Tailored Activity Pacing for Chronic Low Back Pain

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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.