Telehealth Therapy for Chronic Pain

慢性疼痛的远程医疗治疗

• 批准号: 7750166
• 负责人: Julie L Wetherell
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7750166
• 关键词: Ambulatory Care Facilities; Anxiety; Appointment; Area; Automobile Driving; Benign; Biological Markers; Chronic; Clinic; Cognitive; Conflict (Psychology); Data; Disabled Persons; Distant; Distress; Economics; Family; Feeling; Freedom; Funding; Health; Health Services Accessibility; Home environment; Income; Individual; Inferior; Injury; Intervention; Life; Measures; Medical center; Mental Depression; Mental Health; Methods; Mission; Nature; Neuropsychological Tests; Non-Malignant; Outcome; Pain; Pain management; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Price; Procedures; Psychotherapy; Quality of life; Randomized; Rehabilitation Research; Rehabilitation therapy; Research; Rural Community; Sampling; Schools; Services; Site; Sleep; Source; Stress; Symptoms; Technology; Testing; Time; Traumatic Brain Injury; Travel; Veterans; Videoconferences; Videoconferencing; Visit; actigraphy; base; chronic pain; cognitive function; cost; disability; disability payment; experience; health administration; improved; metropolitan; operation; physical conditioning; programs; psychologic; psychosocial; public health relevance; rehabilitation service; research and development; response; satisfaction; social; telehealth; treatment effect

DESCRIPTION (provided by applicant): Project Summary Chronic pain is common, disabling, and costly among veterans and often co-occurs with other conditions such as traumatic brain injury and posttraumatic stress disorder (PTSD). Developing methods to enhance rehabilitation of patients with these conditions is a high priority within the Veterans Health Administration. The proposed study is the next step in the program of research we began with F4306I, "Acceptance-based Therapy for Chronic Pain" (10/1/06-9/30/09), funded by the VA RR&D Service. Although preliminary data suggest that a brief psychosocial intervention, Acceptance and Commitment Therapy (ACT), is effective at reducing distress and improving quality of life for veterans with chronic pain, and ACT is one of the empirically supported psychotherapies the VA is rolling out nationwide, multiple barriers exist to its dissemination. Many veterans live in rural communities at a distance from a VA medical center, and patients with chronic pain often have mobility limitations or financial or time constraints that make travel difficult. Telehealth can help overcome these barriers. By allowing veterans to access state-of-the-art pain treatment in CBOCs or Vet Centers closer to their homes, the VA can provide rehabilitation services to a larger number of patients who need them. We propose a non-inferiority trial to test the hypothesis that ACT for chronic pain delivered by videoconferencing technology is not inferior to ACT for pain delivered in person. Patients (N = 196) with chronic nonmalignant pain for at least six months will be randomized to receive eight individual sessions of ACT either via telehealth or in person. We hypothesize that: 1) improvement in pain interference associated with ACT delivered via telehealth will not be inferior to that associated with ACT delivered in person; 2) improvements in depression, anxiety, PTSD symptoms, quality of life, activity levels, and sleep quality associated with ACT delivered via telehealth will not be inferior to those associated with ACT delivered in person; and 3) attrition rates will be lower and satisfaction higher for individuals receiving ACT via telehealth than for those receiving ACT in person. We will also conduct exploratory analyses to investigate the impact of cognitive function on treatment and the effect of the intervention on biomarkers of stress and health. PUBLIC HEALTH RELEVANCE: Project Narrative Chronic pain is a serious, disabling, and costly problem among veterans. Although psychosocial interventions that can reduce disability and improve quality of life exist, multiple barriers to access limit their dissemination. Telehealth can help overcome those barriers. We propose to compare a brief form of psychosocial pain treatment delivered in person to the same therapy delivered by videoconferencing technology. We anticipate that telehealth delivery of our acceptance-based pain intervention will provide similar benefits to those obtained with in-person delivery while reducing attrition and increasing satisfaction in a sample of 196 veterans with chronic pain.

描述(由申请人提供)： 项目摘要慢性疼痛在退伍军人中是常见的、致残的、代价高昂的，并且经常与其他情况并存，如创伤性脑损伤和创伤后应激障碍(PTSD)。制定方法加强患有这些疾病的患者的康复是退伍军人健康管理局的高度优先事项。这项拟议的研究是我们从F4306I开始的研究计划的下一步，“基于接受的慢性疼痛治疗”(10/1/06-9/30/09)，由退伍军人事务部资助。尽管初步数据表明，一种简短的心理社会干预-接受和承诺疗法(ACT)-在减少慢性疼痛退伍军人的痛苦和提高生活质量方面是有效的，而且ACT是退伍军人管理局在全国范围内推出的经验性支持的心理疗法之一，但其推广存在多种障碍。许多退伍军人住在离退伍军人管理局医疗中心很远的农村社区，慢性疼痛患者往往行动不便，或者经济或时间限制，这使得旅行变得困难。远程医疗可以帮助克服这些障碍。通过允许退伍军人在离家更近的CBOC或兽医中心获得最先进的疼痛治疗，退伍军人管理局可以为更多需要康复服务的患者提供康复服务。我们提出了一项非劣势试验来检验这一假设，即通过视频会议技术提供的慢性疼痛的ACT并不逊于面对面提供的疼痛的ACT。慢性非恶性疼痛至少6个月的患者(N=196)将随机接受八次单独的ACT治疗，要么通过远程医疗，要么亲自接受。我们假设：1)通过远程医疗提供的ACT对疼痛干扰的改善不会低于与亲自接受ACT相关的改善；2)与通过远程医疗提供的ACT相关的抑郁、焦虑、创伤后应激障碍症状、生活质量、活动水平和睡眠质量的改善不会低于通过远程医疗提供的与ACT相关的改善；以及3)通过远程医疗接受ACT的个人的流失率将低于通过远程医疗接受ACT的人，并且满意度将高于亲自接受ACT的人。我们还将进行探索性分析，以调查认知功能对治疗的影响，以及干预对压力和健康的生物标志物的影响。 公共卫生相关性： 项目叙述慢性疼痛在退伍军人中是一个严重的、致残的和昂贵的问题。虽然存在可减少残疾和提高生活质量的心理社会干预措施，但获得这些干预措施的多重障碍限制了其传播。远程医疗可以帮助克服这些障碍。我们建议将一种简单形式的面对面提供的心理社会疼痛治疗与通过视频会议技术提供的相同治疗进行比较。我们预计，我们基于接受的疼痛干预的远程医疗交付将提供与面对面交付类似的好处，同时减少人员流失并提高对196名患有慢性疼痛的退伍军人的满意度。