Interactive Program to Manage and Prevent Back Pain

描述(申请人提供)：在他们生命中的某个时刻，80%的劳动力会遭受某种形式的背部疼痛。它是美国与工作相关的残疾的主要原因，造成数十亿美元的生产力损失以及高昂的医疗、保险和法律成本。对于患有不需要医疗护理的非特异性下腰痛(NLBP)的工人，美国医师学会(ACP)和美国疼痛协会(APS)建议采用多学科方法来管理疼痛，其中包括认知、身体和教育干预。然而，这种类型的程序并不常见。迫切需要开发基于证据的多学科NLBP项目，这些项目可以广泛传播，并减少NLBP对雇主和员工的财务、身体和情感影响。拟议的项目将完成开发，并评估为期六周的基于网络的多学科计划的有效性，该计划针对患有NLBP的工人，不需要治疗。该网站将为四种不同的工作类型量身定做：a)办公室工作，不活跃(即第一阶段；一天中50%或以上时间坐着的工人)；b)非办公室工作不活跃(即出纳员或餐饮服务人员，他们通常在工作时站立，但在其他情况下相对不活跃)；c)非办公室工作，活跃(即活跃的体力劳动，如建筑工人)；以及d)卡车和重型设备操作员(即坐着工作且容易受到强烈震动的个人)。根据ACP和APS指南，该计划将包括背痛评估工具，以筛选需要医疗护理且最有可能没有NLBP的个人，提供关于自我护理选项(例如，热和冰)的循证信息，提供有关非处方药使用的信息，并提供认知行为培训，以减少心理社会风险因素(例如，恐惧和回避)。该计划将帮助用户设定行为治疗目标，并帮助他们安排回访。该项目将包括视频和动画教程、激励性同行表彰、行为建模演示和信息性文章。第一阶段的原型由一个专家小组评估，其中包括医生和APS的成员，并由经历下腰痛的互联网样本工人进行测试。评价结果表明，该方案准确地为专家小组提出的案例研究制定了适当的教育方法。互联网用户对节目的内容、功能和可用性非常满意，他们在知识、自我效能、态度和意图方面表现出显著的进步。在第二阶段，完整的计划将在300名被诊断为NLBP的工人中进行随机对照试验并进行评估。评估将在全美范围内完全在线进行。 与公共健康相关：80%的成年人在一生中的某个时候会受到背痛的困扰，最好用心理、身体和教育策略相结合的多学科方法来治疗。不幸的是，患有不需要医疗护理的非特异性背部疼痛的工人几乎没有选择。医生专注于有潜在疾病的患者，而提供背部疼痛多学科护理的诊所并不容易获得。作为回应，拟议的互联网计划将为工作场所的员工提供为期6周的多学科干预，以自我治疗背部疼痛。

DESCRIPTION (provided by applicant): At some point in their lives, 80 percent of the work force will suffer some form of back pain. It is the leading cause of work-related disability in the U.S., costing billions of dollars in lost productivity and high medical, insurance, and legal costs. For workers suffering from nonspecific low back pain (NLBP) that does not require medical attention, the American College of Physicians (ACP) and American Pain Society (APS) recommend a multidisciplinary approach to pain management that integrates cognitive, physical, and educational interventions. However, this type of program is not commonly available. There is a critical need to develop evidence-based multidisciplinary NLBP programs that can be widely disseminated and reduce the financial, physical, and emotional impact of NLBP on employers and employees. The proposed project will finish development and evaluate the effectiveness of a six-week web-based multidisciplinary program for workers suffering from NLBP that does not require medical treatment. The website will have tailored strands for four different job-types: a) desk job, inactive (i.e., Phase I; workers who are seated 50 percent or more of the day); b) non-desk job - inactive (i.e., cashiers or food service workers who usually stand while working, but are relatively inactive otherwise), c) non-desk job, active (i.e., active physical labor, such as construction workers), and d) truck and heavy equipment operators (i.e., individuals who work while seated and are subject to heavy vibration). In alignment with the ACP and APS guidelines, the program will include a Back Pain Assessment Tool to screen out individuals who require medical care and most likely do not have NLBP, provide evidence-based information on self-care options (e.g., heat and ice), provide information on the use of over-the-counter medication, and offer cognitive behavioral training to reduce psychosocial risk factors (e.g., fear and avoidance). The program will assist users in setting behavioral treatment goals and will help them schedule return visits. The program will incorporate video and animated tutorials, motivational peer testimonials, behavior modeling demonstrations, and informational articles. The Phase I prototype was assessed by a panel of experts, including physicians and members of APS, and was tested by an Internet sample of workers experiencing low back pain. Evaluation results indicated the program accurately developed appropriate educational approaches for case studies presented by the expert panel. Internet users were very satisfied with program content, functionality, and usability, and they showed significant gains in measures of knowledge, self-efficacy, attitude, and intentions. In Phase II, the complete program will be developed and evaluated in a randomized controlled trial with 300 workers diagnosed with NLBP. The evaluation will be conducted entirely online, across the United States. PUBLIC HEALTH RELEVANCE: Back pain, which afflicts 80 percent of adults at some point in their lives, is best treated with a multidisciplinary approach combining psychological, physical, and educational strategies. Unfortunately, workers who suffer nonspecific back pain that does not require medical care have few options. Doctors focus on patients with underlying conditions, and clinics offering multi-disciplinary care for back pain aren't readily available. In response, the proposed Internet program will provide worksite employees with a 6-week multidisciplinary intervention for self-treatment of back pain.