Tai Chi for Chronic Low Back Pain in Older Adults

 描述（由申请人提供）：该项目的最终目标是帮助填补有关慢性腰痛老年人安全有效治疗知识的巨大空白。这种缺陷是一个特殊的问题，因为已经发现对年轻人安全有效的治疗可能不适合老年人，老年人有更高的不良反应风险，可能有不同的需求和治疗偏好。太极拳被发现对年轻人的慢性背痛有效，似乎特别适合患有慢性腰痛的老年人，因为它包括多种治疗元素，温和，并且被发现对老年人更常见的各种健康状况有益。该项目的目标是为成功进行全面试验奠定基础，评估两种剂量的太极拳（标准和增强，其中包括标准+维持太极拳）在一年内改善老年人慢性腰痛的有效性。在本研究的第一阶段（目标1），我们将集中在最终确定的标准太极协议，维护太极协议的发展和发展一个可信的注意力控制组的可行性评估。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（患有慢性腰痛的老年人）合作，调整招募策略，坚持太极拳，安全性和优化该人群的随访率，我们将最终确定入选/排除标准，以最大限度地提高安全性和普遍性。在完成关键的研究内容后，我们将进行一项随机可行性试验，比较增强太极拳与家庭医疗护理。64名年龄在65岁以上的cLBP老年人将被随机分配--32名接受增强型（标准+维持）太极拳治疗，32名接受家庭医疗护理。将在第12、26和52周收集结局。我们将评估在目标1中开发的研究的关键要素是否适合纳入全面试验。最后，我们将与30名试验参与者进行小组讨论，以征求他们对改进程序和方案的想法。这项评估将解决进行大型试验的总体可行性以及纳入增强剂量太极治疗组的价值。如果成功，这项可行性研究将为进行一项有足够把握的随机对照试验铺平道路，以评估太极拳的能力减少慢性腰痛对老年人的影响。鉴于对这一人群缺乏明确安全有效的治疗方法的知识，这一系列研究有可能大大减少许多美国人背痛的痛苦。

 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.