A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults

 描述(由申请人提供)：一种针对老年人慢性肌肉骨骼疼痛的低强度认知行为自我管理干预在2011年一份题为《缓解美国疼痛》的颇具影响力的报告中，医学研究所呼吁人们关注美国慢性疼痛的流行，并呼吁人们注意改善获得有效疼痛治疗的迫切性。为了回应本报告中确定的优先事项，我正在努力制定 为一项独立的研究计划奠定基础，目的是增加老年人慢性疼痛管理的循证认知行为干预措施的可及性。这份申请导师职业发展奖(K01)的申请书建议在5年内开展培训和研究活动，使我能够启动这一研究计划。为此，我组建了一个由导师和顾问组成的跨学科团队，成员包括代表密歇根大学老年病学、麻醉学、心理学、物理医学和康复、公共卫生和精神病学的研究人员，以及独立的实用生命伦理学中心的一名著名疼痛伦理学家。这种额外的支持将建立在我在老年人中进行行为和慢性病自我管理支持研究的坚实基础上。这项建议中的培训和研究目标是紧密相连的。培训目标包括获得这些领域的技能和专门知识。 这些对于我计划的研究计划是必不可少的：1)老年人慢性疼痛的病理生理学和管理，以及这一组中治疗慢性疼痛的认知行为方法；2)老年人的症状和活动监测，这使得能够使用准确和及时的关于患者进展的信息作为行为干预的一部分，同时确定干预效果的潜在中介；以及3)新兴的行为干预研究设计，强调增加研究结果的相关性的务实、适应性和以患者为中心的设计。这些主题将在导师团队的指导下通过课程作业、临床观察和自学来掌握。在整个获奖期间，我还将参加相关的研讨会、研讨会和科学会议。在培训计划之后，我将开发和试点测试一种针对老年人的低强度疼痛CBT干预。干预将使用高科技/高接触的方法。以循证的互联网CBT慢性疼痛治疗干预为起点，我将开发另外两个组件，以增强该计划对老年人的吸引力和潜在疗效：a)由非专科医生进行一系列电话CBT会议，以支持电子模块的使用；以及b)使用移动医疗工具进行症状和活动监测，以更好地针对个别患者的需求进行干预。该项目的开发和中试将通过三个连续的研究目标来完成。为了帮助计划内容的发展，在目标1中，我将对最近两项关于疼痛CBT干预的随机对照试验的数据进行二次分析，以检验疼痛应对策略和CBT目标选择在年龄组之间存在显著差异的假设，并确定对老年人最具吸引力和最具挑战性的CBT技能。我还将组织重点小组，以获得目标干预用户对拟议的促进器和监测部分的可接受性和设计的反馈。在目标2中，我将对老年疼痛患者进行可用性测试，以测试我们的假设，即使用FitBit类型的设备自动上传 与通过IVR呼叫手动上传相比，加速计数据对数据收集的遵守程度明显更高。我们还将评估自动上传和手动上传的可靠性、有效性和可接受性，以确定试点研究中使用的监测策略的最终选择。在目标3中，我将招募50名患有慢性肌肉骨骼疼痛的老年人，并进行一项随机试点试验，以评估其可行性和对PAI影响的影响。如果成功，试点研究的结果将作为在K01的最后一年提出的更大规模的务实试验的初步工作。密歇根大学、公共卫生学院和慢性病管理中心为开展拟议的活动提供了理想的环境。这些单位提供培训机会， 合作，以及跨学科授粉。在获奖期间，广泛的资源将为我的工作提供便利；例如，老年医学中心和老年学研究所、慢性疼痛和疲劳研究中心、密歇根临床和健康研究中心，以及世界级的计算、图书馆和统计支持服务。这种资源丰富的环境，加上一支尽职尽责的导师团队，将有助于我过渡到独立的研究生涯。

 DESCRIPTION (provided by applicant): A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults In an influential 2011 report entitled Relieving Pain in America, the Institute of Medicine called attention to the epidemic of chronic pain in the United States, and to the urgent need to improve access to effective pain treatments. Responding to the priorities set in this report, I am seeking to lay the foundation for an independent research program with the goal of increasing the accessibility of evidence-based, cognitive-behavioral interventions for chronic pain management among older adults. This application for a Mentored Career Development Award (K01) proposes training and research activities over a 5-year period that will enable me to launch this research program. To this end, I have formed an interdisciplinary team of mentors and consultants that includes researchers representing Geriatrics, Anesthesiology, Psychology, Physical Medicine and Rehabilitation, Public Health and Psychiatry at the University of Michigan, as well as a prominent pain ethicist from the independent Center for Practical Bioethics. This additional support will build on my strong foundation in conducting behavioral and chronic illness self-management support research among older adults. The training and research aims in this proposal are closely linked. The training goals include acquiring skills and expertise in the areas that are essential for my planned research program: 1) The pathophysiology and management of chronic pain in older adults and cognitive-behavioral approaches to treating chronic pain in this group; 2) Symptom and activity monitoring in older adults, which enables the use of accurate and timely information about patients' progress as part of behavioral interventions, while identifying potential mediators of intervention effects; and 3) Emerging study designs for testing behavioral interventions, with an emphasis on pragmatic, adaptive and patient-centered designs that increase the relevance of research findings. These topics will be mastered through coursework, clinical observations, and self-study under the guidance of the mentorship team. I will also attend relevant seminars, workshops, and scientific conferences throughout the award period. Following the training program, I will develop and pilot-test a low-intensity pain CBT intervention for older adults. The intervention will use a high tech/high touch approach. Using an evidence-based internet CBT intervention for chronic pain management as a starting point, I will develop two additional components that will enhance the appeal and potential efficacy of this program for older adults: a) a series of telephone CBT sessions by non-specialist practitioners to support use of the electronic modules, and b) symptom and activity monitoring using mobile health tools to better tailor the intervention to individual patients' needs. The development and pilot-testing of this program will be accomplished via three sequential research aims. To aid in the development of program content, in Aim 1, I will conduct secondary analysis of data from two recent RCTs of pain CBT interventions to test the hypothesis that there are significant age group differences in pain coping strategies and choice of CBT goals, and to identify the CBT skills that are most appealing and most challenging to older adults. I will also conduct focus groups to obtain feedback from target intervention users on the acceptability and design of the proposed facilitator and monitoring components. In Aim 2, I will conduct usability testing with older pain patients to test our assumption that using a FitBit-type device to automatically- upload accelerometer data results in markedly greater adherence to data collection than manual upload via IVR calls. We will also evaluate the reliability, validity and acceptability of both automated and manual upload to inform the final choice of monitoring strategy used in the pilot study. In Aim 3, I will recruit 50 older adults with chronic musculoskeletal pain and conduct a randomized pilot trial of the intervention with waitlist controls to assess its feasibility and effects on Pai Impact. If successful, results from the pilot study will serve as preliminary work for a larger pragmatic trial to be proposed in the final year of the K01. The University of Michigan, the School of Public Health, and the Center for Managing Chronic Disease provide the ideal environment for carrying out the proposed activities. These units offer opportunities for training, collaboration, and cross-disciplinary pollination. A wide array of resources will facilitate my wor during the award period; e.g., the Geriatrics Center and Institute of Gerontology, the Chronic Pain and Fatigue Research Center, the Michigan Center for Clinical and Health Research, as well as world-class computing, library, and statistical support services. This resource-rich environment, along with a committed team of mentors, will facilitate my transition to an independent research career.