Risk of Care Escalation after Non-Pharmacologic Treatment: Leveraging Real World Physical Therapy Data

非药物治疗后护理升级的风险：利用真实世界的物理治疗数据

• 批准号: 10598312
• 负责人: TREVOR LENTZ
• 金额: $ 44.28万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598312
• 关键词: Accounting; Acute Pain; Address; Area; COVID-19; COVID-19 impact; Caring; Clinical; Clinical Practice Guideline; Data; Data Set; Decision Making; Development; Goals; Growth; Guidelines; Health; Health Care Costs; Healthcare; Helping to End Addiction Long-term; Human; Image; Individual; Industrialization; Intervention; Knowledge; Modeling; Musculoskeletal Pain; Operative Surgical Procedures; Opioid; Outcome; Pain; Patient Self-Report; Patients; Persons; Physical therapy; Practice Guidelines; Prior Therapy; Probability; Provider; Recommendation; Registries; Research; Risk; Risk Factors; Services; Signal Transduction; United States; Work; addiction; base; care seeking; chronic pain; cost; deprivation; design; disability; health care delivery; high risk; improved; indexing; modifiable risk; multimodality; opioid injection; opioid use; pain-related disability; physical therapist; response; secondary analysis; sociodemographics; treatment response

ABTRACT Musculoskeletal pain is a highly prevalent, costly, and burdensome condition commonly managed with opioids. Opioids do not often adequately address pain and have high risk for misuse and addiction. As a result, clinical practice guidelines strongly recommend non-pharmacologic treatments for musculoskeletal pain. Physical therapists are one of the most common providers of non-pharmacologic pain care in the US. However up to 43% of people receiving non-pharmacologic treatments delivered by physical therapists continue to seek care for their pain condition beyond the physical therapy episode, signaling a sub-optimal response to non- pharmacologic treatment. Additional treatments received often are higher risk, more invasive, and not recommended by current practice guidelines (e.g., opioids, surgery). The overarching aim of this project is to use real-world data to better understand risk factors for poor response to non-pharmacologic care delivered by physical therapists. This knowledge will enhance individual treatment decision making (e.g.., when to consider coordinated multimodal care) and provide direction on how to re-design non-pharmacologic care models to better address risk for poor response. In Aim 1, we will identify baseline factors associated with an unfavorable change in pain-related disability (a common precursor to escalation of care) among patients undergoing treatment by a physical therapist. Using the ATI Outcomes Registry Dataset, one of the largest outcomes datasets specific to physical therapy, we will derive common trajectories of self-reported disability following initiation of care (Sub-Aim 1a) and develop multivariable models to identify risk factors for an unfavorable disability change trajectory (Sub-Aim 1b). Aim 2 will use a separate, large claims-based dataset comprised of industrial union workers to identify baseline factors associated with escalation of care (i.e., subsequent use of imaging, opioids, injection, and surgery) following initiation of treatment by a physical therapist for musculoskeletal pain (Sub-Aim 2a). Sub-Aim 2b will use a subset of the claims-based dataset that is also included in the ATI Outcomes Registry to determine the incremental change in probability of care escalation associated with each one-point improvement in disability score. This information could help clinicians set disability improvement targets for a meaningful reduction in risk for escalating care. In exploratory analyses, we will assess how the mass disruption of healthcare delivery related to COVID-19 impacts these questions. We will perform stratified analyses for each Aim to 1) determine whether disability trajectories and factors associated with those trajectories have changed following the onset of COVID-19, and 2) establish whether receiving physical therapy prior to or after onset of COVID-19 is associated with differences in risk for poor outcomes. Collectively, this work aims to improve the delivery of non-pharmacologic care in an effort to reduce risk for opioid use and better address the substantial personal and societal impact of musculoskeletal pain.

提取 肌肉骨骼疼痛是一种非常普遍、昂贵且负担沉重的疾病，通常用阿片类药物治疗。 阿片类药物通常不能充分解决疼痛问题，而且滥用和成瘾的风险很高。因此，临床 实践指南强烈推荐肌肉骨骼疼痛的非药物治疗。物理 治疗师是美国最常见的非药物疼痛护理提供者之一。然而，直到 43%接受物理治疗师提供的非药物治疗的人继续寻求护理 对于他们的疼痛状况超出物理治疗事件，信号对非最佳反应， 药物治疗接受的其他治疗通常风险更高，更具侵入性， 目前的实践指南建议（例如，阿片类药物、手术）。该项目的首要目标是 使用真实世界数据更好地了解对非药物治疗反应不良的风险因素， 理疗师这些知识将增强个体治疗决策（例如，何时考虑 协调的多模式护理），并就如何重新设计非药物护理模式提供指导， 更好地解决应对不力的风险。在目标1中，我们将确定与不利因素相关的基线因素。 接受治疗的患者中疼痛相关残疾（护理升级的常见前兆）的变化 接受理疗师的治疗使用ATI结局登记数据集， 具体到物理治疗的数据集，我们将得出自我报告的残疾的共同轨迹， 启动护理（子目标1a），并开发多变量模型，以确定不利的 残疾变化轨迹（子目标1b）。Aim 2将使用一个单独的、基于索赔的大型数据集， 产业工会工人确定与护理升级相关的基线因素（即，随后使用 成像、阿片类药物、注射和手术）， 肌肉骨骼疼痛（子目标2a）。子目标2b将使用基于索赔的数据集的一个子集， 纳入ATI结局登记研究，以确定护理升级概率的增量变化 残疾评分每提高一分。这些信息可以帮助临床医生 残疾改善目标是有意义地减少风险，以逐步提高护理水平。在探索性分析中，我们 将评估与COVID-19相关的医疗服务大规模中断如何影响这些问题。我们 将对每个目标进行分层分析，以1）确定残疾轨迹和因素是否 在COVID-19爆发后，与这些轨迹相关的变化，以及2）确定是否 在COVID-19发病之前或之后接受物理治疗与贫困风险的差异有关 结果。总的来说，这项工作旨在改善非药物治疗的提供，以减少 这将有助于减少阿片类药物使用的风险，并更好地解决肌肉骨骼疼痛对个人和社会的重大影响。