN). For patients with chronic low back pain, we will examine the outcomes of clinical massage therapy and progressive muscle relaxation when referred by primary care physicians, as well as selected factors in the physicians' decisions to recommend these therapies.

描述（由申请人提供）：肯塔基州在各州残疾排名第二，慢性腰痛（CLBP）是一种主要残疾，特别是在我们的农村地区。在过去的几年中，阿片类药物的医疗使用显著增加。它们的使用使治疗变得非常复杂，成瘾率和滥用率飙升。肯塔基州和美国的卫生保健提供者需要替代和有效的治疗。根据NCCAM战略研究建议，本研究将调查现有的初级保健实践为基础的研究网络（PBRN）的补充和替代医学（CAM）疗法的卫生服务成果。肯塔基州门诊网络（KAN）是PBRN的合作伙伴。CLBP患者通常愿意尝试传统医学范围之外的治疗选择。按摩和放松疗法在对照试验中表现出相当好的疗效，但它们在“真实的世界”初级保健中的有效性才刚刚开始评估。拟议项目的长期目标建立在这两种既定疗法的基础上，以改善初级保健实践中慢性腰痛（CLBP）的治疗。将研究两种替代（CAM）疗法，渐进式肌肉放松（PMR）和临床按摩疗法（CMT）。拟议项目的短期目标是：（1）检查从初级保健实践转介的CLBP患者的CAM结果，以及（2）更好地了解医生的决策，以推荐CAM治疗CLBP。具体目标1将评价CLBP患者从初级保健转诊至PMR或CMT时健康相关结局的改善。具体目标2将探讨初级保健医生决定向这些患者推荐CAM治疗的选定因素。拟议的研究是独特的，因为它解决了“真实的生活”的临床情况和决策，在城市和农村的临床实践中现有的PBRN。如果这样的CAM转诊证明成功改善CLBP，它将提供相对低成本，非成瘾性的治疗选择纳入初级保健医生的剧目。 公共卫生相关性：“CAM转诊和结果：城市和农村初级保健中的慢性腰痛”项目将在现有的基于实践的研究网络（PBRN）中调查CAM治疗的临床和以患者为导向的结果。对于慢性腰痛患者，我们将检查初级保健医生推荐的临床按摩疗法和渐进式肌肉放松的结果，以及医生决定推荐这些疗法的选定因素。