Self-Administered Acupressure for Veterans with Chronic Back Pain: A Multisite Evaluation of Effectiveness and Implementation

患有慢性背痛的退伍军人的自我穴位按摩：有效性和实施的多站点评估

• 批准号: 10414362
• 负责人: Sarah Krein
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414362
• 关键词: Acupressure; Acupuncture Therapy; Address; Adherence; Age; Ambulatory Care Facilities; Analgesics; Back Pain; Caring; Characteristics; Chinese Traditional Medicine; Chronic; Chronic low back pain; Clinical Practice Guideline; Clinical effectiveness; Communities; Complementary Health; Complex; Control Groups; Country; Education; Educational Curriculum; Effectiveness; Evaluation; Evidence based intervention; Fatigue; Female; Fill-It; Geography; Goals; Health; Health Services Accessibility; Health system; Healthcare; Home; Infrastructure; Integrative Medicine; Intervention; Interview; Knowledge; Low Back Pain; Measures; Medical; Medical center; Mental Depression; Methodology; Methods; Michigan; Opioid; Outcome; Overdose; Pain; Pain interference; Pain management; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Primary Health Care; Process; Protocols documentation; Provider; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Resources; Risk; Self Administration; Self Management; Site; Sleep; Sleep disturbances; Statutes and Laws; Structure; System; Techniques; Testing; Time; Training; Veterans; Veterans Health Administration; Waiting Lists; Work; arm; base; biopsychosocial; care seeking; chronic back pain; chronic pain; chronic pain management; chronic painful condition; common treatment; cost; design; disability; effectiveness evaluation; effectiveness implementation study; efficacy study; ethnic minority population; evidence base; experience; future implementation; high risk; implementation barriers; implementation determinants; implementation efforts; implementation facilitators; improved; innovation; interest; intervention cost; intervention effect; knowledge base; member; multimodality; non-drug; non-opioid analgesic; opioid epidemic; opioid user; pain outcome; pain relief; pain symptom; post intervention; preference; racial and ethnic; recruit; response; sex; side effect; sleep quality; symptom treatment; symptomatic improvement; systematic review; treatment risk; uptake; virtual

Background: It is estimated that about half of the 9 million Veterans who receive care at Veterans Health Administration (VHA) have chronic pain, of which chronic low back pain (CLBP) is a major type. Veterans with CLBP are high healthcare utilizers and are experiencing a dramatic shift in care – from a medical approach that relied on medications like opioids for pain management to a biopsychosocial approach in which evidence - based, lower risk non-pharmacological options are favored. Non-pharmacological interventions, which include complementary and integrative health (CIH) treatments, are now a first line of care. Consequently, Veterans need to be able to access these treatments, but they are complex to deliver and difficult to provide in real-world settings. Thus, non-pharmacological treatments for CLBP need to not only be effective, but also low cost, easy-to-administer, accessible, and acceptable to Veterans and to their providers. Significance: Our long-term goal is to improve chronic pain management for Veterans with CLBP by integrating an effective self-administered acupressure intervention into VHA using current structures that support Veteran-centered care. The proposed project is a crucial first step. It directly addresses priorities from VA, HSR&D, and CARA legislation that seek to provide greater access to non-opioid options for chronic pain, including CIH treatments like acupressure. Innovation and Impact: This project leverages the unique infrastructure within VHA to test and deliver interventions that could have system-wide uptake. Self-administered acupressure is an ideal intervention to test using the existing VHA support structure for CIH treatments, the Whole Health System. Self-administered acupressure is a promising candidate for uptake at VHA given its low risk and ability to be performed at home at any time. In addition to providing evidence that can inform VA clinical practice guidelines for low back pain on effectiveness of self-administered acupressure for CLBP, this project will also inform on how to begin to implement this treatment at VHA, which would support the recent CIH Directive that outlines processes for how to integrate CIH treatments for Veterans. Specific Aims: Aim 1: Determine effectiveness of a 6-week self-administered acupressure protocol on pain interference, disability, fatigue, and sleep post intervention, and [sustained effects at 10 weeks] and 2) Evaluate supports and barriers for implementation of self -administered acupressure to Veterans with CLBP. Methodology: A Type 1 effectiveness-implementation hybrid study will be conducted at three VA sites: Ann Arbor VA Medical Center, Toledo Community-Based Outpatient Clinic, and Flint Community-Based Outpatient Clinic. There will be 300 Veterans recruited from providers at these sites and through classes offered through the Whole Health System, an initiative designed to teach Veterans how to self-manage aspects of their health. Participants who are randomized into the stimulating acupressure arm will be compared to participants randomized into a wait list control group and implementation factors will be measured quantitatively and qualitatively. This work is guided by dissemination frameworks, engaging stakeholders, measuring fidelity, considering site characteristics, and assessing facilitators and barriers to implementation. Next Steps/Implementation: This study contributes to the knowledge base of self -administered acupressure as a treatment for symptoms in CLBP, extending the state of the research beyond efficacy studies. It fills a gap in knowledge about effectiveness and how to best implement self-administered acupressure. This project will provide critical information that can increase the ability to access a patient-preferred, non-opioid pain treatment. If self-administered acupressure is effective, next steps would be to test implementation across several VA sites in different regions and more comprehensively examine facilitators and barriers considering geographical and cultural differences in Veterans across the country.

背景：据估计，在退伍军人健康中心接受护理的900万退伍军人中， 慢性腰痛是慢性疼痛的主要类型之一。退伍军人 CLBP是高医疗保健利用者，正在经历护理的巨大转变-从医疗方法 从依赖阿片类药物来控制疼痛转变为生物心理社会学方法， 基于基础的、风险较低的非药物选择是有利的。非药物干预，包括 补充和综合健康（CIH）治疗，现在是第一线护理。因此，退伍军人 我需要能够获得这些治疗，但它们的交付很复杂，在现实世界中很难提供 设置.因此，CLBP的非药物治疗不仅需要有效，而且需要低成本， 易于管理，可访问，退伍军人和他们的供应商可接受。 意义：我们的长期目标是通过以下方式改善CLBP退伍军人的慢性疼痛管理： 使用当前结构将有效的自我管理穴位按压干预整合到VHA中， 支持以退伍军人为中心的护理。拟议的项目是关键的第一步。它直接解决优先事项， VA，HSR&D和CARA立法，旨在为慢性疼痛提供更多的非阿片类药物选择， 包括穴位按摩等CIH疗法。 创新和影响：该项目利用VHA内部的独特基础设施进行测试和交付 可以在全系统得到采纳的干预措施。自我管理穴位按摩是一种理想的干预， 测试使用现有的VHA支持结构CIH治疗，整个卫生系统。自填 穴位按摩是一个有前途的候选摄取在VHA鉴于其低风险和能力，可以在家里进行 立即使除了提供证据，可以告知VA临床实践指南腰痛 关于CLBP自我管理穴位按压的有效性，本项目还将告知如何开始 在VHA实施这种治疗，这将支持最近的CIH指令，该指令概述了 为退伍军人整合CIH治疗。 具体目的：目的1：确定为期6周的自我穴位按压方案对疼痛的有效性 干预后的干扰、残疾、疲劳和睡眠，以及[10周时的持续效应]和2） 评估支持和实施自我管理穴位按摩与CLBP退伍军人的障碍. 方法：将在三个VA研究中心进行1型有效性-实施混合研究：Ann Arbor VA医疗中心，托莱多社区门诊诊所和弗林特社区门诊 诊所将有300名退伍军人从这些地点的供应商那里招募，并通过 整个卫生系统，旨在教退伍军人如何自我管理他们的健康方面的倡议。 将随机分配到刺激指压组的参与者与 随机分为等待名单对照组，将定量测量实施因素， 定性地。这项工作是由传播框架，参与利益攸关方，衡量忠诚度， 考虑现场特点，评估实施的促进因素和障碍。 下一步/实施：本研究有助于自我管理穴位按摩的知识基础 作为CLBP症状的治疗，将研究状态扩展到疗效研究之外。它填补了 在知识的有效性和如何最好地实施自我管理穴位按摩。该项目将 提供关键信息，可以提高获得患者首选的非阿片类药物疼痛的能力 治疗如果自我管理穴位按摩是有效的，下一步将是测试实施跨 不同地区的几个VA站点，并更全面地研究促进因素和障碍， 全国各地退伍军人的地理和文化差异。