Relationships Between Pain-Related Psychological Factors, Gait Quality, and Attention in Chronic Low Back Pain

项目总结/摘要 慢性下腰痛（cLBP）的步态质量差导致活动能力下降和功能下降。那些 与cLBP和疼痛相关的心理因素（例如，恐惧回避，痛苦灾难化）的风险增加 这些糟糕的临床结果。然而，恐惧回避/痛苦灾难化和 cLBP中的步态质量仍然是未知的，这主要是由于在小样本中使用不一致的步态质量度量。到 为了改善这一高危人群临床结局，迫切需要1）检查 恐惧避免/疼痛灾难化和步态质量使用严格的指标，和2）进行机械 探索步态质量损伤的贡献者。作为实现长期目标的第一步， 对于cLBP的物理治疗干预，本提案的总体目标是：1）确定 避免恐惧/疼痛灾难化和步态质量之间的关系，以及2）测试注意力对步态的贡献 高恐惧回避/痛苦灾难化的人的质量。基本原理是， 其中恐惧回避/疼痛灾难化与步态质量相关，可能导致新的治疗干预 (e.g.,围绕运动的认知重构，注意力转移策略），以改善 这个高危人群。核心假设是：1）恐惧回避/疼痛灾难化与以下因素有关： 更差的步态质量，以及2）与恐惧/灾难化相关的注意力能力降低导致步态不佳 质量.目的1是确定恐惧回避/疼痛灾难化和步态质量之间的关系， cLBP。目的2是确定注意力在恐惧回避/疼痛灾难化之间的关系中的作用 和步态质量。在目标1下，基于加速度计的步态质量指标将从一个大型的现有原始数据中导出。 数据集（n=500），作为正在进行的资助（1U 19 AR 076725 -01）的一部分收集。对于目标2，将有50名参与者 招募来执行双重任务，评估注意力对步态质量的影响。拟建项目 重要的是，它使用严格的，基于加速计的指标来检查恐惧之间的关系， 避免/疼痛灾难化和步态质量，这是识别的第一步也是必要的一步。 新的治疗目标（即，恐惧，注意力相关的缺陷），当在物理治疗中优先考虑时， 这一人群的结果。根据这项奖学金，申请人将获得独特的机会， 通过匹兹堡大学生物工程项目的DPT/PhD进行顶级研究和临床培训。 拟议的项目将在匹兹堡大学NIH资助的BACPAC联盟内完成 机械研究中心，在那里受训者将有无与伦比的机会接触到全国各地的专家， 招聘和生物统计支持，以及新的基础设施，以推动她走向职业生涯作为一个独立的 临床科学家一个由慢性腰痛、步态、注意力、翻译、语言和语言方面的专家组成的导师团队。 研究和疼痛心理学将支持申请人在研究方法/设计，步态， 加速度测量、人体运动、专业发展和指导。

Project Summary/Abstract Poor gait quality in chronic low back pain (cLBP) contributes to decreased mobility and functional decline. Those with cLBP and pain-related psychological factors (e.g., fear-avoidance, pain catastrophizing) are at elevated risk for these poor clinical outcomes. However, the relationships between fear-avoidance/pain catastrophizing and gait quality in cLBP remain unknown, largely due to use of inconsistent gait quality metrics in small samples. To improve clinical outcomes in this at-risk population, there is a critical need to 1) examine relationships between fear-avoidance/pain catastrophizing and gait quality using rigorous metrics, and 2) conduct a mechanistic exploration of contributors to gait quality impairments. As a first step toward the long-term goal of improving physical therapy interventions for cLBP, the overall objective of this proposal is to 1) determine the relationship between fear-avoidance/pain catastrophizing and gait quality, and 2) test the contribution of attention on gait quality in those with heightened fear-avoidance/pain catastrophizing. The rationale is that establishing the ways in which fear-avoidance/pain catastrophizing are related to gait quality may lead to new treatment interventions (e.g., cognitive reframing surrounding movement, attention-shifting strategies) to improve clinical outcomes in this high-risk population. The central hypothesis is that 1) fear-avoidance/pain catastrophizing is associated with worse gait quality, and 2) reduced attention capacity associated with fear/catastrophizing contributes to poor gait quality. Aim 1 is to determine the relationship between fear-avoidance/pain catastrophizing and gait quality in cLBP. Aim 2 is to determine the role of attention in the relationship between fear-avoidance/pain catastrophizing and gait quality. Under Aim 1, accelerometry-based gait quality metrics will be derived from a large, existing raw data set (n=500) collected as part of an ongoing grant (1U19AR076725-01). For Aim 2, 50 participants will be recruited to perform a dual-task assessing the impact of attention on gait quality. The proposed project is significant because it uses rigorous, accelerometry-based metrics to examine relationships between fear- avoidance/pain catastrophizing and gait quality, and it is the first and necessary step toward identification of novel treatment targets (i.e., fear, attention-related deficits) that when prioritized in physical therapy, may improve outcomes in this population. Under this fellowship, the applicant will gain unique opportunities for integration of top-tier research and clinical training through University of Pittsburgh’s DPT/PhD in Bioengineering program. The proposed project will be completed within the University of Pittsburgh NIH-funded BACPAC Consortium Mechanistic Research Center, where the trainee will have unrivaled access to experts across the country, recruitment and biostatistical support, and novel infrastructure to advance her toward a career as an independent clinician-scientist. A mentorship team consisting of experts in chronic low back pain, gait, attention, translational research, and pain psychology will support the applicant’s training goals in research methods/design, gait accelerometry, human movement, professional development, and mentorship.