Addressing the chronic pain epidemic among older adults in underserved community center; The GetActive+ study.

解决服务不足的社区中心老年人中流行的慢性疼痛问题；

• 批准号: 10536153
• 负责人: Christine S Ritchie
• 金额: $ 162.03万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536153
• 关键词: Address; Adoption; Adult; Alternative Health; Area; Attention; Behavioral; Boston; Bypass; Caring; Clinic; Clinical; Clinical Nurse Specialists; Cognitive; Communities; Community Health; Compassion; Complementary Health; Disadvantaged; Economically Deprived Population; Economics; Elderly; Enrollment; Epidemic; Feedback; Focus Groups; Fright; Funding; Growth; Health; Healthcare; Helping to End Addiction Long-term; Hybrids; Immigrant; Impaired cognition; Impairment; Intervention; Language; Life; Link; Loneliness; Manuals; Measures; Medical; Methods; Modeling; Morbidity - disease rate; Neighborhood Health Center; Nurse Practitioners; Nurses; Outcome; Pain; Pain intensity; Pain management; Patient Self-Report; Patients; Performance; Persistent pain; Pharmaceutical Preparations; Phase; Physical Function; Population; Primary Health Care; Problem Solving; Procedures; Proctor framework; Provider; Randomized; Resources; Risk; Social support; Thinking; Time; Training Programs; Visit; Walking; Work; acceptability and feasibility; adverse event risk; base; body-mind; care seeking; chronic musculoskeletal pain; chronic pain; chronic pain management; community center; community clinic; community engaged research; coping; cost; disadvantaged background; disadvantaged population; effectiveness evaluation; effectiveness implementation trial; effectiveness outcome; emotional functioning; ethnic minority; evidence base; experience; falls; health equity; high risk; implementation evaluation; implementation facilitators; implementation outcomes; improved; low socioeconomic status; mindfulness; mortality; multiple chronic conditions; pain outcome; patient population; programs; racial and ethnic; racial diversity; racial minority; resilience; response; sedentary; side effect; skills; social; treatment as usual; underserved community

PROJECT SUMMARY: Chronic musculoskeletal pain (pain > 3 months) is prevalent, costly, challenging to treat and a national priority area. Older adults have the highest rates of chronic pain, and these are expected to increase given the growth of the older adult population over the next three decades. Older adults from underserved communities (low SES, racial and ethnic minorities, immigrants) are at the highest risk for negative pain related health consequences such as lower physical and emotional function and morbidity and mortality. We lack evidence based non-pharmacological treatments to address chronic pain within community health clinics that serve this older adult patient population. GetActive is an evidence-based mind-body activity program that directly targets improvement in pain outcomes by combining cognitive behavioral and mindfulness skills with gradual increase in walking (preferred and safe activity for older adults) linked to valued activities. In direct response to RFA-NS- 22-002 we have partnered with the MGH-Revere HealthCare Center which serves >5,000 disadvantaged older adults, to optimize GetActive to bypass socioecological barriers and effectively engage this population into non-pharmacological pain management strategies. In the R61 phase, we will: 1) develop GetActive+ (optimized GetActive), 2) evaluate its feasibility and acceptability; and 3) refine and finalize training, program manual, measures, and procedures. In the R33 phase, we will conduct a randomized, hybrid type 1 effectiveness-implementation trial (N=200) to evaluate effectiveness and implementation of GetActive+ versus treatment as usual on the following outcomes: 1) self-reported physical function (primary), 2) performance based (6MWT) and objective (step count) physical function, emotional function, pain, social support, loneliness (secondary); and 3) feasibility, acceptability, fidelity and adoption at patient, provider and organization levels (implementation). Through this project we aim to solve the problem of lack of evidence based nonpharmacological treatments for older adults in underserved communities. GetActive+ delivered by clinic staff can be routinely incorporated into group visits (already available at MGH-Revere HealthCare Center and other similar community centers) which are billable, thus providing a sustained model of care for older adults with chronic pain from disadvantaged backgrounds. Because GetActive incorporates mind-body skills with activity (e.g., walking), there is potential for improvement in other outcomes (e.g., decreased risk for morbidity and mortality) over and above pain.

项目摘要： 慢性肌肉骨骼疼痛（疼痛> 3个月）普遍存在，昂贵，挑战性的治疗和国家优先区域。年龄较大 成年人的慢性疼痛发生率最高，鉴于老年人的增长，预计这些疼痛将增加 在接下来的三十年中。来自服务不足的社区（低SE，种族和少数民族，移民）的老年人 与负面疼痛相关的健康后果的风险最高，例如身体和情绪功能降低以及 发病率和死亡率。我们缺乏基于证据的非药物治疗方法来解决社区内的慢性疼痛 为这个老年人患者人群提供服务的卫生诊所。 GetActive是一个基于证据的思维体活动计划 通过将认知行为和正念技能与逐步相结合，直接针对疼痛结果的改善 与有价值活动相关的步行（对老年人的首选和安全活动）的增加。直接响应RFA-NS- 22-002我们与MGH-Revere Healthcare Center合作，该中心为5,000名处境不利的老年人提供服务， 优化绕过社会生态障碍，并有效地使该人群陷入非药物痛苦 管理策略。在R61阶段，我们将：1）开发getActive+（优化的GetActive），2）评估其可行性 和可接受性； 3）完善和完成培训，程序手册，措施和程序。在R33阶段，我们将 进行一项随机，混合1型有效性实施试验（n = 200），以评估有效性和 在以下结果中实施getActive+与往常的治疗：1）自我报告的身体机能 （主要），2）基于绩效（6MWT）和客观（步骤计数）身体机能，情感功能，痛苦，社交 支持，孤独（次要）； 3）患者，提供者和组织的可行性，可接受性，忠诚度和收养 级别（实施）。通过这个项目，我们旨在解决缺乏基于证据的非药物的问题 在服务不足的社区中的老年人治疗。诊所员工交付的getactive+可以定期合并 进行小组访问（已在MGH-Revere Healthcare Center和其他类似社区中心提供） 可账单，从而为弱势背景的慢性疼痛的老年人提供了持续的护理模型。 因为GetActive将思维技巧与活动（例如步行）结合在一起，所以其他可能有所改善 结局（例如，发病率和死亡率的降低）超出了疼痛。