Interactive Program to Manage and Prevent Back Pain

描述（由申请人提供）：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。在美国，它是导致与工作有关的残疾的主要原因，在生产力损失和高昂的医疗、保险和法律费用上花费了数十亿美元。对于患有非特异性腰痛（NLBP）但不需要医疗护理的工人，美国医师学会（ACP）和美国疼痛学会（APS）建议采用多学科的疼痛管理方法，将认知、身体和教育干预相结合。然而，这种类型的程序并不常见。目前迫切需要发展以证据为基础的多学科的NLBP项目，这些项目可以广泛传播，并减少NLBP对雇主和雇员的经济、身体和情感影响。拟议的项目将完成开发和评估一个为期六周的基于网络的多学科项目的有效性，该项目针对的是患有NLBP的工人，不需要药物治疗。该网站将为四种不同的工作类型量身定制：a)案头工作，不活跃（即第一阶段，一天中有50%或更多时间坐着的员工）；B)非案头工作-非案头工作（即收银员或食品服务工人，他们在工作时通常站着，但在其他情况下相对不活动），c)非案头工作，活跃（即体力劳动，如建筑工人），d)卡车和重型设备操作员（即坐着工作并受到强烈振动的个人）。根据ACP和APS的指导方针，该项目将包括一个背痛评估工具，以筛选出需要医疗护理但最有可能没有NLBP的个人，提供基于证据的自我护理选择信息（例如，加热和冰敷），提供使用非处方药物的信息，并提供认知行为训练，以减少心理社会风险因素（例如，恐惧和回避）。该项目将帮助用户设定行为治疗目标，并帮助他们安排回访。该计划将包括视频和动画教程，激励同伴的证言，行为建模示范和信息文章。第一阶段的原型机由包括医生和APS成员在内的一个专家小组进行评估，并通过互联网上有腰痛症状的工人样本进行测试。评估结果表明，该计划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。互联网用户对程序的内容、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，将对300名诊断为NLBP的工人进行随机对照试验，并对整个项目进行开发和评估。评估将在全美范围内完全在线进行。

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.