Mindfulness-based dance/movement therapy for chronic low back pain

基于正念的舞蹈/运动疗法治疗慢性腰痛

• 批准号: 9791346
• 负责人: Minjung Shim
• 金额: $ 22.43万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-25 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791346
• 关键词: Accelerometer; Address; Adult; Aftercare; Analgesics; Attention; Awareness; Caring; Chronic low back pain; Clinical; Clinical Research; Cognition; Dancing; Data; Data Collection; Data Quality; Educational process of instructing; Effectiveness; Emotional; Equipment; Evaluation; Feedback; Feeling; Group Therapy; Growth; Health; Intervention; Knowledge; Link; Manuals; Methodology; Methods; Mind-Body Intervention; Mission; Moods; Movement; Outcome; Pain; Pain intensity; Pain management; Participant; Patients; Perception; Persons; Phase; Physical Function; Physical activity; Pilot Projects; Prevalence; Procedures; Process; Protocols documentation; Public Health; Randomized Controlled Trials; Regulation; Relaxation; Reporting; Research; Self Efficacy; Social Well-Being; Social support; Stress; Structure; Support Groups; Testing; Treatment Protocols; Treatment outcome; base; biopsychosocial; chronic musculoskeletal pain; chronic pain; chronic pain patient; cognitive function; cost; design; disability; efficacy study; efficacy trial; evidence base; experience; follow-up; improved; in vivo; information gathering; innovation; intrinsic motivation; mindfulness; mindfulness intervention; non-opioid analgesic; novel; novel strategies; opioid abuse; pain reduction; post intervention; recruit; response; side effect; skills; social; sound; theories; therapy development; trial comparing

Project Summary. Chronic low back pain (cLBP) is a major public health problem with a lifetime prevalence rate of ~85% in U.S. adults. cLBP is a leading cause of disability and opioid abuse in the U.S. and costs the nation between $100-200 billion annually. Current treatments for cLBP are limited in scope and often result in low treatment engagement. There is a critical need for novel multidimensional treatments for cLBP. One promising mind-body therapy is Mindfulness-based Dance/Movement Therapy (M-DMT). M-DMT integrates mindfulness-based skills with the psychotherapeutic use of movement to promote physical and emotional health and social well-being. M-DMT addresses management of cLBP through the use of (1) in- vivo graded exposure therapy (i.e., dance/body movement) to promote physical activity and functioning, and enhance self- efficacy and perceived control; (2) creative/expressive movement to increase mindfulness skills, relaxation, and self- expression; and, (3) group therapy structure to normalize pain experiences and build social support. Research, albeit lim- ited, have shown positive associations between DMT and mood, stress, mobility, and pain reduction in patients with chronic pain. However, there is a dearth of research to support the efficacy of DMT, in part due to the absence of manual- ized protocols and methodologically sound randomized controlled trials (RCT). In addition, although mindfulness princi- ples are imbedded in DMT, studies have not formally included mindfulness skills with DMT for cLBP. An uncontrolled pilot study by our group in patients with chronic musculoskeletal pain (n=19) including patients with cLBP, suggests that a 10-week group DMT protocol was well-tolerated and feasible. Patients reported improvements in pain intensity, activity avoidance, attention regulation, acceptance, positive reinterpretation and growth, and a reduction in pain medication use. Based on data, we refined and extended the DMT protocol to 12 sessions and integrated mindfulness skills. The overall objectives of the current proposal are to evaluate the feasibility, acceptability and credibility of our refined M-DMT proto- col; to assess and improve methodological procedures for conducting a RCT test of M-DMT; and, to demonstrate proof of principle by gathering information about the process of change between M-DMT and a control condition. Our specific aims include 1) to evaluate the feasibility, acceptability and credibility of a refined 12 session M-DMT protocol for pa- tients with cLBP and to further refine the treatment protocol as needed; 2) to evaluate the feasibility, acceptability and methodological procedures of conducting a RCT comparing the 12-session M-DMT protocol to a social support group in adults with cLBP; and 3) to investigate the process of change in clinical outcomes by treatment conditions in order to demonstrate proof of principle. This study is innovative and significant because it 1) is the first study to addresses the po- tential of M-DMT as a creative, non-opioid intervention for cLBP; 2) utilizes a mixed methods design to evaluate the fea- sibility, acceptability and credibility of the M-DMT protocol; and, 3) will provide important methodological and protocol data and substantive pilot data necessary for the next phase of this line of research, namely a fully powered RCT to evalu- ate efficacy and treatment mechanisms of action.

项目摘要。 慢性下腰痛(CLBP)是一个主要的公共卫生问题，在美国成年人中终生患病率约为85%。慢性LBP是美国残疾和阿片类药物滥用的主要原因，每年给美国造成1000-2000亿美元的损失。目前对慢性下腰痛的治疗范围有限，往往导致治疗参与度低。迫切需要新的多维治疗方法来治疗慢性下腰痛。一种很有前途的心身疗法是基于正念的舞蹈/运动疗法(M-DMT)。M-DMT将以正念为基础的技能与运动的心理治疗应用相结合，以促进身心健康和社会福祉。M-DMT通过使用(1)体内分级暴露疗法(即舞蹈/身体运动)来管理cLBP，以促进体力活动和功能，并增强自我效能和感知控制；(2)创造性/表达运动，以提高正念技能、放松和自我表达；以及(3)团体治疗结构，以使疼痛体验正常化，并建立社会支持。尽管研究有限，但已表明DMT与慢性疼痛患者的情绪、压力、活动能力和疼痛减轻呈正相关。然而，缺乏支持DMT疗效的研究，部分原因是缺乏手动方案和方法学上合理的随机对照试验(RCT)。此外，尽管正念原则被植入DMT中，但研究还没有正式将正念技能纳入慢性LBP的DMT中。我们小组在慢性肌肉骨骼疼痛患者(n=19)中进行的一项非对照先导性研究表明，10周组DMT方案耐受性良好且可行。患者报告在疼痛强度、活动回避、注意力调节、接受、积极的重新解释和成长方面有所改善，并减少了止痛药的使用。基于数据，我们将DMT方案提炼和扩展到12次，并整合了正念技能。目前提案的总体目标是评估我们改进的M-DMT协议的可行性、可接受性和可信度；评估和改进进行M-DMT随机对照试验的方法学程序；并通过收集关于M-DMT和控制条件之间变化过程的信息来证明原则证据。我们的具体目标包括：1)评估改良的12次M-DMT方案用于慢性下腰痛患者的可行性、可接受性和可信度，并根据需要进一步改进治疗方案；2)评估在成人慢性下腰痛患者中进行随机对照试验的可行性、可接受性和方法学程序；以及3)调查治疗条件对临床结果的变化过程，以证明原则的证据。这项研究具有创新性和重要意义，因为它1)是第一项关于M-DMT作为一种创造性的、非阿片类药物干预cLBP的研究；2)使用混合方法设计来评估M-DMT方案的可行性、可接受性和可信度；3)将提供重要的方法学和方案数据以及这一系列研究的下一阶段所需的实质性先导数据，即评估疗效和治疗作用机制的全面随机对照试验。