CAM Referral and Outcomes: Chronic Low Back Pain in Urban and Rural Primary Care

CAM 转诊和结果：城乡初级保健中的慢性腰痛

• 批准号: 7738050
• 负责人: William Gibbs Elder
• 金额: $ 22.17万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7738050
• 关键词: Address; Adoption; Back Pain; Caring; Characteristics; Chronic low back pain; Client satisfaction; Clinical; Collaborations; Communication; Communities; Community Medicine; Complementary and alternative medicine; Decision Making; Education; Effectiveness; Family; Family Physicians; Foundations; Goals; Grant; Health Personnel; Health Services; Kentucky; Licensing; Life; Long-Term Effects; Massage; Medical; Methodology; Modality; Muscle relaxation phase; National Center for Complementary and Alternative Medicine; Opiates; Outcome; Pain; Patients; Pharmaceutical Preparations; Physicians; Practice based research; Preparation; Primary Care Physician; Primary Health Care; Recommendation; Relaxation Therapy; Reporting; Research; Rural; Students; Surveys; Testing; Therapeutic; Time; Training; Universities; addiction; base; clinical practice; control trial; conventional therapy; cost; disability; effective therapy; health related quality of life; improved; lectures; member; patient oriented; practice-based research network; programs; public health relevance; rural area; willingness

DESCRIPTION (provided by applicant): Kentucky ranks 2nd in disability among states, with chronic low back pain (CLBP) as a major disability, especially in our rural areas. In the last few years the medical use of opiate medications has significantly increased. Their use has complicated treatment greatly, with addiction rates and misuse skyrocketing. Kentucky and U.S. health care providers need alternative and effective treatments. Following NCCAM strategic research recommendations, this study will investigate health services outcomes of complementary and alternative medicine (CAM) therapies in an existing primary care practice-based research network (PBRN). The Kentucky Ambulatory Network (KAN) is the partnering PBRN. Patients with CLBP are often willing to try therapeutic options outside the conventional medical spectrum. Massage and relaxation therapies have demonstrated fairly good efficacy in controlled trials but their effectiveness in the "real world" of primary care is only beginning to be evaluated. The long-term goal of the proposed project builds on the foundation of these two established therapies to improve treatment of chronic low back pain (CLBP) in primary care practices. Two alternative (CAM) therapies, progressive muscle relaxation (PMR) and clinical massage therapy (CMT), will be studied. The short-term objectives of the proposed project are to: (1) examine outcomes of CAM for patients with CLBP referred from primary care practices, and (2) better understand physician decision-making to recommend CAM therapy for CLBP. Specific Aim 1 will evaluate improvement in health-related outcomes for patients with CLBP when referred to PMR or CMT from primary care. Specific Aim 2 will explore selected factors in primary care physicians' decisions to recommend CAM therapy to these patients. The proposed study is unique in that it addresses "real life" clinical situations and decision-making in both urban and rural clinical practices within an existing PBRN. Should such CAM referral prove successful for ameliorating CLBP, it would provide relatively low cost, non-addictive treatment options for inclusion in the repertoire of primary care physicians. PUBLIC HEALTH RELEVANCE: The "CAM Referral and Outcomes: Chronic Low Back Pain in Urban and Rural Primary Care" project will investigate clinical and patient-oriented outcomes of CAM therapies in an existing practice-based research network (PBRN). For patients with chronic low back pain, we will examine the outcomes of clinical massage therapy and progressive muscle relaxation when referred by primary care physicians, as well as selected factors in the physicians' decisions to recommend these therapies.

描述（由申请人提供）：肯塔基州在残疾方面排名第二，慢性腰痛（CLBP）是主要的残疾，特别是在我们的农村地区。在过去几年中，阿片类药物的医疗用途显著增加。它们的使用使治疗变得非常复杂，成瘾率和滥用率急剧上升。肯塔基州和美国的医疗保健提供者需要替代和有效的治疗方法。根据NCCAM的战略研究建议，本研究将在现有的基于初级保健实践的研究网络（PBRN）中调查补充和替代医学（CAM）疗法的卫生服务结果。肯塔基流动网络（KAN）是合作的PBRN。CLBP患者通常愿意尝试传统医学范围之外的治疗方案。按摩和放松疗法在对照试验中显示出相当好的疗效，但它们在“现实世界”初级保健中的有效性才刚刚开始得到评估。拟议项目的长期目标建立在这两种既定疗法的基础上，以改善初级保健实践中慢性腰痛（CLBP）的治疗。两种替代（CAM）疗法，渐进式肌肉放松（PMR）和临床按摩疗法（CMT），将进行研究。拟议项目的短期目标是：(1)检查从初级保健实践转介的CLBP患者的CAM结果，(2)更好地了解医生推荐CLBP CAM治疗的决策。特异性目标1将评估从初级保健转介PMR或CMT时CLBP患者健康相关结局的改善。特异性目标2将探讨在初级保健医生决定向这些患者推荐辅助替代疗法的选择因素。拟议的研究的独特之处在于，它解决了现有PBRN中城市和农村临床实践中的“现实生活”临床情况和决策。如果这样的CAM转诊被证明可以成功地改善CLBP，它将为初级保健医生提供相对低成本、非成瘾性的治疗选择。