SMART Stepped Care Management for Low Back Pain in Military Health System

军事卫生系统中腰痛的智能阶梯式护理管理

• 批准号: 10250448
• 负责人: Julie M Fritz
• 金额: $ 167.63万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10250448
• 关键词: Address; Advisory Committees; Advocate; Back Pain; Caring; Chronic; Chronic low back pain; Consultations; Data; Data Collection; Department of Defense; Diagnosis; Effectiveness; Electronic Health Record; Epidemic; Ethics; Evidence based treatment; Gender; Goals; Health; Health Care Costs; Health Services; Heart; Heterogeneity; Human Resources; Information Dissemination; Integrative Therapy; Intervention; Intervention Studies; Low Back Pain; Manuals; Medical; Medicine; Methods; Military Personnel; Mindfulness Training; Modeling; Multi-Institutional Clinical Trial; Outcome; Pain; Pain management; Pathway interactions; Patient Care; Patients; Performance; Personal Satisfaction; Phase; Physical therapy; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Psychological Factors; Quality Control; Randomized; Readiness; Recommendation; Research; Research Personnel; Resources; Services; Site; Sleep disturbances; Soldier; Specific qualifier value; Subgroup; Surgeon; Training; Treatment Step; Triad Acrylic Resin; Utah; Veterans Health Administration; Wellness Center; active duty; base; biopsychosocial; chronic pain; chronic pain management; chronic pain patient; comorbidity; compare effectiveness; cost; cost effectiveness; cost outcomes; data management; design; holistic approach; improved; innovation; military health system; mindfulness; pain model; patient oriented; patient response; post-traumatic symptoms; programs; randomized trial; recruit; sex; social factors; treatment program; trial comparing

PROJECT SUMMARY Chronic pain is a ubiquitous problem and growing concern for the Military Health System (MHS). Low back pain (LBP) is the most common condition that leads to chronic pain. Numerous recommendations have been made to improve care for LBP and chronic pain in the MHS, including implementation of a Stepped Care approach. Stepped Care is a treatment process that begins with broadly accessible, less intesive interventions that can benefit many patients. Those who do not respond to initial treatments are stepped up to more intesive treatment. While Stepped Care is advocated for pain management, and has been beneficial for improving care in other chronic conditions, many questions remain about which treatments to use within each Step, and the importance of sequences of care decisions. The SMART Stepped Care Management Project will support an innovative Sequential Multiple Randomization Trial specifically designed to address these key questions. The Project brings together a team of researchers and clinicians from the MHS and Department of Defense along with a strong research team at the Unversity of Utah with expertise in the planning of multi-site clinical trials, managing and analyzing research data, and facilitating the dissemination of the results. After a Planning Phase to finalize procedures, the SMART trial will be conducted. Patients in the MHS with chronic LBP will be randomly assigned to either receive Physical Therapy or the holistic Move to Health intervention. After 6 weeks we will determine patients' responsiveness to their first treatment Step. Non-responders will be re-randomized to receive either a mindfulness-oriented treatment program or treatment from an Integrative Pain Medicine Center. Specific Aims for the SMART trial are 1) Conduct a SMART trial comparing effectiveness and cost- effectiveness of Step 1 and 2 treatments in a Stepped Care approach for patients with LBP in the MHS with patient-centered and healthcare cost outcomes. Sub-aims will compare main effects of Step 1 and 2 treatment options and the sequencing effects of different treatment combinations; and 2) Examine SMART trial results in pre-specified sub-groups based on sex/gender, age, and pain-related co-morbidities (PTSD, sleep disturbance, post-concussive symptoms).

项目总结 慢性疼痛是一个普遍存在的问题，也是军事卫生系统(MHS)日益关注的问题。腰背 疼痛(LBP)是导致慢性疼痛的最常见的疾病。许多建议已经被提出 为改善MHS中的LBP和慢性疼痛的护理而做出的努力，包括实施分级护理 接近。分步护理是一种治疗过程，它始于广泛可及的、较少干预的干预措施 这可以使许多患者受益。那些对最初的治疗没有反应的人会进一步接受更多的治疗 治疗。虽然阶梯式护理是疼痛管理的倡导者，并一直有益于改善 其他慢性疾病，许多问题仍然是关于在每一步中使用哪些治疗方法，以及 护理决策顺序的重要性。智能分级护理管理项目将支持 创新的序贯多重随机试验专为解决这些关键问题而设计。这个 该项目汇集了来自MHS和国防部的研究人员和临床医生团队 犹他州大学拥有一支强大的研究团队，在规划多地点临床试验方面拥有专业知识， 管理和分析研究数据，并促进结果的传播。在规划阶段之后 为了最终敲定程序，将进行智能审判。MHS中患有慢性LBP的患者将 随机分配接受物理治疗或整体移动到健康干预。6周后 我们将确定患者对第一步治疗的反应。无响应者将被重新随机分组 接受以正念为导向的治疗计划或综合疼痛医学的治疗 中心。智能试验的具体目标是1)进行智能试验，比较有效性和成本- 阶梯式护理方法中第1步和第2步治疗对MHS中LBP患者的疗效 以患者为中心和医疗保健成本结果。分目标将比较第一步和第二步治疗的主要效果 不同治疗组合的选择和排序效果；以及2)检查SMART试验结果 根据性别/性别、年龄和与疼痛相关的共病(创伤后应激障碍、睡眠障碍、 脑震荡后症状)。