A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults

针对老年人慢性肌肉骨骼疼痛的低强度认知行为自我管理干预

• 批准号: 9903177
• 负责人: Mary Rose Janevic
• 金额: $ 11.6万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903177
• 关键词: Accelerometer; Address; Adherence; Adult; Advocacy; Affect; Affective; Age; American; Americas; Analgesics; Anesthesiology; Anxiety; Area; Attention; Award; Behavior Therapy; Behavioral; Bioethics; Biological; Caring; Chronic Disease; Clinical; Cognitive; Cognitive Therapy; Collaborations; Computerized Cognitive Behavioral Therapy; Control Groups; Data; Data Analyses; Data Collection; Data Set; Development; Devices; Diabetes Mellitus; Educational process of instructing; Educational workshop; Elderly; Environment; Epidemic; Ethicists; Ethics; Facial Pain; Fatigue; Feedback; Focus Groups; Foundations; Functional disorder; Geriatrics; Gerontology; Goals; Health; Heart Diseases; Improve Access; Influentials; Institute of Medicine (U.S.); Institutes; Internet; Intervention; Intervention Trial; K-Series Research Career Programs; Libraries; Link; Manuals; Mediator of activation protein; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Michigan; Modeling; Monitor; Outcome; Pain; Pain intensity; Pain management; Participant; Patients; Pattern; Persistent pain; Physical Medicine; Physical Rehabilitation; Pilot Projects; Polypharmacy; Process; Program Development; Psychiatry; Psychology; Public Health; Public Health Schools; Randomized; Reaction; Recommendation; Reporting; Research; Research Activity; Research Design; Research Personnel; Research Support; Research Training; Resources; Risk; Self Management; Series; Services; Social Functioning; Specialist; Symptoms; System; Telephone; Testing; Therapeutic Intervention; Therapy trial; Time; Touch sensation; Training; Training Activity; Training Programs; United States; United States National Institutes of Health; Universities; Validity and Reliability; Waiting Lists; Work; age group; base; behavior test; biopsychosocial; career; chronic musculoskeletal pain; chronic pain; chronic pain management; clinical center; cognitive function; comorbidity; coping; cost; daily functioning; design; disability; eHealth; evidence base; experience; fitbit; group intervention; improved; individual patient; intervention effect; mHealth; older patient; pain patient; pain relief; pain self-management; patient oriented; pilot trial; pragmatic trial; preference; programs; psychologic; public health relevance; recruit; secondary analysis; side effect; skills; social; symposium; tool; training opportunity; usability; young adult

 DESCRIPTION (provided by applicant): A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults In an influential 2011 report entitled Relieving Pain in America, the Institute of Medicine called attention to the epidemic of chronic pain in the United States, and to the urgent need to improve access to effective pain treatments. Responding to the priorities set in this report, I am seeking to lay the foundation for an independent research program with the goal of increasing the accessibility of evidence-based, cognitive-behavioral interventions for chronic pain management among older adults. This application for a Mentored Career Development Award (K01) proposes training and research activities over a 5-year period that will enable me to launch this research program. To this end, I have formed an interdisciplinary team of mentors and consultants that includes researchers representing Geriatrics, Anesthesiology, Psychology, Physical Medicine and Rehabilitation, Public Health and Psychiatry at the University of Michigan, as well as a prominent pain ethicist from the independent Center for Practical Bioethics. This additional support will build on my strong foundation in conducting behavioral and chronic illness self-management support research among older adults. The training and research aims in this proposal are closely linked. The training goals include acquiring skills and expertise in the areas that are essential for my planned research program: 1) The pathophysiology and management of chronic pain in older adults and cognitive-behavioral approaches to treating chronic pain in this group; 2) Symptom and activity monitoring in older adults, which enables the use of accurate and timely information about patients' progress as part of behavioral interventions, while identifying potential mediators of intervention effects; and 3) Emerging study designs for testing behavioral interventions, with an emphasis on pragmatic, adaptive and patient-centered designs that increase the relevance of research findings. These topics will be mastered through coursework, clinical observations, and self-study under the guidance of the mentorship team. I will also attend relevant seminars, workshops, and scientific conferences throughout the award period. Following the training program, I will develop and pilot-test a low-intensity pain CBT intervention for older adults. The intervention will use a high tech/high touch approach. Using an evidence-based internet CBT intervention for chronic pain management as a starting point, I will develop two additional components that will enhance the appeal and potential efficacy of this program for older adults: a) a series of telephone CBT sessions by non-specialist practitioners to support use of the electronic modules, and b) symptom and activity monitoring using mobile health tools to better tailor the intervention to individual patients' needs. The development and pilot-testing of this program will be accomplished via three sequential research aims. To aid in the development of program content, in Aim 1, I will conduct secondary analysis of data from two recent RCTs of pain CBT interventions to test the hypothesis that there are significant age group differences in pain coping strategies and choice of CBT goals, and to identify the CBT skills that are most appealing and most challenging to older adults. I will also conduct focus groups to obtain feedback from target intervention users on the acceptability and design of the proposed facilitator and monitoring components. In Aim 2, I will conduct usability testing with older pain patients to test our assumption that using a FitBit-type device to automatically- upload accelerometer data results in markedly greater adherence to data collection than manual upload via IVR calls. We will also evaluate the reliability, validity and acceptability of both automated and manual upload to inform the final choice of monitoring strategy used in the pilot study. In Aim 3, I will recruit 50 older adults with chronic musculoskeletal pain and conduct a randomized pilot trial of the intervention with waitlist controls to assess its feasibility and effects on Pai Impact. If successful, results from the pilot study will serve as preliminary work for a larger pragmatic trial to be proposed in the final year of the K01. The University of Michigan, the School of Public Health, and the Center for Managing Chronic Disease provide the ideal environment for carrying out the proposed activities. These units offer opportunities for training, collaboration, and cross-disciplinary pollination. A wide array of resources will facilitate my wor during the award period; e.g., the Geriatrics Center and Institute of Gerontology, the Chronic Pain and Fatigue Research Center, the Michigan Center for Clinical and Health Research, as well as world-class computing, library, and statistical support services. This resource-rich environment, along with a committed team of mentors, will facilitate my transition to an independent research career.

 描述（由申请人提供）：针对老年人慢性肌肉骨骼疼痛的低强度、认知行为自我管理干预在2011年一份题为《缓解美国疼痛》的有影响力的报告中，医学研究所呼吁关注美国慢性疼痛的流行，以及改善获得有效疼痛治疗的迫切需要。针对本报告中确定的优先事项，我力求 该基金会是一个独立的研究项目，其目标是增加老年人慢性疼痛管理的循证认知行为干预措施的可及性。这份导师职业发展奖（K 01）申请书提出了为期5年的培训和研究活动，这将使我能够启动这项研究计划。为此，我组建了一个由导师和顾问组成的跨学科团队，其中包括代表密歇根大学老年医学、麻醉学、心理学、物理医学和康复、公共卫生和精神病学的研究人员，以及来自独立的实用生物伦理学中心的著名疼痛伦理学家。这种额外的支持将建立在我在老年人中进行行为和慢性疾病自我管理支持研究的坚实基础上。本建议中的培训和研究目标是密切相关的。培训目标包括获得该领域的技能和专业知识 这是必不可少的我计划的研究计划：1）老年人慢性疼痛的病理生理学和管理，以及治疗该组慢性疼痛的认知行为方法; 2）老年人的症状和活动监测，这使得使用准确和及时的信息，患者的进展作为行为干预的一部分，同时确定干预效果的潜在介质; 3）新兴的行为干预测试研究设计，强调务实，适应性和以患者为中心的设计，增加研究结果的相关性。这些主题将通过课程，临床观察和自学的指导下，导师团队掌握。在整个获奖期间，我还将参加相关的研讨会、讲习班和科学会议。在培训计划之后，我将为老年人开发和试点测试低强度疼痛CBT干预。干预将使用高科技/高接触方法。使用基于证据的互联网CBT干预慢性疼痛管理作为起点，我将开发两个额外的组件，以增强该计划对老年人的吸引力和潜在功效：a）由非专业从业者进行的一系列电话CBT课程，以支持电子模块的使用，和B）使用移动的健康工具进行症状和活动监测，以更好地针对个体患者的需求定制干预。该计划的开发和试点测试将通过三个连续的研究目标来完成。为了帮助项目内容的发展，在目标1中，我将对最近两项疼痛CBT干预的RCT数据进行二次分析，以检验疼痛应对策略和CBT目标选择存在显着年龄组差异的假设，并确定对老年人最具吸引力和最具挑战性的CBT技能。我亦会举办焦点小组讨论会，就建议的促进者和监察组成部分的可接受性和设计，征询目标介入服务使用者的意见。在目标2中，我将对老年疼痛患者进行可用性测试，以测试我们的假设，即使用Fitbit类型的设备自动上传 与通过IVR呼叫手动上传相比，加速度计数据显著提高了数据收集的依从性。我们亦会评估自动及人手上载的可靠性、有效性及可接受性，以作为先导研究最终选择的监察策略。在目标3中，我将招募50名患有慢性肌肉骨骼疼痛的老年人，并进行一项随机试点试验，以评估其可行性和对派影响的干预措施。如果成功，试点研究的结果将作为K 01最后一年提出的更大规模实用试验的初步工作。密歇根大学、公共卫生学院和慢性病管理中心为开展拟议的活动提供了理想的环境。这些单位提供培训机会， 协作和跨学科的授粉。各种各样的资源将有助于我在获奖期间的工作;例如，老年医学中心和老年学研究所、慢性疼痛和疲劳研究中心、密歇根临床和健康研究中心，以及世界一流的计算、图书馆和统计支持服务。这种资源丰富的环境，沿着一个致力于导师团队，将促进我过渡到一个独立的研究生涯。