Feasibility of Remote-Delivery Interventions: Tai Chi and Wellness for PTSD and Pain in Veterans

项目摘要 创伤后应激障碍（PTSD）影响了近四分之一的退伍军人， 退伍军人管理局的医疗机构。PTSD与许多健康相关的问题有关，特别是 慢性肌肉骨骼疼痛，越来越多地被认为是一种全身性疾病，影响精神和 身体迫切需要解决创伤后应激障碍和慢性疼痛的可行治疗。太极是一种古老的 中国运动，采用综合身心的方法，以提高生活质量。太极拳在 已被证明可以改善各种慢性疾病患者的心理健康和身体健康。 条件然而，到目前为止，还没有研究检查太极拳对创伤后应激障碍和退伍军人疼痛的影响。以来 在COVID-19爆发后，无需面对面接触即可提供的干预措施大大减少了 needed.通过视频会议平台提供的远程身心干预可以减少 治疗因PTSD相关回避、旅行相关挑战或公共卫生社会问题而孤立的退伍军人 距离限制。这项拟议的研究将评估远程太极拳治疗创伤后应激障碍的可行性 老兵的痛苦这个试验代表了建立这种身心关系的长期目标的第一步 通过远程视频会议平台为退伍军人提供治疗，以解决这些疾病。在第一阶段， 研究小组将适应并做一个“演习”的两个现有的12周，每周两次的干预措施（太极拳和 a健康控制），用于通过视频会议为研究人群提供服务。在第一阶段，团队将 招募12名参与者（每组6人），利用定量和定性反馈， 规范干预措施。在第二阶段，36名参与者将被随机分配到3个队列（n = 12 对于每个队列，每组n = 6）到太极或健康组12周， 治疗后随访评估。远程随机试验的可行性和可接受性 将确定这两种干预措施和评估方案。可行性将通过以下方式进行量化： 受试者合格率、招募率、自然减员率以及治疗和评估方案的依从性。 可行性将通过（1）实现征聘目标的能力来表明，包括妇女和少数族裔 参与，以及（2）至少75%的参与者定期参加会议并参与家庭活动 实践和70%完成干预后和后续评估。将通过以下方式评估可接受性： 参与者对治疗满意度标准化测量的评级，辅以定性退出 采访70%的受试者报告治疗满意度表明可接受性， 可信度本试验的信息将用于设计一项大型随机对照研究， 太极拳对改善患有创伤后应激障碍和慢性肌肉骨骼疼痛的退伍军人的预后的功效。的 拟议的研究对于建立充分评估新型、可获得的非药物的程序至关重要 在未来的大规模太极试验中，PTSD和慢性疼痛的症状管理方法。

Project Summary Posttraumatic stress disorder (PTSD) affects almost one quarter of military Veterans seeking care from Veterans Administration healthcare facilities. PTSD is associated with many health-related issues, especially chronic musculoskeletal pain, and is increasingly considered a systemic disorder, affecting both mind and body. Accessible treatments that address PTSD and chronic pain are urgently needed. Tai Chi is an ancient Chinese exercise that uses an integrated mind-body approach to enhance quality of life. Tai Chi delivered in groups has been shown to improve both mental health and physical health in patients with a variety of chronic conditions. However, no studies to date have examined Tai Chi for PTSD and pain in Veterans. Since the onset of COVID-19, interventions that can be delivered without the need for face-to-face contact are greatly needed. Remote mind-body interventions delivered via videoconferencing platforms can reduce barriers to treatment for Veterans isolated by PTSD-related avoidance, travel related challenges, or public health social distancing restrictions. The proposed study will evaluate the feasibility of remotely delivered Tai Chi for PTSD and pain in Veterans. This trial represents first steps toward a long-term goal of establishing this mind-body treatment to address these maladies for Veterans via a remote videoconferencing platform. In Phase One, the research team will adapt and do a ‘dry run’ of two existing 12-week, twice per week interventions (Tai Chi and a Wellness control) for delivery via videoconferencing for the study population. In Phase One, the team will recruit 12 participants (6 in each group) and utilize quantitative and qualitative feedback to refine and standardize the interventions. In Phase Two, 36 participants will be randomly assigned over 3 cohorts (n = 12 for each cohort, n = 6 for each group) to either a Tai Chi or a Wellness group for 12 weeks with a three-month post-treatment follow up assessment. The feasibility and acceptability of a remotely delivered randomized trial of these two interventions and the assessment protocols will be determined. Feasibility will be quantified using rates of participant eligibility, recruitment, attrition, and adherence to the treatment and assessment protocols. Feasibility will be indicated (1) by the ability to meet recruitment goals, including women and minority participation, and (2) by having at least 75% of participants regularly attend sessions and engage in home practice and 70% complete post-intervention and follow-up assessments. Acceptability will be assessed via participants’ ratings on a standardized measure of treatment satisfaction, supplemented by qualitative exit interviews. Acceptability will be indicated by 70% of the participants reporting treatment satisfaction and credibility. Information from this trial will be utilized to design a large randomized control study evaluating the efficacy of Tai Chi for improving outcomes for Veterans with PTSD and chronic musculoskeletal pain. The proposed study will be pivotal to establish procedures to fully evaluate a novel, accessible, nonpharmacologic approach for symptom management of PTSD and chronic pain in a future large-scale trial of Tai Chi.