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，约有一半 给药(VHA)有慢性疼痛，其中慢性腰痛(CLBP)是主要类型。退伍军人与 CLBP 是医疗保健利用率较高的机构，并且正在经历护理方式的巨大转变——从医疗方法开始 依赖阿片类药物等药物来控制疼痛的生物心理社会方法，其中证据- 基于风险较低的非药物选择受到青睐。非药物干预措施，包括 补充和综合健康（CIH）治疗现在是一线护理。因此，退伍军人 需要能够获得这些治疗，但它们实施起来很复杂，并且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，而且成本低， 易于管理、易于使用且为退伍军人及其提供者所接受。 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： 使用当前的结构将有效的自我管理的指压干预融入 VHA 支持以退伍军人为中心的护理。拟议的项目是至关重要的第一步。它直接解决了来自 VA、HSR&D 和 CARA 立法旨在为慢性疼痛提供更多非阿片类药物选择， 包括针压等 CIH 治疗。 创新和影响：该项目利用 VHA 内独特的基础设施来测试和交付 可以在全系统范围内采用的干预措施。自我穴位按摩是一种理想的干预措施 使用 CIH 治疗的现有 VHA 支持结构（整个健康系统）进行测试。自我管理 鉴于穴位按摩风险低且能够在家中进行，因此它是 VHA 的一个有前途的候选者 随时。除了提供可以为 VA 腰痛临床实践指南提供信息的证据外 关于自我穴位按摩对 CLBP 的有效性，该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，该指令概述了如何处理的流程 为退伍军人整合 CIH 治疗。 具体目标： 目标 1：确定为期 6 周的自我穴位按摩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周时的持续影响]和2) 评估对患有 CLBP 的退伍军人实施自我穴位按摩的支持和障碍。 方法： 1 类有效性实施混合研究将在三个 VA 地点进行： 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 诊所。将从这些站点的提供者处以及通过通过提供的课程招募 300 名退伍军人 整个健康系统，一项旨在教导退伍军人如何自我管理健康方面的倡议。 随机分配到刺激穴位按摩组的参与者将与参与者进行比较 随机分配到等候名单对照组，并对实施因素进行定量测量和 质量上。这项工作以传播框架为指导，吸引利益相关者，衡量保真度， 考虑场地特征，并评估实施的促进因素和障碍。 后续步骤/实施：这项研究有助于建立自我穴位按摩的知识库 作为 CLBP 症状的治疗方法，将研究范围扩展到功效研究之外。它填补了一个空白 有关有效性以及如何最好地实施自我穴位按摩的知识。该项目将 提供关键信息，可以提高获得患者偏好的非阿片类药物疼痛的能力 治疗。如果自我穴位按摩有效，下一步将是测试整个实施情况 不同地区的多个 VA 站点，并更全面地检查促进因素和障碍，考虑到 全国退伍军人的地理和文化差异。