Improving Outcomes for Older Veterans with Chronic Back Pain and Depression

改善患有慢性背痛和抑郁症的老年退伍军人的治疗结果

• 批准号: 10175011
• 负责人: UNA E. MAKRIS
• 金额: --
• 依托单位: VA NORTH TEXAS HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175011
• 关键词: Administrator; Age; Aging; Attention; Award; Back Pain; Behavior; Behavior Therapy; Behavioral; Caring; Chronic; Chronic low back pain; Clinical; Comparative Effectiveness Research; Complex; Data; Decision Making; Effectiveness; Elderly; Eligibility Determination; Emotional; Ensure; Evaluation; Feasibility Studies; Feedback; Geriatrics; Goals; Health; Health Care Costs; Health Personnel; Intervention; Interview; Investigation; Lead; Literature; Measurement; Medical; Medication Management; Mental Depression; Mentors; Motivation; Older Population; Operative Surgical Procedures; Outcome; Outcomes Research; Pain; Participant; Patient Outcomes Assessments; Patients; Perception; Pharmacology; Physicians; Polypharmacy; Population; Procedures; Process; Public Health; Qualitative Methods; Quality of life; Randomized; Randomized Controlled Trials; Recurrent back pain; Research; Research Methodology; Research Personnel; Risk Factors; Safety; Sampling; Self Management; Site; Structure; Support System; Target Populations; Techniques; Telephone; Testing; Veterans; Visit; Work; aging population; base; behavior change; career; career development; chronic back pain; chronic musculoskeletal pain; chronic pain; comorbid depression; comorbidity; control trial; cost; depressive symptoms; design; disability; effectiveness evaluation; evidence base; frailty; health training; implementation research; improved; improved outcome; meetings; multi-component intervention; multiple chronic conditions; pilot trial; programs; psychologic; recruit; response; rheumatologist; skills; social; theories; therapy development

Chronic low back pain is the 2nd most common reason for physician visits; annual related costs exceed $100 billion, and are expected to rise with the aging population. Prior work confirms that back pain in older adults results in significant physical, psychological and social consequences. We also know that depression frequently co-exists with chronic low back pain and complicates management. A feasible, effective behavioral intervention targeting chronic low back pain and comorbid depression in older Veterans is sorely needed. This is especially true for older Veterans where the efficacy and safety of pharmacologic and surgical options are often less favorable than in younger populations. Existing interventions are not adequate or sufficient as they have not been specifically focused on older Veterans, nor have they targeted both chronic back pain and depression simultaneously. The goal of this VA CDA-2 proposal is to develop, in an iterative process, a multi- component, health coach-telephone-delivered, behavioral intervention that will ultimately improve outcomes of disability and depression in older Veterans with chronic low back pain and depression. The proposed research has 3 interrelated specific aims: 1) develop a behavioral intervention for the target population of older Veterans with chronic low back pain and depression using input from expert, patient and other stakeholder groups; 2) pre-test and refine the intervention in an iterative process by conducting the behavioral intervention in a sample of 10 older Veterans who, along with other stakeholders, will provide feedback on intervention content and delivery; and, 3) conduct a pilot randomized control trial to evaluate feasibility of study procedures and outcome measurement. Dr. Makris' career goals are to become an independent investigator and a national leader with expertise in improving outcomes in medically complex older Veterans with chronic low back pain. She has assembled an exceptional team of mentors who are leaders in outcomes research, geriatrics, behavioral intervention development, evaluation and implementation. During the award period, the applicant will gain skills in behavioral intervention development, qualitative methods, stakeholder engagement, comparative effectiveness and implementation research methods. As a rheumatologist focused on aging research, and with her commitment to improving outcomes in older Veterans, this award would prepare Dr. Makris to lead efforts nationally to develop non-pharmacologic management approaches to improve patient reported outcomes for medically complex older Veterans with chronic low back pain and comorbid depression.

慢性腰痛是就诊的第二个最常见原因；每年相关费用超过 100 美元 亿，预计将随着人口老龄化而增加。先前的研究证实老年人的背痛 导致严重的身体、心理和社会后果。我们还知道抑郁症 经常与慢性腰痛同时存在，并使治疗变得复杂。可行、有效的行为 迫切需要针对老年退伍军人的慢性腰痛和共病抑郁症进行干预。这 对于老年退伍军人来说尤其如此，因为他们的药物和手术选择的有效性和安全性 往往不如年轻人更受青睐。现有的干预措施还不够充分，因为它们 没有专门针对老年退伍军人，也没有针对慢性背痛和 同时抑郁。 VA CDA-2 提案的目标是在迭代过程中开发一个多 组成部分，健康教练电话提供的行为干预，最终将改善结果 患有慢性腰痛和抑郁症的老年退伍军人的残疾和抑郁症。拟议的研究 有 3 个相互关联的具体目标：1) 为老年退伍军人的目标人群制定行为干预措施 根据专家、患者和其他利益相关者团体的意见，治疗慢性腰痛和抑郁症； 2） 通过对样本进行行为干预，在迭代过程中预先测试和完善干预措施 10 名老年退伍军人将与其他利益相关者一起提供有关干预内容和 送货; 3) 进行试点随机对照试验，以评估研究程序的可行性和 结果测量。 Makris 博士的职业目标是成为一名独立调查员和国家 在改善患有慢性腰痛的复杂老年退伍军人的治疗效果方面拥有专业知识的领导者。 她组建了一支出色的导师团队，他们是结果研究、老年病学、 行为干预的制定、评估和实施。在奖励期内，申请人 将获得行为干预开发、定性方法、利益相关者参与方面的技能， 比较有效性和实施研究方法。作为一名专注于衰老的风湿病学家 研究，以及她致力于改善老年退伍军人的结果，该奖项将为博士做好准备。 Makris 将领导全国开发非药物管理方法以改善患者状况 报告了患有慢性腰痛和共病抑郁症的医学复杂老年退伍军人的结果。