Implementing a Cognitive/Exercise Therapy for Back Pain in The Community Setting

描述(申请人提供)：在老年人中，慢性背痛(CBP)是一种常见的、病态的和代价高昂的疾病。CBP的非药物疗法，包括认知-行为疗法和运动疗法，可以由患有CBP的老年人进行可行，已被证明有效，但很少被受影响的个人使用。我们目前的疼痛管理知识与患有慢性BP的老年人对治疗的使用有限之间的这种差距，为旨在测试和实施促进受慢性BP不利影响的个人采用的战略的努力提供了强有力的支持。鉴于先前的研究已经证明了在疼痛管理方面存在显著的种族差异，因此，在这个时候，针对高危种族/少数民族似乎特别有理由这样做。研究人员已经开发了一种适合年龄的干预措施-即综合认知-行为和运动疗法(CBET)方案-用于治疗老年人的CBP，现在寻求与未来的利益相关者合作，在社区环境中进行实施前测试。该项目的具体目标是在实施之前使用以社区为基础的参与性研究方法来完善我们的干预措施：(1)调查社区合作伙伴(即，干预措施的潜在消费者和将管理该计划的老年中心的主任)，了解他们是否准备好为CBP采用自我管理计划，以及(2)在服务于三个特定种族/民族群体的高级中心进行实地测试，这些中心服务于三个特定的种族/民族群体：西班牙裔美国人、非裔美国人和非西班牙裔美国人。这项研究的产品将包括经过现场测试和修改的协议，以及为未来计划实施而向利益相关者通报的战略。这项工作的长期目标是为上述干预措施制定一项有效和可持续的执行战略，以社区老年人为目标。为该项目组建的多学科调查团队由在老年医学和疼痛管理(M.Carrington Reid博士)、社会学和行为现象测量(Elaine Wethington博士)以及老年物理治疗和教学发展与评估(Katherine Beissner博士)领域具有互补专业知识的个人组成，他们非常有资格进行计划中的研究。

DESCRIPTION (provided by applicant): Among older persons, chronic back pain (CBP) is a common, morbid, and costly disorder. Non-drug therapies for CBP including cognitive-behavioral and exercise treatments can be feasibly performed by older adults with CBP, have proven efficacy, but are seldom used by affected individuals. This gap between our current pain-management knowledge and limited use of the therapies by older persons with CBP provides strong support for efforts designed to test and implement strategies that facilitate adoption among individuals adversely affected by CBP. Given that prior research has documented significant racial disparities with respect to pain management, targeting at-risk racial/ethnic minorities appears particularly warranted at this time. The investigators have developed an age-appropriate intervention - i.e., an integrated, cognitive- behavioral and exercise therapy (CBET) protocol - for the treatment of CBP among older adults, and now seek to partner with future stakeholders to conduct pre-implementation testing in a community-based setting. The specific aims of this project are to use a community-based participatory research approach to refine our intervention prior to implementation by: (1) surveying community partners (i.e., prospective consumers of the intervention and directors of senior centers where the program will be administered) about their readiness to adopt a self-management program for CBP and perceived barriers to program adoption; and by (2) field testing the intervention in senior centers that serve three specific racial/ethnic groups: Hispanic American, African American, and non-Hispanic White Americans. Products of this research will include a field-tested and modified protocol, as well as stakeholder informed strategies for future program implementation. The long-term aim of this work is to develop an effective and sustainable implementation strategy for the above intervention, targeting community-dwelling older persons. The multi-disciplinary investigative team assembled for this project consists of individuals with complementary expertise in the areas of geriatric medicine and pain management (Dr. M. Carrington Reid), sociology and measurement of behavioral phenomena (Dr. Elaine Wethington), and geriatric physical therapy and instructional development and evaluation (Dr. Katherine Beissner), and are highly qualified to conduct the planned research.