Internet-based osteoarthritis pain coping skills intervention

描述（由申请人提供）：2100万美国人患有骨关节炎（OA），这是一种进行性关节疾病，可导致僵硬、疼痛、活动范围减少、痛苦以及身体、社会和角色功能减退。OA疼痛的药物治疗是有限的，存在风险，特别是对于老年人群。然而，认知行为疼痛应对技能干预已被证明可有效减少OA疼痛，残疾和痛苦。不幸的是，现有的项目只覆盖了有限数量的患者，因为它们需要患者前往接受面对面的培训。有必要采取干预措施，解决因OA而功能和生活质量严重下降的迅速增长的人口中更大比例的人的需求。通过互联网提供经过验证的疼痛管理干预措施是解决这一需求的一种有希望的方法，特别是考虑到美国老年人越来越多地使用互联网。为了最有效，基于互联网的干预措施需要模仿面对面干预措施的关键特征。拟议的干预措施将通过将经证实的亲身疼痛应对技能协议转化为基于互联网的交互式应用程序来实现，该应用程序使用多媒体和专家系统技术来模拟亲身干预。它将提供个性化的反馈，交互式的问题解决和动画演示，它将结合班杜拉的社会认知理论的学习技术，包括建模，掌握经验和社会强化。该项目包括两个阶段，对应两个具体目标。在第一阶段，我们将把面对面的干预翻译成在互联网上提供。这一阶段将包括从患者和专家治疗师焦点小组收集反馈，这将有助于完善该计划。在第二阶段，我们将进行一项小规模的随机对照试验，这将使我们能够检查和改进旨在增加动机和坚持8周的基于互联网的干预过程中的功能。该试验还将使我们能够证明其可行性，耐受性，安全性和前景。我们假设试验将证明互联网在提供OA疼痛应对技能干预方面的有效性。总之，这些活动将为本研究下一阶段的全面随机对照试验中的测试做好准备。该项目的承诺得到了多学科研究团队的加强，该团队在认知行为干预方面具有专业知识，这些干预措施教会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反馈报告，以及开发引人入胜的，用户友好的，交互式的基于计算机的学习和评估程序。相关性：这种基于互联网的OA疼痛应对技能干预针对的是一个重大的个人和公共卫生问题，并扩大了获得医疗支持的疼痛自我管理计划的机会，使其能够覆盖更大比例的患有OA疼痛和相关残疾的庞大且不断增长的人群。 公共卫生相关性：该项目将把一种针对骨关节炎（OA）患者的经证实的疼痛应对技能干预转化为一种吸引人且易于使用的基于互联网的干预，该干预使用创新技术来模仿传统的面对面培训课程。这种方法的一个显著好处是，它有望将有效治疗的范围扩大到越来越多的OA患者中的更大比例，例如，那些不能或不愿意旅行接受培训的患者。如果发现有效，这种基于互联网的OA疼痛应对技能干预将成为解决数百万美国人需求的宝贵工具，这些美国人的功能和生活质量因OA疼痛和残疾而严重降低。

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.