Investigating Movement-evoked Pain in osteoArthritic Conditions (IMPACT): An Observational Study to Inform Culturally-Tailored Intervention Development

膝关节骨关节炎(OA)是持续性肌肉骨骼疼痛的最大问题来源之一， 老年人的功能和活动能力下降，生活质量下降。尽管这些都是常见的结果 与骨质疏松症有关，它们在年长的非裔美国人中更严重。这些对健康老龄化的威胁 要求进一步调查导致骨性关节炎疼痛和残疾的最重要的驱动因素，即运动。这个 由于运动引起的疼痛，称为运动诱发疼痛(MEP)，通常会阻止完全参与 在日常生活活动和自我管理行动中，如身体活动/锻炼。因此，MEP是一种 是导致骨性关节炎患者高冲击性慢性疼痛和残疾的重要因素；然而，我们对 在老年非裔美国人中，促进MEP及其管理的机制严重有限。因此， 这一分两个阶段的以患者为导向的导师研究职业发展奖(K23)的总体目标是 通过(1)描述MEP的生物心理-社会行为机制和功能来填补这一知识空白 以及(2)开发基于机制的自我管理干预(使用 为黑人老年人量身定做的文化干预措施[积极主动])。这一干预将解决最关键的 以及与文化相关的MEP和老年非裔美国人功能受损的预测因子。我们的方法 代表了对当前慢性肌肉骨骼静态疼痛评估的新的实质性的背离 通过用运动来衡量疼痛的障碍。这项K23建议培训和研究活动将启动 在非裔美国老年人中推进疼痛和残疾科学的研究计划。至 为此，我组建了一个由代表护理、心理学/疼痛的资深科学家组成的跨学科团队 科学、老龄化和流行病学/社区参与，他们将提供指导，帮助我实现 提出了培训目标，并促进了我向独立研究职业的过渡。主要培训目标 我的研究计划的基本内容包括：(1)加深对生物、心理、社会和行为的理解-- 骨性关节炎疼痛的环境机制，(2)开发综合知识库在骨性关节炎中的应用 在实验设计中参与社区参与研究，以及(3)加强翻译研究 作为一名独立调查员的技能，能够进行严格的临床试验 非药理学、行为性慢性疼痛自我管理干预的有效性 社区(例如，南部非洲裔美国人)。K23第二阶段将采用基于社区的参与式 混合方法以协作方式创建主动干预。佛罗里达大学和美国大学 康涅狄格州是疼痛研究的强大孵化器，并提供理想的环境来扩展PI的先前 努力并开辟一条途径，以独特的方式理解多种生物、心理、社会和行为机制 参与慢性疼痛的种族内部体验，这是发现更好的治疗方法的关键 干预和自我管理行为。

Knee osteoarthritis (OA) is one the most problematic sources of persistent musculoskeletal pain, impaired function and mobility, and reduced quality of life in older adults. Although these are common outcomes associated with OA, they are disproportionately worse in older African Americans. These threats to healthy aging demand further investigation into the most significant driver of OA pain and disability, which is movement. The experience of pain due to movement, known as movement-evoked pain (MEP), often prohibits full participation in daily living activities and self-management actions such as physical activity/exercise. MEP is consequently a substantial contributor to high-impact chronic pain and disability in people with OA; yet, our understanding of the mechanisms contributing to MEP and its management in older African Americans is severely limited. Therefore, the overall goals for this two-phased Mentored Patient-Oriented Research Career Development Award (K23) is to fill this knowledge gap by (1) characterizing the biopsychosocial-behavioral mechanisms of MEP and function and (2) develop a mechanism-based self-management intervention (Pain Relief for OsteoArthritis using Culturally-Tailored InterVentions for Black Elders [PROACTIVE]). This intervention will address the most pivotal and culturally-relevant predictors of MEP and impaired function in older African Americans. Our methods represent a new and substantive departure from current static pain assessments in chronic musculoskeletal disorders by measuring pain with movement. This K23 proposes training and research activities that will launch a program of research which advances the science of pain and disability in African American older adults. To this end, I have assembled an interdisciplinary team of senior scientists representing nursing, psychology/pain science, aging, and epidemiology/community engagement who will provide mentorship to help me achieve proposed training goals and facilitate my transition to an independent research career. Primary training goals essential to my research program include: (1) advance understanding of biopsychosocial and behavioral- environmental mechanisms of OA pain, (2) develop a comprehensive knowledge base in the application of community-engaged participatory research within experimental designs, and (3) enhance translational research skills to function as an independent investigator capable of conducting rigorous clinical trials testing the effectiveness of non-pharmacological, behavioral chronic pain self-management interventions within a cultured community (e.g., southern African Americans). Phase 2 of the K23 will apply community-based participatory mixed-methods to collaboratively create the PROACTIVE intervention. The University of Florida and University of Connecticut are strong incubators for pain research and provide ideal environments to extend the PI’s prior work and forge a path towards understanding multiple biopsychosocial and behavioral mechanisms uniquely involved in the intra-ethnic experience of chronic pain, which are key to the discovery of better therapeutic interventions and self-management behaviors.