Improving Outcomes for Older Veterans with Chronic Back Pain and Depression

慢性下腰痛是第二大常见就诊原因；每年相关费用超过100美元 10亿，预计随着人口老龄化，这一数字将会上升。先前的研究证实，老年人的背部疼痛 造成重大的生理、心理和社会后果。我们也知道抑郁症 经常与慢性腰痛并存，并使治疗复杂化。一种可行、有效的行为 针对老年退伍军人的慢性下腰痛和共病抑郁症的干预是迫切需要的。这 对于老年退伍军人来说尤其如此，他们的药物和手术选择的有效性和安全性是 在年轻人群中往往不那么有利。现有干预措施不充分或不充分，因为它们 没有特别关注老年退伍军人，也没有同时针对慢性背痛和 同时患有抑郁症。这项退伍军人事务部CDA-2提案的目标是在迭代过程中开发多个 健康教练电话提供的行为干预组件，最终将改善 患有慢性下腰痛和抑郁症的老年退伍军人的残疾和抑郁。拟议的研究 有3个相互关联的具体目标：1)为老年退伍军人的目标人群制定行为干预 使用专家、患者和其他利益相关者团体的意见，诊断慢性下腰痛和抑郁症；2) 通过在样本中进行行为干预，在迭代过程中预先测试和细化干预 与其他利益相关者一起提供干预内容反馈的10位年长退伍军人 以及，3)进行试点随机对照试验，以评估研究程序和 结果衡量。马克里斯博士的职业目标是成为一名独立的调查员和一名国家 在改善患有慢性下腰痛的医学上复杂的老年退伍军人的预后方面具有专业知识的领导者。 她组建了一支杰出的导师团队，他们是成果研究、老年病学、 行为干预的制定、评估和实施。在授权期内，申请人 将获得行为干预开发、定性方法、利益相关者参与、 比较有效性和实施性研究方法。作为一名专注于衰老的风湿病医生 由于她致力于改善老年退伍军人的结果，这一奖项将使她准备好。 Makris将在全国范围内领导开发非药物管理方法以改善患者 报道了医学上复杂的老年退伍军人合并慢性腰痛和抑郁症的结果。

Chronic low back pain is the 2nd most common reason for physician visits; annual related costs exceed $100 billion, and are expected to rise with the aging population. Prior work confirms that back pain in older adults results in significant physical, psychological and social consequences. We also know that depression frequently co-exists with chronic low back pain and complicates management. A feasible, effective behavioral intervention targeting chronic low back pain and comorbid depression in older Veterans is sorely needed. This is especially true for older Veterans where the efficacy and safety of pharmacologic and surgical options are often less favorable than in younger populations. Existing interventions are not adequate or sufficient as they have not been specifically focused on older Veterans, nor have they targeted both chronic back pain and depression simultaneously. The goal of this VA CDA-2 proposal is to develop, in an iterative process, a multi- component, health coach-telephone-delivered, behavioral intervention that will ultimately improve outcomes of disability and depression in older Veterans with chronic low back pain and depression. The proposed research has 3 interrelated specific aims: 1) develop a behavioral intervention for the target population of older Veterans with chronic low back pain and depression using input from expert, patient and other stakeholder groups; 2) pre-test and refine the intervention in an iterative process by conducting the behavioral intervention in a sample of 10 older Veterans who, along with other stakeholders, will provide feedback on intervention content and delivery; and, 3) conduct a pilot randomized control trial to evaluate feasibility of study procedures and outcome measurement. Dr. Makris' career goals are to become an independent investigator and a national leader with expertise in improving outcomes in medically complex older Veterans with chronic low back pain. She has assembled an exceptional team of mentors who are leaders in outcomes research, geriatrics, behavioral intervention development, evaluation and implementation. During the award period, the applicant will gain skills in behavioral intervention development, qualitative methods, stakeholder engagement, comparative effectiveness and implementation research methods. As a rheumatologist focused on aging research, and with her commitment to improving outcomes in older Veterans, this award would prepare Dr. Makris to lead efforts nationally to develop non-pharmacologic management approaches to improve patient reported outcomes for medically complex older Veterans with chronic low back pain and comorbid depression.