Delivering a Mobile and Web Based Self Directed Complementary And Integrative Health Program to Veterans and Their Partners to Manage Pain and PTSD

慢性疼痛是退伍军人群体中最普遍的医疗条件之一。疼痛 通常会出现共病症状，特别是创伤后应激障碍（PTSD）。 共病慢性疼痛和PTSD显著影响退伍军人及其家属的生活质量 家庭利用互补和综合健康（CIH）的多方面疗法是 在退伍军人事务部内授权补充临床实践指南，改善退伍军人的生活质量， 发挥作用的能力。这项研究将评估CIH干预管理疼痛和PTSD相关 在生物心理社会框架内取得成果。拟议的干预行动，即使命重建， (MR)这是一个用户驱动的二元自我护理管理计划，通过在线和移动的应用程序提供 以前已经证明在非临床定义的社区为基础的 退伍军人/军人。这项研究是需要测试MR的影响，在临床定义的 作为临床服务的补充，以评估后续实施的可能性 退伍军人事务部（VA）。 这一提案的重新提交是响应退伍军人的报告的愿望CIH和几个 VA倡议，包括RR&D当前关注的非药理学活动的特殊领域- 基于慢性疼痛的干预措施，影响疼痛减轻、功能和生活质量。退伍军人管理局 卫生部长战略优先事项和新出现的VA全健康计划确定 获得CIH的疼痛和自我护理管理作为优先事项，以实现最佳的退伍军人健康。 为了响应这些优先事项，2016年VA最新技术会议（SOTA）和 综合成瘾恢复法（CARA）规定VA的承诺，进行严格的 研究将非药物和CIH方法整合到护理中，重点是疼痛 管理这项建议也是对VA的阿片类药物安全倡议（OSI）和疼痛的回应。 护理使命，优先考虑疼痛的非药物治疗选择。的 本研究的短期目标是确定MR对（1）慢性疼痛、PTSD和 相关成果和（2）退伍军人及其合作伙伴的关系成果。长期 目标是确定使用CIH自我护理管理的有效性和可持续性 像MR这样的项目，以改善患有慢性疼痛和创伤后应激障碍的退伍军人的预后， 伙伴我们提出了一个为期四年的混合方法随机对照试验MR的两个武器 （治疗和等待名单对照）在患有疼痛和PTSD共病的退伍军人的临床样本中， 他们的伙伴（例如，配偶）。具体目标是：（目标1）确定MR有效性， 身体（疼痛，睡眠），创伤后应激障碍（侵入，唤醒，回避，麻木），和心理 （抑郁、压力、焦虑）症状和全球健康（生活质量）;（目的2）确定MR 对社会（关系满意度，对自己/他人的同情）结果的有效性 退伍军人和他们的合作伙伴;（目标3）描述退伍军人和合作伙伴对MR的感知价值， 参与者的子样本。样本将由退伍军人和伴侣二人组（N = 228）组成， 安阿伯、普吉特海湾和坦帕VA设施。目标1和2的数据收集将包括自我报告 在4个月的时间内评估4个数据点，以评估身体，心理和社会 结果。还将收集MR使用前两个月的八份每周报告，以评估 MR利用率，疼痛和压力水平。目标3的数据收集将包括电话访谈 从随机选择的MR治疗组二对子样本（n = 42）中检查MR用户 经验和他们的建议使MR对退伍军人和他们的合作伙伴有用。

Chronic pain is one of the most prevalent medical conditions in the Veteran population. Pain often presents with comorbid conditions, specifically post-traumatic stress disorder (PTSD). Comorbid chronic pain and PTSD significantly impact the quality of life of Veterans and their families. Multi-faceted therapies leveraging complementary and integrative health (CIH) are mandated within VA to complement clinical practice guidelines improve Veterans' quality of life and ability to function. This research will evaluate a CIH intervention to manage pain and PTSD related outcomes within a bio-psychosocial framework. The proposed intervention, Mission Reconnect (MR), a user-driven, dyadic, self-care management program delivered online and by mobile app that has previously shown to be effective in a non-clinically defined community-based Veteran/military population. This research is needed to test MR's effects in a clinically defined population as a complement to clinical services to assess for potential subsequent implementation within the Department of Veterans Affairs (VA). This proposal resubmission is responsive to Veterans' reported desire for CIH and several VA initiatives, including RR&D's current special areas of interest for non-pharmacological activity- based interventions for chronic pain impacting pain reduction, function and quality of life. The VA Secretary of Health Strategic Priorities and the emerging VA Whole Health Program identify access to CIH for pain and self-care management as a priority to achieve optimal Veteran health. To be responsive to these priorities the 2016 VA State-of-the-Art Conference (SOTA) and Comprehensive Addiction Recovery Act (CARA) mandated VA's commitment to conduct rigorous research to integrate non-pharmacological and CIH approaches into care, with emphasis on pain management. This proposal is also responsive to the VA's Opioid Safety Initiative (OSI) and Pain Care Mission which prioritize the need for nonpharmacological treatment options for pain. The short-term goal of this study is to determine the effects of MR on (1) chronic pain, PTSD and related outcomes and (2) relationship outcomes for Veterans and their partners. The long-term goal is to determine the effectiveness and sustainability of using CIH self-care management programs like MR to improve outcomes for Veterans with chronic pain and PTSD, and their partners. We propose a four-year mixed-methods randomized controlled trial of MR with two arms (treatment & wait-list control) in a clinical sample of Veterans with comorbid pain and PTSD, and their partners (e.g., spouse). The specific aims are to: (Aim 1) Determine MR effectiveness for physical (pain, sleep), PTSD (intrusion, arousal, avoidance, numbing), and psychological (depression, stress, anxiety) symptoms, and global health (quality of life); (Aim 2) Determine MR effectiveness for social (relationship satisfaction, compassion for self/others) outcomes among Veterans and their partners; and (Aim 3) Describe Veteran and partner perceived value of MR in a sub-sample of participants. The sample will consist of Veteran and partner dyads (N = 228) at the Ann Arbor, Puget Sound, and Tampa VA facilities. Aim 1 & 2 data collection will include self-report assessment of 4-data points over a 4-month period to evaluate physical, psychological, and social outcomes. Eight weekly reports will also be collected for the first two months of MR use to assess MR utilization, and pain and stress levels. Aim 3 data collection will include telephone interviews from a randomly selected sub-sample of MR treatment group dyads (n = 42) to examine MR user experiences and their suggestions making MR useful for Veterans and their partners.