IVR-based cognitive behavior therapy for chronic low back pain

这项拟议中的研究将测试一种创新方法--交互式语音应答的有效性 (IVR)，用于提供经经验验证的心理治疗（认知行为疗法 [CBT]），以改善退伍军人的可及性。IVR是一个 计算机化界面，允许患者使用他们的电话：1）获得预先记录的 教学信息，2）报告有关疼痛相关症状和疼痛依从性的数据 应对技巧练习，3）接受个性化的治疗师反馈。虽然CBT已经 在两个Meta分析中，显示有效降低疼痛强度、残疾和情感困扰， 分析，传统的CBT对治疗师来说是时间密集型的，需要患者经常进行 办公室访问。IVR的使用将允许退伍军人通过按键从家中访问CBT 电话，从而使他们能够在方便时获得治疗，而无需前往 一个门诊预约。患有慢性腰痛的退伍军人将被随机分组， 接受标准CBT或基于IVR的CBT的人数相等。主要结局 疼痛强度将是衡量标准。次要结局指标将是生活质量和身体状况。 和情绪功能。将在治疗前（基线）对研究参与者进行评价，12 基线后（治疗后）以及基线后3个月和6个月（随访）。 本研究的探索性目的是检查：（1）临床结局以外的因素， 治疗可能不同（脱落率，治疗满意度，治疗可信度， 行为目标完成）;和（2）调节者（例如，年龄、性别、人种/种族、疼痛部位 地点和数量、药物使用和精神病合并症） 参与和参与，坚持治疗师对疼痛应对技能的建议 实践和成果。

The proposed study will test the efficacy of an innovative method, interactive voice response (IVR), for delivering an empirically validated psychological treatment (cognitive behavior therapy [CBT]) for chronic low back pain in order to improve accessibility to veterans. IVR is a computerized interface that allows patients to use their telephone to: 1) obtain pre-recorded didactic information, 2) report data regarding pain-related symptoms and adherence to pain coping skill practice, and 3) receive personalized therapist feedback. Although CBT has been shown to be effective in reducing pain intensity, disability, and affective distress in two meta- analyses, traditional CBT is time intensive for therapists and requires patients to make frequent office visits. The use of IVR will allow veterans to access CBT from their home via a touch-tone telephone, thereby allowing them to access treatment at their convenience without travel to the VA for an outpatient appointment. Veterans with chronic low back pain will be randomized in equal numbers to receive either standard CBT or IVR-based CBT. The primary outcome measure will be pain intensity. Secondary outcome measures will be quality of life and physical and emotional functioning. Study participants will be evaluated pre-treatment (baseline), 12 weeks post-baseline (post-treatment) and at 3 and 6 months post-baseline (follow-up). Exploratory objectives of the study are to examine: (1) factors other than clinical outcomes on which the treatments may differ (drop-out rate, treatment satisfaction, treatment credibility, and behavioral goal accomplishment); and (2) moderators (e.g., age, sex, race/ethnicity, pain site location and number, medication use and psychiatric comorbidities) of treatment engagement and participation, adherence to therapist recommendations for pain coping skill practice and outcomes.