Preventing Disability from MSK Pain in Northern Tanzania

预防坦桑尼亚北部 MSK 斯隆疼痛造成的残疾

• 批准号: 10264053
• 负责人: Adam Goode
• 金额: $ 6.43万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10264053
• 关键词: Activities of Daily Living; Address; Adherence; Africa; Age; Ambulatory Care; Arthralgia; Arthritis; Attention; Awareness; Car Phone; Caring; Clinic; Clinical; Collaborations; Community Participation; Country; Degenerative polyarthritis; Effectiveness; Elderly; Exercise; Exercise Therapy; Future; Geography; Goals; Health; Health Services Accessibility; Healthcare; Home; Hospitals; Image; Impaired cognition; Individual; Institutes; Internist; Intervention; Knowledge; Left; Life Expectancy; Low Back Pain; Low income; Measurement; Measures; Methods; Modeling; Musculoskeletal; Musculoskeletal Diseases; Musculoskeletal Pain; Orthopedics; Pain; Patient Self-Report; Patients; Pharmaceutical Preparations; Physical activity; Physical therapy; Prevalence; Productivity; Recommendation; Research; Rheumatoid Arthritis; Risk; Role; Rural; Service delivery model; Services; Specialist; Surgeon; Tanzania; Text; Text Messaging; Text Telephone; Translations; United States; United States National Institutes of Health; Veterans; Work; chronic pain; cognitive function; cost; design; disability; experience; functional decline; implementation framework; implementation research; improved; improved functioning; innovation; intervention refinement; low income country; mHealth; mortality; pain reduction; physical therapist; poor sleep; population health; prevent; programs; research study; rheumatologist; scale up; telephone coaching; theories; therapy development; years lived with disability

Abstract Musculoskeletal pain can be debilitating. Left untreated, musculoskeletal pain leads to functional decline, independent of other health conditions, that for older adults is known to increase the risk for cognitive decline and even mortality. Common practice for addressing chronic pain—pain that is lasting more than three months—is to refer people to specialists such as rheumatologists or orthopaedic surgeons, or to obtain expensive imaging and medications. Less often are non-pharmacological interventions prescribed with a particular focus on exercise as therapy despite demonstrated effectiveness. Physical therapy-led exercise therapy holds great promise for delivering high value care for individuals with musculoskeletal pain or limitations in daily activities. The significance of the physical therapists role in caring for people with joint pain or with arthritis is heightened in low-income settings where access to specialists is limited, and greater attention to unnecessary prescribing of images and medications is needed. There is a critical need to establish new models of musculoskeletal care in low-income countries like where we will focus in Northern Tanzania because life expectancy is increasing and yet, more people are living with disability. Low back pain, for example, is the second leading cause of disability in Tanzania and the rate of disabling low back pain has increased 36% from 2007 to 2017. Research collaborations across countries can help build capacity and support translation of effective care models for improved population health. Our five year goal is to have implemented a model of care that expands access to physical therapists using text and telephone support of exercise at home in even rural and remote villages. Our proposed two-year implementation research study builds on existing partnerships to adapt and plan for scaling up an intervention we found effective with older adult Veterans in the United States. Guided by the Institute for Healthcare Improvement Framework for Going to Full Scale, we will accomplish two specific aims. (1) Explore the feasibility, reach, appropriateness, acceptability, and costs of an innovative MSK care model for Northern Tanzania compared with current practice. (2) Adapt and refine the physical therapy, text message and telephone counseling components of the model to be locally relevant and expand availability and access to care. The scalable intervention and new knowledge generated from the proposed implementation research will guide our research team to go full scale in Northern Tanzania and spread to other regions for improved population health.

摘要 肌肉骨骼疼痛可以使人衰弱。如果不治疗，肌肉骨骼疼痛会导致功能下降， 与其他健康状况无关，老年人的认知能力下降的风险增加 甚至死亡率。解决慢性疼痛的常见做法-持续超过三个月的疼痛 个月-是指人们的专家，如风湿病学家或整形外科医生，或获得 昂贵的成像和药物。较少使用非药物干预， 特别关注运动作为治疗，尽管已证明有效。物理治疗主导的运动 治疗具有很大的希望，为肌肉骨骼疼痛或 日常活动的限制。物理治疗师在照顾关节疼痛患者中的作用 在低收入环境中，接触专家的机会有限， 需要注意不必要的图像和药物处方。迫切需要建立 在低收入国家，如我们将重点关注的坦桑尼亚北方， 因为预期寿命在增加，但更多的人生活在残疾中。腰痛，因为 例如，在坦桑尼亚，腰痛是残疾的第二大原因， 从2007年到2017年增长了36%。跨国家的研究合作可以帮助建设能力， 支持转化有效的护理模式，以改善人口健康。我们的五年目标是 实施了一种护理模式，通过短信和电话支持， 甚至在农村和偏远的村庄，我们建议的两年实施研究 在现有伙伴关系的基础上，调整和计划扩大我们发现对老年人有效的干预措施 美国的成年退伍军人。由医疗保健改善框架研究所指导， 为了全面实施，我们将实现两个具体目标。(1)探索可行性，范围，适当性， 可接受性，以及坦桑尼亚北方创新的MSK护理模式的成本与目前相比， 实践(2)调整和完善物理治疗，短信和电话咨询部分， 该模式应与当地相关，并扩大获得护理的机会。可扩展的干预和新的 从拟议的实施研究中获得的知识将指导我们的研究团队全面开展 在坦桑尼亚北方，并传播到其他地区，以改善人口健康。