Internet-based osteoarthritis pain coping skills intervention

描述(申请人提供)：2100万美国人患有骨性关节炎(OA)，这是一种进行性关节疾病，会导致僵硬、疼痛、活动范围缩小、痛苦以及身体、社会和角色功能的下降。对骨性关节炎疼痛的药物治疗是有限的，而且存在风险，特别是对老年人群。然而，认知行为疼痛应对技能干预已被证明在减少骨性关节炎疼痛、残疾和痛苦方面有效。不幸的是，现有的计划覆盖的患者数量有限，因为它们需要患者旅行才能接受面对面的培训。需要采取干预措施，满足迅速增长的人口中更大比例的人的需要，这些人的功能和生活质量因办公自动化而严重降低。通过互联网提供经过验证的疼痛管理干预措施是满足这一需求的一种有前途的方式，特别是在美国老年人越来越多地使用互联网的情况下。为了最有效，基于互联网的干预需要模仿面对面干预的关键特征。拟议的干预将通过将经过验证的面对面疼痛应对技能协议转换为基于互联网的交互式应用程序来实现这一点，该应用程序使用多媒体和专家系统技术来模拟面对面干预。它将提供个性化反馈、交互式问题解决和动画演示，并将融入班杜拉社会认知理论的学习技术，包括建模、掌握体验和社会强化。该项目包括两个阶段，与两个具体目标相对应。在第一阶段，我们将把面对面的干预转化为在互联网上交付。这一阶段将包括收集患者和专家治疗师焦点小组的反馈，这将有助于完善计划。在第二阶段，我们将进行一项小规模的随机对照试验，这将使我们能够在为期8周的基于互联网的干预过程中检查和改进旨在增加动机和坚持的特征。试验还将使我们能够证明其可行性、耐受性、安全性和前景。我们假设，这项试验将证明互联网对于提供这种骨性关节炎疼痛应对技能干预的有效性。综上所述，这些活动将为本研究下一阶段的全面随机对照试验测试程序做好准备。这个项目的前景得到了多学科研究团队的加强，该团队在以下方面拥有专业知识：进行认知行为干预，教导OA患者使用应对技能来管理他们的疼痛，使用专家系统技术开发和实施个性化的计算机化反馈报告，以及开发用于学习和评估的引人入胜的、用户友好的、交互式的计算机程序。相关性：这一基于互联网的骨性关节炎疼痛应对技能干预针对的是一个重大的个人和公共健康问题，并扩大了经验支持的疼痛自我管理计划的使用范围，以便它能够接触到患有骨性关节炎疼痛和相关残疾的大量且不断增长的人口的更大比例。 公共卫生相关性：该项目将把针对骨关节炎(OA)患者的经过验证的疼痛应对技能干预转化为一种引人入胜且易于使用的基于互联网的干预，它使用创新技术来模拟传统的面对面培训课程。这种方法的一个重要好处是，它有望将有效治疗的范围扩大到越来越多的骨性关节炎患者，例如，那些不能或不愿旅行接受培训的人。如果被证明是有效的，这种基于互联网的骨性关节炎疼痛应对技能干预将是一个宝贵的工具，可以满足数百万因骨性关节炎疼痛和残疾而功能和生活质量严重下降的美国人的需求。

DESCRIPTION (provided by applicant): Twenty-one million Americans live with osteoarthritis (OA), a progressive joint disease that causes stiffness, pain, reduced range of motion, distress, and decrements in physical, social, and role functioning. Medical treatments for OA pain are limited and present risks, especially for older populations. However, cognitive behavioral pain coping skills interventions have proven effective for decreasing OA pain, disability, and distress. Unfortunately, existing programs reach a limited number of patients because they require patients to travel to receive in-person training. There is a need for interventions that address the needs of a larger proportion of the rapidly growing population of people whose functioning and quality of life are severely diminished by OA. Delivering proven pain management interventions via the Internet is a promising way to address this need, especially in light of increasing use of the Internet by older Americans. To be most effective, an Internet-based intervention would need to mimic key features of in-person interventions. The proposed intervention will do that by translating a proven in-person pain coping skills protocol into an interactive Internet- based application that uses multimedia and expert systems technology to mimic in-person interventions. It will provide individualized feedback, interactive problem solving, and animated demonstrations, and it will incorporate learning techniques from Bandura's Social Cognitive Theory, including modeling, mastery experiences, and social reinforcement. The project includes two phases, corresponding to two specific aims. In Phase I we will translate the in-person intervention for delivery on the Internet. This phase will including gathering feedback from patient and expert therapist focus groups, which will help refine the program. In Phase II we will conduct a small-scale randomized controlled trial that will enable us to examine and refine features designed to increase motivation and adherence over the course of the 8-week Internet-based intervention. The trial will also enable us to demonstrate its feasibility, tolerability, safety, and promise. We hypothesize that the trial will demonstrate the effectiveness of the Internet for delivery of this OA pain coping skills intervention. Taken together, these activities will prepare the program for testing in a full-scale randomized controlled trial in the next stage of this research. The promise of this project is enhanced by the multi-disciplinary research team, which has expertise in the conduct of cognitive behavioral interventions that teach OA patients to use coping skills to manage their pain, developing and implementing individualized computerized feedback reports using expert systems technology, and development of engaging, user-friendly, interactive computer-based programs for learning and assessment. Relevance: This Internet-based OA pain coping skills intervention targets a significant individual and public health problem and expands access to an empirically-supported pain self- management program so that it can reach a greater proportion of the large and growing population of people suffering from OA pain and related disability. PUBLIC HEALTH RELEVANCE: This project will translate a proven pain coping skills intervention for osteoarthritis (OA) patients into an engaging and easy-to-use Internet-based intervention that uses innovative technologies to mimic traditional, in- person training sessions. A significant benefit of this approach is its promise for extending the reach of an efficacious treatment to a larger proportion of the growing population of OA patients, for instance, those who are unable or unwilling to travel for training. If found to be effective, this Internet-based OA pain coping skills intervention will be a valuable tool for addressing the needs of the millions of Americans whose functioning and quality of life are severely diminished by OA pain and disability.