Improving Outcomes for Older Veterans with Chronic Back Pain and Depression

慢性腰痛是第二个最常见的原因，医生访问;每年的相关费用超过100美元 十亿，预计将随着人口老龄化而上升。先前的研究证实，老年人的背痛 造成严重的生理、心理和社会后果。我们也知道抑郁症 经常与慢性腰痛并存，使治疗复杂化。一个可行的，有效的行为 针对老年退伍军人的慢性腰痛和共病抑郁症的干预是非常必要的。这 对于老年退伍军人尤其如此，因为药物和手术选择的有效性和安全性 往往不如年轻人群有利。现有的干预措施是不够的， 没有专门针对老年退伍军人，也没有针对慢性背痛和 抑郁症同时这个VA CDA-2提案的目标是在一个迭代过程中开发一个多 组成部分，健康教练电话交付，行为干预，最终将改善的结果， 残疾和抑郁症的老年退伍军人与慢性腰痛和抑郁症。拟议研究 有3个相互关联的具体目标：1）为老年退伍军人的目标人群制定行为干预措施 使用来自专家、患者和其他利益相关者群体的输入，治疗慢性腰痛和抑郁症; 2） 通过在样本中进行行为干预，在迭代过程中对干预进行预测试和改进 沿着其他利益相关者的10名年长退伍军人将提供干预内容的反馈， 分娩;以及，3）进行初步随机对照试验，以评估研究程序的可行性，以及 结果测量。Makris博士的职业目标是成为一名独立调查员和一名全国性的 在改善患有慢性腰痛的医学复杂老年退伍军人的结局方面具有专业知识的领导者。 她组建了一支杰出的导师团队，他们是成果研究、老年医学、 行为干预的开发、评估和实施。在获奖期间，申请人 将获得行为干预发展，定性方法，利益相关者参与， 比较有效性和实施研究方法。作为一名专注于衰老的风湿病学家 研究，并与她的承诺，以改善老年退伍军人的结果，这个奖项将准备博士。 Makris领导全国努力开发非药物管理方法，以改善患者 报告了患有慢性腰痛和共病抑郁症的医学复杂老年退伍军人的结局。

Chronic low back pain is the 2nd most common reason for physician visits; annual related costs exceed $100 billion, and are expected to rise with the aging population. Prior work confirms that back pain in older adults results in significant physical, psychological and social consequences. We also know that depression frequently co-exists with chronic low back pain and complicates management. A feasible, effective behavioral intervention targeting chronic low back pain and comorbid depression in older Veterans is sorely needed. This is especially true for older Veterans where the efficacy and safety of pharmacologic and surgical options are often less favorable than in younger populations. Existing interventions are not adequate or sufficient as they have not been specifically focused on older Veterans, nor have they targeted both chronic back pain and depression simultaneously. The goal of this VA CDA-2 proposal is to develop, in an iterative process, a multi- component, health coach-telephone-delivered, behavioral intervention that will ultimately improve outcomes of disability and depression in older Veterans with chronic low back pain and depression. The proposed research has 3 interrelated specific aims: 1) develop a behavioral intervention for the target population of older Veterans with chronic low back pain and depression using input from expert, patient and other stakeholder groups; 2) pre-test and refine the intervention in an iterative process by conducting the behavioral intervention in a sample of 10 older Veterans who, along with other stakeholders, will provide feedback on intervention content and delivery; and, 3) conduct a pilot randomized control trial to evaluate feasibility of study procedures and outcome measurement. Dr. Makris' career goals are to become an independent investigator and a national leader with expertise in improving outcomes in medically complex older Veterans with chronic low back pain. She has assembled an exceptional team of mentors who are leaders in outcomes research, geriatrics, behavioral intervention development, evaluation and implementation. During the award period, the applicant will gain skills in behavioral intervention development, qualitative methods, stakeholder engagement, comparative effectiveness and implementation research methods. As a rheumatologist focused on aging research, and with her commitment to improving outcomes in older Veterans, this award would prepare Dr. Makris to lead efforts nationally to develop non-pharmacologic management approaches to improve patient reported outcomes for medically complex older Veterans with chronic low back pain and comorbid depression.