Transcending COVID-19 barriers to pain care in rural America: Pragmatic comparative effectiveness trial of evidence-based, on-demand, digital behavioral treatments for chronic pain

超越美国农村地区疼痛护理的 COVID-19 障碍：针对慢性疼痛的循证、按需、数字行为治疗的实用比较有效性试验

• 批准号: 10242572
• 负责人: Brennan Spiegel
• 金额: $ 106.31万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-10 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242572
• 关键词: 3-Dimensional; 3D virtual reality; 3D world; Address; Affect; Alabama; Algorithms; American; Anxiety; Authorization documentation; Behavior Therapy; COVID-19; COVID-19 pandemic; California; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic Disease; Clinical; Cognitive Therapy; Computers; Consensus; Coronavirus; Coupled; Data; Development; Distress; Educational Curriculum; Electronic Health Record; Epidemic; Esthesia; Fright; Future; Geography; Goals; Goggles; Head; Health; Health Services Accessibility; Health system; Healthcare; Home; International; Internet; Intervention; Learning; Louisiana; Measures; Medical; Medicare; Mental Depression; Mental Health; Mental Health Services; Meta-Analysis; Mobile Health Application; Opioid; Pain; Pain intensity; Pain interference; Pain management; Patient Care; Patient Rights; Patients; Persons; Pharmaceutical Preparations; Prediction of Response to Therapy; Privacy; Provider; Psyche structure; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Risk; Running; Rural; Rural Community; Schedule; Self Administration; Services; Sleep; Sleeplessness; Social isolation; Stress; Support Groups; Surveys; Techniques; Technology; Telemedicine; Telephone; Testing; Time; Training; Transcend; Visit; Vulnerable Populations; Work; adverse outcome; base; beneficiary; biopsychosocial; care delivery; care seeking; care systems; chronic pain; chronic pain management; chronic pain patient; clinical care; comparative effectiveness trial; computer program; digital; digital health; digital treatment; emotional distress; evidence base; experience; health care availability; health care quality; health management; high risk; indexing; mHealth; non-opioid analgesic; opioid epidemic; opioid use; pain reduction; pandemic disease; primary outcome; programs; psychological distress; psychosocial; rapid growth; recruit; rural America; rural Americans; rural residence; satisfaction; self-management program; skills; social; social vulnerability; sociodemographics; substance use; treatment program; treatment response; two-dimensional; video visit; virtual; virtual reality; virtual world

PROJECT SUMMARY The COVID-19 pandemic has affected everyone in different ways. For people from the rural America with chronic diseases, particularly those who experience pain, the pandemic can not only worsen pain, but also it can trigger anxiety, depression, trouble sleeping, and substance use. This psychological distress is exacerbated by physical and social isolation, fear of seeking in-person visits, and diminished ability to access clinical care during the pandemic. One way doctors and health systems are reaching out is by video visits, where patients and their providers communicate online via the Internet. However, video visits still have limits. Therefore, we can help support them with other techniques. Beyond video visits, there are home-based programs that patients can administer themselves to help manage their pain. These proven programs can overcome staffing shortfalls, be used across long distance to reach anyone in the world and can be used at the time and place of the patients' choosing. In this study, we will compare two available, evidence-based, digital treatment programs that patients can use at home. The goal is to see if one approach is better than the other, and whether certain patients respond to one more than the other. The first program is an app that can run on any smartphone or computer. The program offers an 8-week, at-home curriculum to learn and practice new skills that can help manage pain. The program runs on a standard screen on your phone or computer. The second program is also a proven, 8-week program, but it uses a technology called virtual reality, or VR. VR involves wearing specialized goggles that create a sensation of being in a 3D world. Evidence shows that virtual worlds can help people learn and retain new skills that help reduce pain. The study will recruit 300 people from rural communities in California, Louisiana, and Alabama and randomize them into either the 2D or 3D programs. We will then follow patients for 8 weeks days and measure their pain levels. We will also measure signs of distress, including Coronavirus-related anxiety, along with measuring medications used for pain, such as opioids, and the impact of pain on overall quality of life. To conduct the study, we will ask patients to periodically complete short surveys online and allow permission for the research team to collect information from the electronic health record. We developed this study working with patient partners from the American Chronic Pain Association (ACPA), and they will be part of the research team throughout the conduct, analysis, and reporting of the study. The results will help patients, doctors, and health system decide how best to administer home-based, patient-administered, digital treatment programs for pain, and will offer recommendation on how to select the right treatment for the right patient.

项目总结