Development of an Internet-based Behavioral Pain Management Intervention

基于互联网的行为疼痛管理干预措施的开发

• 批准号: 8990406
• 负责人: Diana M Higgins
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990406
• 关键词: Address; Behavior Therapy; Behavioral; Caring; Cellular Phone; Chronic; Chronic low back pain; Clinic; Clinic Visits; Cognitive; Cognitive Therapy; Commuting; Coping Skills; Cues; Data; Development; Dimensions; Disease; Education; Effectiveness; Equipment and supply inventories; Evidence based program; Exercise; Exposure to; Failure; Family; Fatigue; Feedback; Geography; Hand; Health; Individual; Institute of Medicine (U.S.); Internet; Intervention; Learning; Letters; Life; Literature; Measures; Medical; Medicine; Mental Health; Methods; Modification; Monitor; Moods; Numeric Rating Scale; Opioid; Outcome; Pain; Pain Clinics; Pain intensity; Pain management; Participant; Patients; Persons; Phase; Physical activity; Pilot Projects; Private Sector; Provider; Public Health Informatics; Qualifying; Randomized Controlled Trials; Recommendation; Recruitment Activity; Relative (related person); Relaxation; Reporting; Research; Research Institute; Resources; Risk; Rural; Safety; Sampling; Self Management; Services; Site; Sleep; Sleep Disorders; Solutions; Stress; Structure; Symptoms; Telephone; Testing; Therapeutic; Training and Education; Travel; Veterans; West Haven-Yale Multidimensional Pain Inventory; Woman; base; chronic pain; cost; cost effective; depressive symptoms; design; disability; efficacy evaluation; evidence base; experience; follow-up; improved; improved functioning; interdisciplinary approach; interest; mobile application; negative mood; novel; patient expectation; prevent; programs; psychologic; public health relevance; satisfaction; skills; social stigma; tool; treatment as usual; usability

DESCRIPTION (provided by applicant): The VHA has identified pain management as a high priority. Data document that perhaps a majority of Veterans receiving care in VHA, including OEF/OIF/OND [[and women]] Veterans, report the presence of pain. CLBP, in particular, is among the most prevalent and costly of all disorders treated in VHA. Among the most promising therapies for reducing pain and improving functioning among persons with CLBP are low cost and low risk non-pharmacological interventions such as exercise and behavioral interventions. Despite evidence supporting their effectiveness, access barriers often prevent Veterans from receiving these interventions. A growing body of evidence suggests that behavioral interventions, including those for persons with CLBP, can be delivered successfully via the Internet. Development of a viable Internet-based delivery platform to facilitate Veteran access to such interventions for CLBP offers an important solution to several access barriers. Within VHA, the availability of MyHealtheVet offers an ideal platform for hosting a pain self-management intervention. The primary objectives of the proposed study are to: (1) develop an integrative, Internet-based, Veteran-centered behavioral intervention, the Veteran Pain Management Resource Center (VPMRC) for CLBP, and (2) examine preliminary efficacy, usability, and satisfaction of this intervention in a representative sample of Veterans with CLBP. To achieve these objectives, a [[24-month]] pilot study with two phases is proposed. During Phase I, the VPMRC will be developed and feedback from 15 Veterans with CLBP and an Expert Panel of pain management clinicians will be used to modify the program. As currently envisioned, the VPMRC will serve as a resource to help Veterans learn and practice adaptive behavioral and cognitive pain coping skills such as relaxation and stress reduction methods, exercise and structured physical activity, and activity pacing, among others. During Phase II, a pilot feasibility trial of the VPMRC will be conducted to test the preliminary efficacy and usability of, and satisfaction with the VPMRC. Fifty-five Veterans with CLBP will be recruited for Phase II. All participants will continue to receive their usual care from VHA providers. During [[the 10-week]] therapeutic window, weekly telephone calls from research staff will serve to cue and monitor participants' use of the Internet program. At [[ten]] weeks post-baseline, participants will be formally reassessed. Planned statistical analyses will test the hypothesis that Veterans who engage in the VPMRC program will demonstrate a clinically meaningful reduction in pain-related functional interference as measured by a 0.6 point decrease in individual scores on the West Haven-Yale Multidimensional Pain Inventory-Interference Scale, relative to baseline. Additional analyses will test whether participants are more likely to report clinically meaningful reductions in pain intensity and improvements in fatigue, sleep, and mood, relative to baseline. Participants are also hypothesized to report high levels of interest and credibility, use of, and satisfaction with the VPMRC. The Phase II quantitative outcomes data will further assist with modification and revision of the VPMRC. If the project is successful and demonstrates preliminary efficacy, further evaluation of efficacy via randomized controlled trial, followed by dissemination and implementation efforts, may increase access to pain self-management treatment and increase effectiveness of care for Veterans with CLBP. PUBLIC HEALTH RELEVANCE: Chronic low back pain (CLBP) is among the most prevalent and costly disorders among Veterans receiving care in VHA facilities. Behavioral interventions such as exercise and cognitive behavior therapy are known to be effective for CLBP but are often not readily available or easily accessed. The overall objective of the proposed project is to develop and test the preliminary efficacy and usability of and satisfaction with an integrative, Internet-based, behavioral pain self-management program, the Veterans Pain Management Resource Center (VPMRC), in Veterans with CLBP. The VPMRC will be designed and built to be compatible with MyHealtheVet (MHV). If successful, the long term objective is to migrate the VPMRC to the MHV platform to provide widespread and easy access for Veterans across VHA, regardless of geography or other access barriers.

描述（由申请人提供）： VHA 已将疼痛管理视为重中之重。数据显示，也许大多数在 VHA 接受护理的退伍军人，包括 OEF/OIF/OND [[和女性]]退伍军人，都报告存在疼痛。 尤其是 CLBP，是 VHA 治疗的所有疾病中最常见且费用最高的疾病之一。减少 CLBP 患者疼痛和改善功能的最有前途的疗法是低成本和低风险的非药物干预措施，例如运动和行为干预措施。尽管有证据支持其有效性，但准入障碍常常阻碍退伍军人接受这些干预措施。越来越多的证据表明，行为干预措施，包括针对 CLBP 患者的干预措施，可以通过互联网成功实施。开发一个可行的基于互联网的交付平台，以促进退伍军人获得此类 CLBP 干预措施，为解决一些准入障碍提供了重要的解决方案。在 VHA 内，MyHealtheVet 的可用性为举办疼痛自我管理干预提供了一个理想的平台。 拟议研究的主要目标是：(1) 开发一种综合的、基于互联网的、以退伍军人为中心的行为干预措施，即针对 CLBP 的退伍军人疼痛管理资源中心 (VPMRC)，以及 (2) 在 CLBP 退伍军人的代表性样本中检查该干预措施的初步功效、可用性和满意度。为了实现这些目标，建议进行 [[24 个月]] 分两个阶段的试点研究。在第一阶段，将开发 VPMRC，并使用 15 名 CLBP 退伍军人和疼痛管理临床医生专家小组的反馈来修改该计划。按照目前的设想，VPMRC 将作为一种资源，帮助退伍军人学习和练习适应性行为和认知疼痛应对技能，例如放松和减压方法、锻炼和结构化身体活动以及活动节奏等。第二阶段将进行VPMRC的试点可行性试验，以测试VPMRC的初步功效、可用性和满意度。第二阶段将招募 55 名 CLBP 退伍军人。所有参与者将继续从 VHA 提供者处获得常规护理。在[[10周]]治疗窗口期间，研究人员每周都会打电话来提示和监控参与者对互联网程序的使用。在基线后[[十]]周，将对参与者进行正式重新评估。 计划的统计分析将检验以下假设：参与 VPMRC 计划的退伍军人将表现出临床上有意义的疼痛相关功能干扰减少，通过西黑文-耶鲁多维疼痛量表干扰量表的个人评分相对于基线下降 0.6 分来衡量。其他分析将测试参与者是否更有可能报告相对于基线而言具有临床意义的疼痛强度降低以及疲劳、睡眠和情绪改善。 假设参与者对 VPMRC 表现出高度的兴趣和可信度、使用和满意度。第二阶段定量结果数据将进一步协助VPMRC的修改和修订。如果该项目成功并显示出初步疗效，通过随机对照试验进一步评估疗效，然后进行传播和实施工作，可能会增加获得疼痛自我管理治疗的机会，并提高对患有 CLBP 的退伍军人的护理效果。 公共卫生相关性： 慢性腰痛 (CLBP) 是在 VHA 机构接受护理的退伍军人中最普遍且最昂贵的疾病之一。众所周知，运动和认知行为疗法等行为干预措施对 CLBP 有效，但往往不易获得或容易获得。拟议项目的总体目标是开发和测试退伍军人疼痛管理资源中心 (VPMRC) 的综合性、基于互联网的行为疼痛自我管理计划的初步功效、可用性和满意度。 VPMRC 的设计和制造将与 MyHealtheVet (MHV) 兼容。如果成功，长期目标是将 VPMRC 迁移到 MHV 平台，为跨 VHA 的退伍军人提供广泛且轻松的访问，无论地理位置或其他访问障碍如何。