Combined Chiropractic Care and Tai Chi for Chronic Non-Specific Neck Pain

脊椎按摩疗法和太极拳相结合治疗慢性非特异性颈部疼痛

• 批准号: 10703431
• 负责人: Peter Michael Wayne
• 金额: $ 25.67万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-12 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703431
• 关键词: Activities of Daily Living; Address; Adult; Area; Awareness; Biological Factors; Biomechanics; Boston; Caring; Chiropractor; Chronic; Chronic neck pain; Clinical; Clinical Management; Communities; Complement; Complementary Health; Complex; Data Collection; Diagnosis; Disease Management; Educational Materials; Educational process of instructing; Etiology; Exercise; Functional disorder; Funding; Future; Goals; Health Care Costs; Health Personnel; Individual; Integrative Medicine; Interoception; Intervention; Interview; Kinesthesis; Learning; Lifting; Low Back Pain; Manuals; Mediating; Methods; Migraine; Modality; Monitor; Movement; Musculoskeletal; National Center for Complementary and Integrative Health; Neck; Neck Pain; Outcome; Pain; Pain management; Participant; Pathology; Patients; Pattern; Persons; Pilot Projects; Posture; Prevalence; Procedures; Protocols documentation; Provider; Psychological Factors; Public Health; Quality of life; Randomized; Reporting; Research; Safety; Self Efficacy; Self Management; Severities; Site; Spinal Manipulation; Strategic Planning; Structure; Tai Ji; Techniques; Therapeutic; Training; Visit; Waiting Lists; Walking; Work; arm; biopsychosocial; chiropracty; chronic pain management; chronic painful condition; cognitive process; cognitive skill; design; disability; effectiveness evaluation; evidence base; exercise prescription; flexibility; functional disability; improved; instructor; mind/body; mindfulness; multi-component intervention; multimodality; pain reduction; pharmacologic; productivity loss; psychologic; recruit; rumination; skills training; social factors; study population; systematic review; three-arm trial; treatment as usual; trial comparing; years lived with disability

Chronic nonspecific neck pain (CNNP), which is not due to organic pathology, is responsible for significant direct health care costs, health care provider visits, and work-related productivity loss. Though one of the top five chronic pain conditions in terms of prevalence and years lost to disability, to date, neck pain has received only a small fraction of the research funding given to low back pain. Consequently, there is a limited evidence base to guide management. Both pharmacological and non-pharmacological interventions are widely used to manage CNNP, but effect sizes are, at best, low to moderate, and no one therapy stands out as superior. CNNP is best understood from a biopsychosocial framework that recognizes etiology, severity, and outcomes as a complex and interrelated array of biological, psychological and social factors and points to the promise of complementary and integrative health approaches for successful disease management and treatment. Accordingly, this application explores the feasibility of pragmatically delivering and clinically evaluating the combined impact of two widely available approaches for managing CNNP––chiropractic care and Tai Chi (TC). These specific modalities were chosen because both individually show promise in managing CNNP, and based on their complementary approaches, strengths, and therapeutic components, there is a strong likelihood of additive or synergist effects when the two are delivered in a coordinated manner. Our long-term goal is to conduct a multi-site fully powered trial evaluating the effectiveness of chiropractic care combined with TC training to reduce pain and disability in adults with CNNP. As a first step, we propose to conduct a three-arm, mixed-methods pilot study. We will recruit and randomize (1:1:1) 48 adults with CNNP to receive: 1) 10 chiropractic treatments (delivered over 16 weeks) with concurrent TC training (16 weeks of in- person group training) plus enhanced usual care (EUC; usual care (UC) with CNNP educational materials); 2) chiropractic care plus EUC; or 3) EUC alone. Individuals will be followed for 8 weeks after the end of their intervention period to assess longer-term outcomes. Aim 1 will evaluate our ability to recruit a network of chiropractors and Tai Chi instructors, refine our interventions, and assess fidelity of intervention protocols. Aim 2 will assess the feasibility of recruiting, retaining and monitoring the safety of adults with CNNP into our trial. Aim 3 will refine data collection procedures and evaluate outcomes for future trials. Given the widespread availability of chiropractic and TC nationally, if proven effective, this multimodal approach for treating CNNP could represent a practical strategy with immediate public health impact. This application aligns with NCCIH’s 2021-2025 Strategic Plan, including advancing research on the whole person and investigating non-pharmacological pain management strategies that can improve first-line chronic pain management.

慢性非特异性颈痛（CNNP），这不是由于有机病理，是负责显着的 直接医疗保健费用、医疗保健提供者的访问以及与工作相关的生产力损失。虽然其中一个顶级的 五种慢性疼痛疾病的患病率和致残年数，迄今为止，颈部疼痛已收到 只有一小部分的研究资金用于腰痛。因此，只有有限的证据 基地指导管理。药物和非药物干预被广泛用于 管理CNNP，但效果大小充其量是低到中等，没有一种治疗方法是上级的。 CNNP最好从一个生物心理社会框架来理解，该框架认识到病因、严重程度和 结果作为一个复杂的和相互关联的生物，心理和社会因素的阵列，并指出， 成功管理疾病的互补和综合保健方法的前景， 治疗因此，该应用程序探索了务实地交付和临床的可行性 评估两种广泛使用的CNNP管理方法的综合影响-脊椎按摩护理 太极（Tai Chi）之所以选择这些具体的方式，是因为这两种方式各自都显示出管理 CNNP，并基于其互补的方法，优势和治疗成分， 当两者以协调的方式提供时，很可能产生叠加或叠加效应。 我们的长期目标是进行一项多地点的充分动力试验，评估脊椎按摩疗法的有效性。 护理结合TC培训，以减少CNNP成人的疼痛和残疾。作为第一步，我们建议 进行三组混合方法的试点研究。我们将招募并随机（1：1：1）分配48名CNNP成人， 接受：1）10次脊椎按摩治疗（超过16周），同时进行TC培训（16周的 人组培训）加增强型常规护理（EUC;常规护理（UC）与CNNP教育材料）; 2） 脊椎指压治疗加EUC;或3）单独EUC。个体将在他们的研究结束后随访8周。 干预期，以评估长期结果。目标1将评估我们招募网络的能力， 脊椎按摩师和太极教练，完善我们的干预措施，并评估干预方案的保真度。目的 2将评估招募、保留CNNP成人患者并监测其安全性的可行性。 目标3将完善数据收集程序，并评估未来试验的结果。 鉴于脊椎按摩疗法和TC在全国范围内的广泛可用性，如果证明有效，这种多模式 治疗CNNP的方法可以代表具有直接公共卫生影响的实用策略。这 申请符合NCCIH的2021-2025战略计划，包括推进对整个人的研究 并研究非药物性疼痛管理策略， 管理