A proactive walking trial to reduce pain in Black Veterans

对退伍军人医疗保健的预期影响。该项目将导致非药物干预 退伍军人慢性肌肉骨骼病(MSK)患者的疼痛减轻和功能改善 疼痛，通过增加行走。干预措施将通过电话实施，以接触到经历过 高质量慢性疼痛护理的障碍。这种干预措施是专门为解决以下因素而设计的 有助于黑人退伍军人中的MSK痛苦；然而，我们预计它也将使非黑人退伍军人受益。 项目背景。慢性肌肉骨骼疼痛(MSK)是以下最常见的情况之一 退伍军人，影响退伍军人初级保健中约60%的人。尽管感知到的有效性 在所有VA患者中，慢性疼痛治疗较低，黑人患者比白人患者更不可能感觉到他们的疼痛 治疗是有效的，而且更有可能因疼痛而出现功能障碍。有越来越多的 一致认为，慢性MSK疼痛最好的治疗方法是生物心理社会方法，承认其作用 心理和环境因素，其中一些因种族而异。例如，黑人的经历 更大的与疼痛相关的恐惧和较低的应对疼痛的自我效能(心理因素)，以及 使身体活动困难的社区(环境贡献者)。然而，目前还缺乏 有效的干预措施，以改善少数族裔患者的疼痛治疗，特别是针对 心理和环境方面的贡献。 项目目标。我们的长期目标是提高疼痛治疗的质量和公平性，以便 改善所有退伍军人的疼痛结果。此应用程序的目标是测试多个 专门针对黑人退伍军人中有效疼痛护理的已知障碍的组件干预 患有慢性MSK疼痛。我们的主要假设是电话传递的干预，强调 步行，结合了行动计划、动机访谈(MI)和认知行为疗法 (CBT)技术和计步器的使用，将改善黑人退伍军人的核心慢性疼痛结果。 其次，我们将确定我们的干预是否也有利于患有MSK的非黑人患者 项目方法。我们提出了一项随机试验，以测试干预的有效性与 250名黑人和250名非黑人慢性MSK疼痛患者的日常护理(UC)。来自亚特兰大的病人 VAMC将使用最近资助的退伍军人队列研究中的数据进行识别，这些退伍军人被诊断为 退伍军人管理局护理中的MSK疼痛。将通过电话对患者进行筛查，如果符合条件，将实施完整的基线 调查。符合条件的患者将被随机分配到常规护理(UC)或干预条件(IC)。 干预参与者将接受计步器介导的步行干预，其中将包括Action 计划和使用MI和CBT技术。干预将在6个电话咨询中进行 三个多月的疗程。UC患者将收到一份信息手册和一份 计步器。这项研究旨在找出IC和UC组在黑人和非黑人之间的差异 黑人团体。主要结果是慢性疼痛相关的身体功能，由修订的 罗兰和莫里斯残疾问卷，这是方法倡议建议的一项措施， 临床试验中的疼痛评估(IMMPACT)。我们还将研究是否 干预改善了IMMPACT推荐的其他领域(疼痛强度、情绪功能和 总体进步评级)。次要目标包括审查潜在的调解人 干预，探讨干预是否影响服务利用和阿片类镇痛剂的使用，以及 探索干预是否减少了疼痛结局中的种族差异。措施将通过以下方式进行评估 在基线、3个月和6个月时进行电话调查。主要目标的数据分析将遵循意向治疗 方法论。

Anticipated Impacts on Veterans Healthcare. This project will result in a non-pharmacological intervention to reduce pain and improve functioning among Veteran in VA care suffering from chronic musculoskeletal (MSK) pain, by increasing walking. The intervention will be administered by phone to reach patients who experience barriers to high quality chronic pain care. This intervention is specifically designed to address factors that contribute to MSK pain among black Veterans; however, we expect that it will also benefit non-black Veterans. Project Background. Chronic musculoskeletal (MSK) pain is one of the most common conditions among Veterans, affecting approximately 60% of those seen in VA primary care. Although perceived effectiveness of chronic pain treatment is low among all VA patients, black patients are less likely than whites to perceive their treatment as effective, and are more likely to experience functional limitations due to pain. There is growing consensus that chronic MSK pain is best addressed by a biopsychosocial approach that acknowledges the role of psychological and environmental factors, some of which differ by race. For example, blacks experience greater pain-related fear and lower self-efficacy in coping with pain (psychological contributors), and neighborhoods that make physical activity difficult (environmental contributors). However, there is a lack of effective interventions to improve pain treatment among minority patients, particularly those that target psychological and environmental contributors. Project Objective. Our long term goal is to improve the quality and equity of pain treatment in order to improve pain outcomes for all Veterans. The objective of this application is to test the effectiveness of a multi- component intervention that specifically targets known barriers to effective pain care among blacks Veterans with chronic MSK pain. Our primary hypothesis is that a telephone-delivered intervention, which emphasizes walking and incorporates Action Planning, Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) techniques, and the use of pedometers, will improve core chronic pain outcomes in black Veterans. Secondarily, we will determine whether our intervention also benefits non-black patients with MSK Project Methods. We propose a randomized trial to test the effectiveness of the intervention compared with usual care (UC) among 250 black and 250 non-black patients with chronic MSK pain. Patients from the Atlanta VAMC will be identified using data from the recently funded VA cohort study of Veterans with diagnoses of MSK pain in VA care. Patients will be screened by phone, and, if eligible, will be administered the full baseline survey. Eligible patients will be randomly assigned to the Usual Care (UC) or intervention condition (IC). Intervention participants will receive a pedometer-mediated walking intervention that will incorporate Action Planning and the use MI and CBT techniques. The intervention will be delivered in 6 telephone counseling sessions over three months. Patients in the UC condition will receive an informational brochure and a pedometer. The study is powered to find a difference between the IC and UC groups within the black and non- black groups. The primary outcome is chronic pain-related physical functioning, assessed by the revised Roland and Morris Disability Questionnaire, a measure recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). We will also examine whether the intervention improves other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement). Secondary objectives include examining potential mediators targeted by the intervention, exploring whether the intervention affects service utilization and use of opioid analgesics, and exploring whether the intervention reduces racial disparities in pain outcomes. Measures will be assessed by phone survey at baseline, 3 months, and 6 months. Data analysis of primary aims will follow intent-to-treat methodology.