IVR-based cognitive behavior therapy for chronic low back pain

这项拟议的研究将测试一种创新方法--交互式语音应答的有效性 (IVR)，提供经验性验证的心理治疗(认知行为治疗 [CBT])用于慢性下腰痛，以改善退伍军人的可及性。IVR是一种 计算机化的界面，允许患者使用他们的电话：1)获取预先录制的 教学信息，2)报告有关疼痛相关症状和对疼痛的坚持的数据 应对技能练习，以及3)接受个性化的治疗师反馈。尽管CBT一直是 在减少疼痛强度、残疾和情感苦恼方面显示出有效的两个元 分析，传统的CBT对治疗师来说是时间密集型的，需要患者频繁地 办公室来访。IVR的使用将允许退伍军人在家中通过按键访问CBT 电话，从而使他们可以在方便的时候获得治疗，而不需要前往 预约门诊的退伍军人事务部。患有慢性下腰痛的退伍军人将被随机分配到 相同的号码接受标准CBT或基于IVR的CBT。主要结果是 衡量的将是疼痛强度。次要结果指标将是生活质量和身体状况 和情绪功能。研究参与者将在治疗前进行评估(基线)，12 基线后几周(治疗后)，基线后3个月和6个月(随访)。 这项研究的探索性目标是检查：(1)临床结果以外的因素 哪些治疗方法可能不同(脱落率、治疗满意度、治疗可信度和 行为目标实现)；和(2)主持人(例如，年龄、性别、种族/民族、痛点 治疗的地点和数量、用药情况和精神疾病 参与和参与，遵守治疗师关于疼痛应对技能的建议 实践和结果。

The proposed study will test the efficacy of an innovative method, interactive voice response (IVR), for delivering an empirically validated psychological treatment (cognitive behavior therapy [CBT]) for chronic low back pain in order to improve accessibility to veterans. IVR is a computerized interface that allows patients to use their telephone to: 1) obtain pre-recorded didactic information, 2) report data regarding pain-related symptoms and adherence to pain coping skill practice, and 3) receive personalized therapist feedback. Although CBT has been shown to be effective in reducing pain intensity, disability, and affective distress in two meta- analyses, traditional CBT is time intensive for therapists and requires patients to make frequent office visits. The use of IVR will allow veterans to access CBT from their home via a touch-tone telephone, thereby allowing them to access treatment at their convenience without travel to the VA for an outpatient appointment. Veterans with chronic low back pain will be randomized in equal numbers to receive either standard CBT or IVR-based CBT. The primary outcome measure will be pain intensity. Secondary outcome measures will be quality of life and physical and emotional functioning. Study participants will be evaluated pre-treatment (baseline), 12 weeks post-baseline (post-treatment) and at 3 and 6 months post-baseline (follow-up). Exploratory objectives of the study are to examine: (1) factors other than clinical outcomes on which the treatments may differ (drop-out rate, treatment satisfaction, treatment credibility, and behavioral goal accomplishment); and (2) moderators (e.g., age, sex, race/ethnicity, pain site location and number, medication use and psychiatric comorbidities) of treatment engagement and participation, adherence to therapist recommendations for pain coping skill practice and outcomes.