Tai Chi for Chronic Low Back Pain in Older Adults

 描述(由申请者提供)：该项目的最终目标是帮助填补对患有慢性下腰痛的老年人安全有效的治疗知识的实质性空白。这一缺陷是一个特别的问题，因为已经发现对年轻人安全有效的治疗方法可能不适合于面临较高不良反应风险且可能有不同需求和治疗偏好的老年人群。太极被发现对年轻人的慢性背痛有效，似乎特别适合患有慢性下腰痛的老年人，因为它包含多种治疗元素，温和，被发现对老年人更常见的各种健康状况有益。这个项目的目标是为成功地进行一项全面的试验奠定基础，评估两种剂量的太极(标准太极和增强太极，其中包括标准太极)在一年中改善老年人慢性下腰痛的有效性。在这项研究的第一阶段(目标1)，我们将集中于敲定标准太极协议，开发维护太极协议，以及评估建立可信的注意控制组的可行性。在最终确定可行性试验文件的过程中，我们将与患者合作伙伴(患有慢性下腰痛的老年人)合作，为这一人群调整招募、坚持太极、安全性和优化随访率的策略，并最终确定纳入/排除标准，以最大限度地提高安全性和普适性。在最终确定主要研究内容后，我们将进行一项随机可行性试验，比较强化太极和常规医疗。64名患有cLBP-65岁的老年人将被随机分组-32名接受强化(标准维护)太极拳治疗，32名接受常规医疗治疗。结果将在12周、26周和52周收集。我们将评估在目标1中开发的研究的关键要素是否足以纳入全面试验。最后，我们将与30名审判参与者举行情况汇报讨论小组，以征求他们对改进程序和方案的想法。这项评估将讨论进行一项大型试验的总体可行性，以及纳入增强型太极治疗臂的价值。如果成功，这项可行性研究将为进行一项动力充足的随机对照试验铺平道路，评估太极减少慢性下腰痛对老年人的影响的能力。鉴于缺乏针对这一人群的明显安全有效的治疗方法的知识，这一系列研究有可能大幅减轻许多患有背痛的美国人的痛苦。

 DESCRIPTION (provided by applicant): The ultimate goal of this project is to help fill the substantial gap in knowledge about safe and effective treatments for older adults with chronic low back pain. This deficiency is a particular problem because treatments that have been found safe and effective for younger adults may not be appropriate for an older population that is at higher risk of adverse effects and that may have different needs and treatment preferences. Tai Chi, which has been found effective for chronic back pain in younger adults, seems particularly well-suited for older adults with chronic low back pain because it includes multiple therapeutic elements, is gentle and has been found beneficial for a variety of health conditions more common to older adults. The goal of this project is to prepare the foundation for successfully conducting a full-scale trial evaluating the effectiveness of two doses of Tai Chi (Standard and Enhanced, which includes Standard + Maintenance Tai Chi) for improving chronic low back pain in older adults over the course of a year. In the first phase of this study (Aim 1), we will focus n finalization of a Standard Tai Chi protocol, development of the maintenance Tai Chi protocol and assessment of the feasibility of developing a credible attention control group. In the course of finalizing our feasibility trial documents, we will work with patient partners (older adults wit chronic low back pain) to adapt strategies for recruitment, adherence to Tai Chi, safety, and optimizing follow-up rates for this population and we will finalize the inclusion/exclusion criteri to maximize safety and generalizability. After finalizing the key study components, we will conduct a randomized feasibility trial comparing Enhanced Tai Chi with Usual Medical Care. Sixty-four older adults with cLBP - 65+ years of age will be randomized---32 to the Enhanced (standard + maintenance) Tai Chi and 32 to Usual Medical Care. Outcomes will be collected at 12, 26, and 52 weeks. We will evaluate the adequacy of key elements of the study developed in Aim 1 for inclusion in a full-scale trial. Finally, we will conduct debriefing discussion groups wih 30 trial participants to elicit their ideas for improving the procedures and protocols. This evaluation will address the overall feasibility of conducting a large trial and the value of includng the Enhanced dose Tai Chi treatment arm. If successful, this feasibility study will pave the way for conducting an adequately-powered randomized controlled trial evaluating the ability of Tai Chi to reduce the impact of chronic low back pain on older adults. In view of the absence of knowledge about clearly safe and effective treatments for this population, this line of research has the potential for substantially reducing the suffering of many Americans with back pain.