Implementing Evidence-Based Treatments for Persistent Back Pain into Primary Care

在初级保健中实施针对持续性背痛的循证治疗

• 批准号: 8529466
• 负责人: DANIEL C. CHERKIN
• 金额: $ 19.4万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8529466
• 关键词: Acupuncture procedure; Address; American; American College of Physicians; Back Pain; Caring; Chronic; Clinic; Cognitive Therapy; Complementary and alternative medicine; Complex; Development; Educational Materials; Ensure; Evaluation; Evidence based intervention; Evidence based treatment; Familiarity; Future; Guidelines; Health; Healthcare; Integrated Delivery of Health Care; Intervention; Knowledge; Leadership; Learning; Massage; Medical; Methods; Mind-Body Intervention; Modification; Monitor; Muscle relaxation phase; National Center for Complementary and Alternative Medicine; Opioid; Outcome; Pain; Pain management; Patients; Pharmaceutical Preparations; Physicians; Plant Roots; Primary Health Care; Process; Recommendation; Rehabilitation therapy; Research; Research Personnel; Societies; Spinal Manipulation; Staging; System; Techniques; Testing; TimeLine; Washington; Yoga; chronic back pain; clinical care; clinical practice; dissemination research; economic cost; effective therapy; evidence base; evidence based guidelines; health care service organization; implementation research; improved; interest; non-cancer pain; programs; progressive relaxation therapy; response; social; success; systematic review

DESCRIPTION (provided by applicant): This proposal responds to the National Center for Complementary and Alternative Medicine's interest in identifying effective ways to implement evidence-based interventions into "health care settings that deliver pain management strategies which incorporate complementary and alternative medicine approaches. It addresses the substantial gap between knowledge of effective treatments for persistent back pain and implementation of this knowledge into practice. The 8 treatments now recommended for persistent back pain by high quality guidelines are mostly complementary and alternative medical (CAM) and mind-body techniques (i.e., spinal manipulation, acupuncture, massage, yoga, cognitive behavioral therapy, progressive relaxation). Clinicians' lack of knowledge about these treatments presents a particular challenge for encouraging their use by patients. Furthermore, little is known about the challenges of implementing any evidence-based CAM interventions into practice or how these challenges might be addressed. To help overcome these obstacles, we propose to formally evaluate the process of implementing back pain guidelines including CAM and mind/body treatments for chronic back pain into primary care practice. Because of the large personal, social, and economic costs of back pain in the U.S., the potential benefits of improvements in clinical care for back pain are enormous. We propose a formative evaluation of the pilot implementation of evidence-based guidelines for persistent back pain into a Group Health (GHC) primary care clinic. Formative evaluation recognizes that health care organizations are complex adaptive systems which are constantly changing in unpredictable ways. For this reason, our evaluation method will include ongoing monitoring and modification to identify barriers, facilitators and other adaptable factors that could influence th program's success. Specific Aims: Prior to implementation, we will identify, explore, and describe the barriers and facilitators to implementing the guidelines in a primary care pilot clini and modify the plan accordingly (Aim 1). During implementation, we will identify discrepancies between the plan and its operationalization and monitor the impacts and indicators of progress toward desired outcomes (Aim 2). After implementation, we will analyze the lessons from the previous stages and from a debriefing of the stakeholders to identify alternative explanations for the results (Aim 3). This information will be used to finalize the implementation plan before spreading it to other GHC clinics and disseminated to others interested in implementing evidence-based treatments into other settings. In view of the disappointing results of previous efforts to implement back pain guidelines and the lack of research evaluating the effect of implementing evidence-based CAM and mind-body treatments into medical care settings, our findings will provide information that will be critical for the success of future efforts to bridge these gaps between research and practice.

描述(由申请人提供)：这项建议回应了国家补充和替代医学中心在寻找有效方法将循证干预实施到“提供结合补充和替代医学方法的疼痛管理战略的医疗保健环境”方面的兴趣。它解决了有效治疗持续性背痛的知识和将这一知识付诸实践之间的巨大差距。目前高质量指南推荐的治疗持续性背痛的8种疗法大多是补充和替代医学(CAM)和心身技术(即脊柱手法、针灸、按摩、瑜伽、认知行为疗法、渐进式放松)。临床医生对这些治疗缺乏了解，这对鼓励患者使用这些治疗提出了特别的挑战。此外，对于将任何基于证据的CAM干预措施付诸实践的挑战或如何应对这些挑战，人们知之甚少。为了帮助克服这些障碍，我们建议正式评估将背部疼痛指南(包括CAM和慢性背部疼痛的精神/身体治疗)实施到初级保健实践中的过程。由于美国背痛在个人、社会和经济方面的巨大成本，改善背痛临床护理的潜在好处是巨大的。我们建议对团体卫生(GHC)初级保健诊所试点实施的持续性背痛循证指南进行形成性评估。形成性评价认识到，卫生保健组织是复杂的适应性系统，不断以不可预测的方式变化。因此，我们的评估方法将包括持续的监测和修改，以确定障碍、促进者和其他可能影响该计划成功的适应性因素。具体目标：在实施之前，我们将确定、探索和描述在初级保健试点诊所实施指南的障碍和促进者，并相应地修改计划(目标1)。在执行过程中，我们将查明该计划与其实施之间的差异，并监测实现预期成果的影响和进展指标(目标2)。在实施之后，我们将分析前几个阶段和利益攸关方汇报情况的经验教训，以确定对结果的替代解释(目标3)。这些信息将用于最终确定实施计划，然后将其传播到其他GHC诊所，并传播给其他有兴趣在其他环境中实施循证治疗的人。鉴于之前实施背痛指南的努力结果令人失望，以及缺乏评估在医疗保健环境中实施循证CAM和心身治疗的效果的研究，我们的发现将提供对未来桥接努力成功至关重要的信息 这些研究和实践之间的差距。

项目成果

Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting.

• DOI: 10.1016/j.apmr.2018.02.016
• 发表时间: 2018-08
• 期刊: Archives of physical medicine and rehabilitation
• 影响因子: 4.3
• 作者: Suri P;Delaney K;Rundell SD;Cherkin DC
• 通讯作者: Cherkin DC

Evaluation of a risk-stratification strategy to improve primary care for low back pain: the MATCH cluster randomized trial protocol.

• DOI: 10.1186/s12891-016-1219-0
• 发表时间: 2016-08-24
• 期刊: BMC musculoskeletal disorders
• 影响因子: 2.3
• 作者: Cherkin D;Balderson B;Brewer G;Cook A;Estlin KT;Evers SC;Foster NE;Hill JC;Hawkes R;Hsu C;Jensen M;LaPorte AM;Levine MD;Piekara D;Rock P;Sherman K;Sowden G;Wellman R;Yeoman J
• 通讯作者: Yeoman J

Patient Perspectives on Communication with Primary Care Physicians about Chronic Low Back Pain.

患者对与初级保健医生沟通慢性腰痛的看法。

• DOI: 10.7812/tpp/16-177
• 发表时间: 2017
• 期刊: The Permanente journal
• 作者: Evers,Sarah;Hsu,Clarissa;Sherman,KarenJ;Balderson,Ben;Hawkes,Rene;Brewer,Georgie;LaPorte,Anne-Marie;Yeoman,John;Cherkin,Dan
• 通讯作者: Cherkin,Dan