Tailored Activity Pacing for Chronic Low Back Pain

描述(由申请人提供)： 慢性下腰痛(CLBP)是退伍军人报告的最常见的疼痛类型，并导致一系列负面影响，包括失业、功能障碍和生活质量下降。尽管非药物干预被认为是CLBP治疗的一个重要方面，但很少有针对退伍军人的干预措施来解决独特的症状和心理社会经验。优化症状管理的一种方法是进行简短的量身定做的干预，这种干预可以在临床护理的背景下提供，并且对退伍军人有利。一种这样的干预是活动步调，这是一种人们学习平衡活动和休息以完成必要和有价值的活动的策略。这种类型的策略已被证明在降低总体症状严重程度和增加其他慢性疼痛患者的体力活动方面有效。这项建议的首要目标是完善和评估活动起搏干预措施，以改善为患有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实现。研究一是在为期7天的家庭监测期内，使用手腕佩戴的加速度计对患有CLBP的退伍军人进行实时症状严重性、疼痛相关的运动恐惧和体力活动的检查。40名退伍军人将参与这项为期8个月的研究。线性混合模型将被用来检验症状严重程度、疼痛相关恐惧和体力活动之间和受试者内部的差异，并将为我们在研究III中提供量身定制活动节奏的教育方法提供参考。研究II由一系列焦点小组组成-2个是退伍军人，1个是康复专业人员-将检查患者和提供者在将量身定制的自我管理计划整合到当前VA治疗方案中的障碍。研究III将在一项先导性研究中开始评估量身定制的活动起搏干预措施的有效性，以减轻患有CLBP的退伍军人的总体症状负担。这种活动起搏干预最初是在患有骨性关节炎的成年人身上开发和测试的。简而言之，这个量身定制的计划包括与职业治疗师进行2次一对一的访问，在此期间，参与者学习根据他们自己的症状和在之前的家庭监测期建立的活动模式来安排活动(或不活动)的“休息时间”。10名退伍军人将随机接受量身定制的计划，10名退伍军人将随机接受他们通常的护理。活动起搏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体力活动提供有价值的见解。总而言之，他们将为进一步开发和翻译有针对性的、基于个人的方法来管理患有CLBP的退伍军人的症状提供信息。 公共卫生相关性： 慢性下腰痛(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。虽然有症状管理计划来帮助减少CLBP患者的残疾，但很少有计划关注退伍军人及其独特的症状和心理社会经历。这项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，以提供对个人如何参与日常生活的全面评估，并增加了CLBP的负担及其护理偏好。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目前的临床倡议，以减轻患有慢性疼痛的退伍军人的疾病负担。

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.