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

项目总结 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(关节内非关节炎髋关节病变) 占中青年慢性髋关节疼痛病例的60%。手术和非手术治疗 髋关节相关的疼痛不能提供普遍的好处，因为疼痛和功能障碍对大多数患者来说仍然存在。具有以下特征的个人 持续性疼痛通常会减少他们的活动量，以减少症状，尽管有强有力的证据表明，有规律的体力活动 减轻慢性肌肉骨骼疼痛。心理社会健康状况不佳(即低自我效能感，高痛苦灾难性，以及 运动恐惧症)在患有慢性肌肉骨骼疼痛的人中很常见，并进一步强化了对 体力活动。心身干预改善心理社会健康，迄今尚未实施，以提供 为髋关节相关疼痛患者提供全面、心理知情的护理。我将通过开发来填补这一空白 (目标1和目标2)和帮助改善心理社会健康(HIPS)的可行性测试(目标3)，这是一种新颖的多模式MindBody干预措施，旨在改善久坐不动的髋关节相关疼痛和心理社会健康状况较差的个人的体力活动。 遵循慢性疼痛的恐惧回避模型(FAM)，多模式髋关节心身干预将包括 疼痛教育、正念训练和目标设定，以改善心理社会健康并促进专注于 康复。我假设髋关节身心干预将改善久坐不动的人的体力活动。 髋关节相关疼痛和心理社会健康状况不佳的个人。增加体力活动将改善疼痛、功能和 整体福祉。髋关节心身干预将由物理治疗师以混合面对面电话的形式提供，以减少地理障碍，并使没有宽带互联网接入的患者能够参与其中。 将身心干预结合到心理知情的临床实践中已初步证明 有效性；然而，缺乏证据支持它的广泛采用。该项目的调查结果将直接向 髋关节心身干预的多点可行性研究(3年NCCIH R01)。这是可行性的有力证据 (这个K23和未来的多点可行性RCT)和有效性(未来的R01)身心干预，如髋关节，和 随后将身心干预植入理疗诊所将为广泛采用提供支持 心理上了解情况的康复。候选人的长期目标是成为一个独立的、由NIH资助的 科学家通过开发和实施有效的心身和心理康复促进心理知情康复 康复干预，以优化临床结果，改善慢性髋关节疼痛患者的幸福感。这 K23将通过提供受保护的时间来支持这一目标，以完成正念和身心的关键训练 干预发展和临床试验，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.