A proactive walking trial to reduce pain in Black Veterans

一项旨在减轻黑人退伍军人疼痛的主动步行试验

• 批准号: 8672103
• 负责人: Diana J Burgess
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8672103
• 关键词: Address; Affect; Analgesics; Back Pain; Baseline Surveys; Behavior; Caring; Chronic; Clinical Trials; Cognitive Therapy; Cohort Studies; Consensus; Counseling; Data; Data Analyses; Diagnosis; Discrimination; Effectiveness; Effectiveness of Interventions; Emotional; Environmental Risk Factor; Evaluation; Exercise; Exposure to; Face; Fright; Funding; Goals; Healthcare; Hip Pain; Individual; Informal Social Control; Intervention; Life; Measurement; Measures; Mediating; Mediator of activation protein; Methodology; Methods; Minority; Motivation; Musculoskeletal; Musculoskeletal Diseases; Musculoskeletal Pain; Neighborhoods; Opioid; Opioid Analgesics; Outcome; Pain; Pain Measurement; Pain intensity; Pamphlets; Participant; Patients; Physical Function; Physical activity; Primary Health Care; Process; Professional counselor; Provider; Psychological Factors; Questionnaires; Race; Reporting; Research; Role; Self Efficacy; Self Management; Specific qualifier value; Surveys; Techniques; Telephone; Testing; Treatment outcome; Veterans; Walking; Work; base; biopsychosocial; chronic pain; cohort; compare effectiveness; coping; design; disability; effective intervention; experience; functional disability; health care service utilization; improved; improved functioning; innovation; knee pain; motivational enhancement therapy; outreach; primary outcome; programs; psychologic; racial and ethnic disparities; racial disparity; randomized trial; service utilization; treatment as usual

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.

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， 在患有慢性肌肉骨骼（MSK）的退伍军人护理中减轻疼痛并改善功能 疼痛，通过增加行走。干预措施将通过电话进行，以接触到有以下情况的患者： 高质量慢性疼痛护理的障碍。这项干预措施是专门针对以下因素而设计的： 有助于黑人退伍军人之间的MSK疼痛;然而，我们预计，它也将有利于非黑人退伍军人。 项目背景。慢性肌肉骨骼（MSK）疼痛是最常见的疾病之一， 退伍军人，影响约60%的人看到在VA初级保健。尽管人们认为 慢性疼痛治疗在所有VA患者中较低，黑人患者比白人患者更不可能感知到他们的疼痛。 治疗有效，并且更有可能由于疼痛而经历功能限制。人们越来越 一致认为慢性MSK疼痛最好通过生物心理社会方法来解决， 心理和环境因素，其中一些因种族而异。例如，黑人经历 与疼痛相关的恐惧更大，应对疼痛的自我效能更低（心理因素），以及 使身体活动困难的社区（环境贡献者）。然而，缺乏 有效的干预措施，以改善少数民族患者的疼痛治疗，特别是那些针对 心理和环境因素。 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， 改善所有退伍军人的疼痛结果。该应用程序的目的是测试多- 专门针对黑人退伍军人中有效疼痛护理的已知障碍的组成干预 慢性MSK疼痛我们的主要假设是，电话传递的干预，强调 步行，并结合行动规划，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非黑人MSK患者 项目方法。我们建议进行一项随机试验，以测试干预的有效性， 250名黑人和250名非黑人慢性MSK疼痛患者的常规治疗（UC）。亚特兰大的病人 VAMC将使用最近资助的退伍军人队列研究的数据进行鉴定， 在VA护理MSK疼痛。将通过电话对患者进行筛选，如果合格，将给予完整的基线 调查.合格患者将被随机分配至家庭护理（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， 计划和使用MI和CBT技术。干预将通过6次电话咨询进行 三个多月的会议。UC患者将收到一份信息手册和一份 计步器该研究旨在发现黑人和非黑人中IC组和UC组之间的差异。 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，一个由方法倡议推荐的测量， 临床试验中的疼痛测量和评估（IMMPACT）。我们亦会研究 干预改善了IMMPACT推荐的其他领域（疼痛强度，情绪功能， 整体改善率）。次要目标包括检查潜在的介体， 干预，探索干预是否影响服务利用和阿片类镇痛药的使用，以及 探索干预是否减少了疼痛结果的种族差异。将通过以下方式评估措施： 在基线、3个月和6个月时进行电话调查。主要目的的数据分析将遵循意向治疗 方法论