Tailored Activity Pacing for Chronic Low Back Pain

针对慢性腰痛的定制活动节奏

• 批准号: 8203697
• 负责人: Susan L. Murphy
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8203697
• 关键词: Address; Adult; Affect; Back; Back Pain; Caring; Chronic low back pain; Clinical; Clinical Trials; Degenerative polyarthritis; Development; Education; Effectiveness; Equilibrium; Evaluation; Exercise; Face; Fatigue; Focus Groups; Fright; Goals; Health Personnel; Home environment; Individual; Instruction; Intervention; Learning; Life; Modeling; Monitor; Movement; Occupational Therapist; Outcome; Pain; Pain interference; Participant; Patients; Pattern; Physical activity; Pilot Projects; Provider; Quality of Care; Quality of life; Randomized; Rehabilitation therapy; Reporting; Research; Rest; Schedule; Self Management; Series; Severities; Source; Symptoms; Testing; Time; Translations; Unemployment; Variant; Veterans; Visit; Wrist; base; body mechanics; burden of illness; care preference; chronic back pain; chronic pain; clinical care; design; disability; experience; flexibility; functional disability; improved; insight; programs; psychosocial; success; symptom management; treatment as usual

DESCRIPTION (provided by applicant): Chronic low back pain (CLBP) is the most common type of pain reported by veterans, and contributes to an array of negative effects, including unemployment, functional impairment, and reduced quality of life. Although non-pharmacological interventions are recognized as an important aspect of CLBP treatment, there are very few veteran-specific interventions that address unique symptom and psychosocial experiences. One way to optimize symptom management is with a brief tailored intervention that can be delivered within the context of clinical care, and is amenable to veterans. One such intervention is activity pacing, a strategy in which people learn to balance activity with rest to accomplish their necessary and valued activities. This type of strategy has been shown effective in reducing overall symptom severity and increasing physical activity among people with other chronic pain conditions. The overarching aim of this proposal is to refine and evaluate an activity pacing intervention that may improve the quality of care provided to veterans with CLBP. This will be accomplished using three integrated studies conducted concurrently over 2 years. Study I is an examination of real-time symptom severity, pain-related fear of movement, and physical activity in veterans with CLBP using wrist-worn accelerometers in a 7-day home monitoring period. Forty veterans will participate in this study over 8 months. Linear mixed models will be used to examine between and within-subject variation in the relationship of symptom severity, pain-related fear, and physical activity and will inform our education approach to tailoring activity pacing in Study III. Study II consists of a series of focus groups - 2 with veterans and 1 with rehabilitation professionals - that will examine both the patient and provider barriers to integrating a tailored self-management program into current VA treatment offerings. Study III will begin to evaluate the effectiveness of a tailored activity pacing intervention to reduce the overall symptom burden in veterans with CLBP in a pilot study. This activity pacing intervention was originally developed and tested in adults with osteoarthritis. Briefly, the tailored program involves 2 one-on-one visits with an occupational therapist during which participants learn to schedule 'breaks' from activity (or inactivity) based on their own symptom and activity patterns established in a previous home monitoring period. Ten veterans will be randomized to receive the tailored program and 10 will be randomized to continue with their usual care. The effects of activity pacing on pain interference and back-pain related disability will be evaluated at 10-weeks post baseline. Each study will provide valuable insight into how back pain symptoms affect physical activity. In aggregate, they will inform further development and translation of a focused, individually-based approach to symptom management in veterans with CLBP. PUBLIC HEALTH RELEVANCE: Chronic low back pain (CLBP) is the most common type of pain reported by veterans and it interferes with activity engagement in different ways. Although there are symptom management programs to help reduce disability in patients with CLBP, very few of them are focused on veterans and their unique symptom and psychosocial experiences. The proposed research features both subjective and objective input from veterans and their health care providers to provide a comprehensive evaluation of how individuals participate in daily life with the added burden of CLBP and their preferences for care. The ultimate goal of this project is to implement a new and effective non-pharmacological treatment option that is line with current VA clinical initiatives to reduce disease burden in veterans with chronic pain.

描述（由申请人提供）： 慢性腰痛 (CLBP) 是退伍军人报告的最常见的疼痛类型，会导致一系列负面影响，包括失业、功能障碍和生活质量下降。尽管非药物干预措施被认为是 CLBP 治疗的一个重要方面，但很少有专门针对退伍军人的干预措施可以解决独特的症状和心理社会经历。优化症状管理的一种方法是采用简短的定制干预措施，该干预措施可以在临床护理的背景下进行，并且适合退伍军人。其中一种干预措施是活动节奏，这是一种人们学会平衡活动与休息以完成必要且有价值的活动的策略。这种策略已被证明可以有效降低其他慢性疼痛患者的总体症状严重程度并增加体力活动。该提案的总体目标是完善和评估活动节奏干预措施，以提高为患有 CLBP 的退伍军人提供的护理质量。这将通过在两年内同时进行的三项综合研究来完成。研究 I 是在 7 天的家庭监测期内使用腕戴式加速度计检查 CLBP 退伍军人的实时症状严重程度、与疼痛相关的运动恐惧和体力活动。四十名退伍军人将参与这项为期 8 个月的研究。线性混合模型将用于检查症状严重程度、疼痛相关恐惧和体力活动之间关系的受试者之间和受试者内的变化，并将为我们在研究 III 中调整活动节奏的教育方法提供信息。研究 II 由一系列焦点小组组成，其中 2 个由退伍军人组成，1 个由康复专业人员组成，这些小组将检查患者和提供者将定制的自我管理计划整合到当前 VA 治疗产品中的障碍。研究 III 将开始评估量身定制的活动节奏干预措施的有效性，以减少试点研究中患有 CLBP 的退伍军人的总体症状负担。这种活动节奏干预最初是在患有骨关节炎的成人中开发和测试的。简而言之，量身定制的计划包括与职业治疗师进行两次一对一的拜访，在此期间，参与者学习根据自己的症状和之前家庭监测期间建立的活动模式安排活动（或不活动）的“休息”时间。十名退伍军人将被随机分配接受量身定制的计划，另外 10 名退伍军人将被随机分配继续接受常规护理。活动节奏对疼痛干扰和背痛相关残疾的影响将在基线后 10 周进行评估。每项研究都将为背痛症状如何影响身体活动提供有价值的见解。总的来说，它们将为进一步开发和转化针对患有 CLBP 的退伍军人进行有针对性的、基于个体的症状管理方法提供信息。 公共卫生相关性： 慢性腰痛 (CLBP) 是退伍军人报告的最常见的疼痛类型，它以不同的方式干扰活动参与。尽管有症状管理项目可以帮助减少 CLBP 患者的残疾，但很少有项目关注退伍军人及其独特的症状和心理社会经历。拟议的研究以退伍军人及其医疗保健提供者的主观和客观意见为特色，对个人在 CLBP 的额外负担下如何参与日常生活以及他们对护理的偏好进行综合评估。该项目的最终目标是实施一种新的有效的非药物治疗方案，该方案符合退伍军人管理局当前的临床举措，以减轻患有慢性疼痛的退伍军人的疾病负担。