Feasibility of At Home Telehealth Yoga for Treating Chronic Pain

翻译后摘要：50-75%的退伍军人在初级保健报告经历慢性疼痛（1，2）。慢性疼痛是 药物治疗往往包括成瘾或过量的风险。认识到范围 为了解决这一问题，退伍军人事务部促进了补充和综合保健（CIH）， 传统的疼痛治疗。瑜伽是一种流行的CIH方法，对治疗许多类型的 慢性疼痛最近的一篇文献综述（3）得出结论，瑜伽作为一种 治疗慢性肌肉痉挛型疼痛，这是最常见的慢性疼痛类型。因此，委员会认为， 这项建议的重点是瑜伽治疗慢性肌肉骨骼疼痛。VA Palo Alto医疗保健 系统运行一个临床瑜伽计划的退伍军人使用两种模式;传统的亲自瑜伽，和诊所- 基于远程瑜伽，其中瑜伽教练与退伍军人事务部诊所的退伍军人使用实时互动 视频会议。我们的试验数据表明，基于诊所的远程瑜伽与面对面瑜伽一样安全有效 用于治疗慢性肌肉骨骼疼痛然而，这种远程保健模式并没有克服障碍， 前往诊所的时间、费用和困难。最近，退伍军人管理局推出了一项新的基于网络的远程医疗服务， 一个名为VA视频连接（VVC）的系统，该系统允许退伍军人与他们的医疗保健提供者进行交流 从家里通过平板电脑。VVC可用于团体或个人会话，具有巨大的潜力 在家里进行治疗。其他研究小组早期尝试开发家庭远程瑜伽， 遇到了技术问题。VVC提供了一个令人兴奋的机会来克服这些问题， 资源丰富、可扩展且技术先进的系统。理想情况下，随机对照试验将是 进行严格比较在家里远程瑜伽在人瑜伽治疗慢性肌肉骨骼疼痛。 在考虑进行这样的试验之前，我们需要评估并克服交付的技术障碍 在家远程瑜伽使用VVC。本提案的第一阶段侧重于完善现有的瑜伽协议， 适用于使用通过VVC提供的家庭远程瑜伽治疗肌肉骨骼疼痛（n=20）。每一位老兵都将 我们将使用迭代过程来识别和克服技术问题， 技术带来的限制。这个阶段的产品将是一个为期12周的瑜伽干预。2期 将证明进行一项随机对照试验的可行性，该试验涉及使用 第一阶段制定的瑜伽方案。我们将招募并随机选择患有慢性肌肉骨骼疼痛的退伍军人 两个治疗组之一：面对面瑜伽和在家远程瑜伽（每组n=15）。初步可行性 结果将包括招募率、保留率、方案依从性、参与者满意度、 治疗交付和不良事件。我们还将评估测量心率变异性的可行性， 与瑜伽的假定作用机制有关的实验结果。结果将提供 大型随机对照试验的早期可行性数据。

Abstract: Between 50-75% of veterans in primary care report experiencing chronic pain (1, 2). Chronic pain is treatment-resistant, and medications often include the risk of addiction or overdose. In recognition of the scope of this problem, the VA has promoted complementary and integrative health (CIH) for use in conjunction with conventional pain treatments. Yoga is a popular CIH approach and is effective in treating many types of chronic pain. A recent literature review (3) concluded that evidence is particularly strong for yoga as a treatment for chronic musculoskeletal-type pain, which is the most common type of chronic pain. Accordingly, this proposal focuses on yoga treatment for chronic musculoskeletal pain. The VA Palo Alto Health Care System runs a clinical yoga program for veterans using two modalities; traditional in-person yoga, and clinic- based teleyoga in which a yoga instructor communicates with veterans at VA clinics using real-time interactive video conferencing. Our pilot data suggest that clinic-based teleyoga is as safe and effective as in-person yoga for treating chronic musculoskeletal pain. However, this telehealth model does not overcome barriers such as the time, cost and difficulty of travel to a clinic. Very recently, the VA launched a new web-based telehealth system called VA Video Connect (VVC), which allows veterans to communicate with their health care providers from home via a tablet computer. VVC can be used for group or individual sessions and has immense potential for delivering treatments at home. Earlier attempts by other research groups to develop at-home teleyoga have been met with technical problems. VVC offers an exciting opportunity to overcome these problems using a well-resourced, scalable, and technically advanced system. Ideally, a randomized controlled trial would be performed to rigorously compare at-home teleyoga to in-person yoga for treating chronic musculoskeletal pain. Before such a trial can be considered, we need to evaluate and overcome the technical barriers of delivering at-home teleyoga using VVC. Phase 1 of this proposal focuses on refining an existing yoga protocol to make it suitable for treating musculoskeletal pain using at-home teleyoga delivered via VVC (n=20). Each veteran will be given a tablet computer and we will use an iterative process to identify and overcome the technical limitations imposed by the technology. The product of this phase will be a 12-week yoga intervention. Phase 2 will demonstrate the feasibility of conducting a randomized controlled trial involving at-home teleyoga using the yoga protocol developed in Phase 1. We will enroll and randomize veterans with chronic musculoskeletal pain to one of two treatment groups: in-person yoga and at-home teleyoga (n=15 per group). Primary feasibility outcomes will include rates of recruitment, retention, protocol adherence, participant satisfaction, fidelity of treatment delivery, and adverse events. We will also assess the feasibility of measuring heart rate variability as an experimental outcome that is related to the putative mechanism of action of yoga. The results will provide early stage feasibility data for a larger randomized controlled trial.