Effects of Physical Activities on Pain and Functional Recovery in Low Back Pain

体力活动对腰痛疼痛和功能恢复的影响

• 批准号: 10377320
• 负责人: Pradeep Suri
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10377320
• 关键词: Accounting; Age; Analgesics; Benign; Categories; Characteristics; Clinical Practice Guideline; Cohort Analysis; Cohort Studies; Complex; Cross-Over Studies; Crossover Design; Data; Development; Educational Intervention; Flare; Foundations; Frequencies; Fright; Future; Guidelines; Hearing; Hearing problem; Home; Hour; Individual; Intervention; Learning; Lifting; Low Back Pain; Measures; Mental Depression; Mental Health; Methods; Modernization; Movement; Myocardial Infarction; Occupational Health; Opioid; Pain; Pain intensity; Patients; Periodicity; Physical activity; Primary Health Care; Process; Productivity; Quality of life; Questionnaires; Randomized Controlled Trials; Recommendation; Recording of previous events; Recovery; Recovery of Function; Recurrence; Research; Risk; Role; Sampling Studies; Services; Stress; Technology; Testing; Veterans; Work; Workplace; actigraphy; base; biopsychosocial; chronic pain management; design; disability; evidence base; experimental study; follow-up; innovation; interest; longitudinal analysis; mHealth; novel strategies; opioid misuse; opioid use; pain outcome; post-traumatic stress; primary outcome; protective effect; rehabilitation research; research and development; secondary outcome; suicidal morbidity; suicidal risk

Low back pain (LBP) is the #1 cause of disability worldwide and a leading cause among Veterans. LBP has a recurrent course for most individuals, involving the periodic occurrence of new episodes that patients must manage. New LBP episodes therefore are critical juncture points where interventions hold promise for optimizing functional recovery, promoting return to work (RTW), and averting a cascade of downstream consequences such as opioid use, mental health problems, and even the risk of suicide and death. The general advice to remain active during a new LBP episode is a key part of clinical practice guidelines. However, existing guidelines provide no specific recommendations about the types of activity (e.g., lifting, bending, etc.) that should be engaged in or avoided (“Which?”) or the duration/intensity of such activities should they be performed (“How?”). The guidelines therefore do not address a major concern of patients with LBP, which is that certain activities may have short-term effects on pain exacerbations or “flares”, or cause sustained detrimental effects on pain or function. The distinctions between healthy, benign, and detrimental activities are also important to clinicians, who are often called upon to complete “work restriction forms” as part of the RTW process. An ideal set of work restrictions after a new LBP episode would limit only those activities that are likely to cause flares of pain (short-term effects) or poor overall functional recovery in the longer term (overall effects). However, there exist no empirically derived data concerning the short-term vs. overall effects of specific activities during a new episode of LBP, with which to guide work restrictions. Instead, in standard practice, clinicians’ recommendations to engage in or avoid specific activities rely on their personal practice style and may limit functional recovery if overly restrictive. The proposed research will use a novel approach to distinguish the short-term effects of activities from the overall effects of such activities, by conducting a longitudinal case-crossover study nested within a cohort study. This design accounts for measured and unmeasured confounds by using each case as his/her own control, analogous to a crossover experiment, capitalizing on modern mobile health and actigraphy technology. Aim 1: Estimate the short-term effects (24 hours) of specific physical activities on pain flares in Veterans with LBP. A longitudinal case-crossover study will be conducted to identify activities that trigger flares among 550 Veterans of working age (18-65 yrs) seen for a new LBP episode in VA primary care. The primary outcome is a validated flare definition characterized by pain and functional impact. Analyses will use a biopsychosocial framework accounting for potential confounders and moderators, such as pain characteristics, work-related factors, catastrophizing, fear of movement, depression, post-traumatic stress, and opioid use. Aim 2: Estimate the overall effects of specific physical activities among Veterans with LBP. A cohort study approach to the Aim 1 study sample will examine associations between the frequency of specific activities over the first 8 weeks of follow-up, and overall LBP-related functional recovery as defined by the Roland-Morris Disability Questionnaire at 12-month follow-up (primary outcome). Analyses will also use a biopsychosocial framework accounting for a broad range of other factors, as done for Aim 1. Secondary outcomes include average pain intensity, lost work productivity, quality of life, and opioid use at 12 months. These study aims will produce the first evidence-based estimates of the short-term and overall risks of activities during LBP. These data will (1) support Veterans with LBP in navigating the complex process of recovery, (2) assist VA clinicians in providing work restrictions, and (3) inform the development of a future educational intervention for LBP that can be tested in a future RCT. Thus, this work responds directly to the Rehabilitation Research and Development service’s call for activity-based interventions for chronic pain.

腰痛 (LBP) 是全球第一大残疾原因，也是退伍军人中的主要原因。 对于大多数人来说，复发病程，涉及周期性发生新的发作，患者必须 因此，新的腰痛发作是干预措施有望实现的关键时刻。 优化功能恢复、促进重返工作岗位 (RTW) 并避免下游连锁反应 后果包括阿片类药物的使用、心理健康问题，甚至自杀和死亡的风险。 在新的腰痛发作期间保持活跃的一般建议是临床实践指南的关键部分。 然而，现有的指南没有提供有关活动类型的具体建议（例如，举重、 应该进行或避免的弯曲等）或此类活动的持续时间/强度 因此，该指南并未解决患有此类疾病的患者主要关心的问题。 LBP，即某些活动可能会对疼痛加剧或“发作”产生短期影响，或导致 对疼痛或功能的持续不健康影响 健康、良性和不健康之间的区别。 活动对信徒来说也很重要，他们经常被要求填写“工作限制表”作为一部分 在新的 LBP 事件发生后，一套理想的工作限制将仅限制这些活动。 可能会导致疼痛（短期影响）或长期整体功能恢复不良 （总体影响）。但是，没有关于短期与总体影响的经验数据。 新一轮光体痛期间特定活动的影响，以此来指导工作限制。 相反，在标准实践中，人群参与或避免特定活动的建议取决于他们的 个人练习风格，如果过度限制，可能会限制功能恢复。拟议的研究将使用 区分活动的短期影响与此类活动的总体影响的新颖方法，通过 在队列研究中进行纵向病例交叉研究。 通过使用每个案例作为他/她自己的控制，测量和未测量的混淆，类似于交叉 实验，利用现代移动健康和体动记录技术。 目标 1：评估特定身体活动对疼痛发作的短期影响（≤24 小时） 患有 LBP 的退伍军人将进行纵向病例交叉研究，以确定触发的活动。 退伍军人管理局初级保健中心 550 名工作年龄的退伍军人（18-65 岁）中出现了新的 LBP 发作。 主要结果是经过验证的耀斑定义，其特征是疼痛和功能影响。 生物心理社会框架考虑了潜在的混杂因素和调节因素，例如疼痛特征， 与工作相关的因素、灾难性情绪、对运动的恐惧、抑郁、创伤后应激障碍和阿片类药物的使用。 目标 2：估计 LBP A 退伍军人中特定体育活动的总体影响。 目标 1 研究样本的研究方法将检查特定频率之间的关联 随访前 8 周的活动，以及 LBP 相关功能恢复（如 12 个月随访时的 Roland-Morris 残疾问卷（主要结果）也将使用。 生物心理社会框架考虑了广泛的其他因素，如目标 1 所做的那样。次要 结果包括 12 个月时的平均疼痛强度、工作效率下降、生活质量和阿片类药物使用情况。 这些研究目标将对短期和总体风险进行首次基于证据的估计。 这些数据将 (1) 支持患有 LBP 的退伍军人应对复杂的过程。 恢复，(2) 协助 VA 爱好者提供工作限制，以及 (3) 告知未来的发展 可以在未来的随机对照试验中测试 LBP 的教育干预因此，这项工作直接响应。 康复研究与开发服务呼吁对慢性疼痛采取基于活动的干预措施。