Development and feasibility of a mind-body intervention to improve physical activity for patients with chronic hip pain

项目摘要 慢性髋关节疼痛每年影响1820万成年人，伴有髋关节相关疼痛（关节内非关节炎性髋关节病变） 占青年至中年人慢性髋关节疼痛病例的60%。手术和非手术治疗 髋关节相关疼痛不能提供普遍的益处，因为疼痛和功能障碍对大多数患者持续存在。人士 持续的疼痛往往减少他们的活动，以尽量减少症状，尽管有强有力的证据表明，定期的体力活动， 减少慢性肌肉骨骼疼痛。心理健康状况不佳（即，低自我效能，高痛苦灾难化，和 运动恐惧症）在患有慢性肌肉骨骼疼痛的个体中很常见，并进一步加强了对运动恐惧症的低参与。 体力活动。身心干预改善心理健康，但迄今为止，尚未实施，以提供 为髋关节相关疼痛患者提供全面的心理护理。我将通过开发来填补这一空白 (Aims 1和2）和可行性测试（目标3）帮助改善心理社会健康（HIPS），一种新颖的，多模态的头脑身体干预，以改善患有髋关节相关疼痛和社会心理健康状况差的久坐者的身体活动。 根据慢性疼痛的恐惧回避模型（FAM），多模式HIPS身心干预将包括 疼痛教育、正念训练和目标设定，以改善心理健康，促进专注于 康复活动.我假设，HIPS身心干预将改善久坐不动的人的身体活动。 与髋关节相关的疼痛和不良心理健康的个人。增加体力活动将改善疼痛，功能和 整体福祉。HIPS身心干预将由物理治疗师亲自进行混合电话格式，以减少地理障碍，使没有宽带互联网接入的患者能够参与。 将身心干预纳入心理学告知的临床实践已经初步证明， 功效;然而，缺乏证据支持其“广泛采用”。该项目的结果将直接告知 多地点可行性研究（3年NCCIH R 01）的HIPS身心干预。可行性的有力证据 (this K23和未来的多中心可行性RCT）和身心干预措施（如HIPS）的有效性（未来的R 01），以及 随后将身心干预嵌入物理治疗诊所将为广泛采用提供支持 心理上的康复候选人的长期目标是成为一个独立的，NIH资助的 科学家通过开发和实施有效的身心健康， 康复干预，以优化临床结果，改善慢性髋关节疼痛患者的健康状况。这 K23将通过提供受保护的时间来完成正念和身心方面的关键训练来支持这一目标 干预开发和临床试验，以补充她在物理康复和生物力学方面的专业知识。

PROJECT SUMMARY Chronic hip pain affects 18.2 million adults annually, with hip-related pain (intra-articular non-arthritic hip pathologies) accounting for 60% of chronic hip pain cases in young- to middle-aged adults. Surgery and non-operative treatments for hip-related pain fail to provide ubiquitous benefit as pain and dysfunction persist for a majority of patients. Individuals with persistent pain often reduce their activity to minimize symptoms despite strong evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychosocial health (i.e., low self-efficacy, high pain catastrophizing, and kinesiophobia) is common among individuals with chronic musculoskeletal pain and further reinforces low participation in physical activity. Mind-body interventions improve psychosocial health, yet to date, have not been implemented to provide comprehensive, psychologically informed care for patients with hip-related pain. I will fill this gap through the development (Aims 1 and 2) and feasibility testing (Aim 3) of Helping Improve PSychosocial Health (HIPS), a novel, multimodal mindbody intervention to improve physical activity for sedentary individuals with hip-related pain and poor psychosocial health. Following the Fear Avoidance Model (FAM) of chronic pain, the multimodal HIPS mind-body intervention will incorporate pain education, mindfulness training, and goal-setting to improve psychosocial health and facilitate focused engagement in rehabilitation. I hypothesize that the HIPS mind-body intervention will improve physical activity among sedentary individuals with hip-related pain and poor psychosocial health. Increased physical activity will improve pain, function and overall well-being. The HIPS mind-body intervention will be delivered by physical therapists in a hybrid in-persontelephone format to reduce geographic barriers and enable the participation of patients without broadband internet access. The incorporation of mind-body interventions into psychologically informed clinical practice has demonstrated preliminary efficacy; however, evidence is lacking to support its’ broad adoption. Findings from this project will directly inform a multisite feasibility study (3-year NCCIH R01) of the HIPS mind-body intervention. Rigorous evidence of the feasibility (this K23 and future multisite feasibility RCT) and efficacy (future R01) of mind-body interventions such as HIPS, and the subsequent embedding of mind-body interventions into physical therapy clinics will provide support for the broad adoption of psychologically informed rehabilitation. The candidate’s long-term goal is to become an independent, NIH-funded scientist advancing psychologically informed rehabilitation by developing and implementing effective mind-body and rehabilitative interventions to optimize clinical outcomes and improve well-being for patients with chronic hip pain. This K23 will support this goal by providing protected time to complete critical training in mindfulness and mind-body intervention development and clinical trials to complement her expertise in physical rehabilitation and biomechanics.