Integrated Care for Depression and Chronic Back Pain

抑郁症和慢性背痛的综合护理

• 批准号: 7100092
• 负责人: Michael R Von Korff
• 金额: $ 7.03万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-01 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7100092
• 关键词: antidepressants; backache; behavioral /social science research tag; chronic disease /disorder; clinical research; clinical trials; cognitive behavior therapy; comorbidity; functional ability; health care cost /financing; human subject; human therapy evaluation; major depression; method development; patient care management; patient oriented research; sign /symptom; therapy compliance; therapy design /development

DESCRIPTION (provided by applicant): Research Goal: Our long-term goal is to improve the functional, symptom and cost of care outcomes among patients with co-morbid depression and chronic pain. This proposal seeks support for a pilot study of an integrated intervention for depression and chronic back pain. The proposed pilot study will accomplish the following specific aims: Aim 1: Develop an integrated intervention for chronic back pain patients with major depression. This research will develop an integrated, biopsychosocial intervention for chronic back pain patients with major depression. The integrated intervention incorporates proven interventions for major depression (Problem-Solving Therapy and/or antidepressant medications depending on patient preferences) with brief cognitive-behavioral interventions for chronic back pain, also of proven effectiveness. Aim 2: Develop methods for inducing and assessing intervention fidelity. We will assess the delivery, receipt and enactment of the integrated intervention with multiple methods (provider ratings, patient ratings, patient logs, and independent ratings of audiotapes). We will assess the inter-rater reliability of independent ratings of audiotapes, the convergent validity of fidelity measures obtained from different sources, and the correlation of different components of intervention fidelity. Aim 3: Conduct a pilot test of the integrated intervention for depressed chronic back pain patients. We will conduct a pilot test of the integrated intervention with 50 intervention and 50 care as usual control patients. The pilot RCT will assess screening completion and eligibility rates; participation in the integrated intervention among patients randomly assigned to the intervention arm; the fidelity of provider delivery and patient receipt of the intervention; levels of patient enactment of the intervention as assessed by measures of patient adherence with pharmacologic and behavioral treatments; acceptability of the integrated intervention to participating primary care physicians; and intervention effect size at 6 months for pain, depression and functional outcomes. We will assess the incremental benefit of integrated management of depression and chronic back pain relative to brief cognitive-behavioral intervention for back pain alone (through comparison of intervention patients to historical controls receiving only a cognitive-behavioral intervention for chronic back pain).

描述（由申请人提供）： 研究目标：我们的长期目标是改善患有抑郁症和慢性疼痛的患者的功能、症状和护理结果的成本。 该提案寻求对抑郁症和慢性背痛综合干预试点研究的支持。 拟议的试点研究将实现以下具体目标： 目标 1：为患有重度抑郁症的慢性背痛患者制定综合干预措施。 这项研究将为患有重度抑郁症的慢性背痛患者开发一种综合的生物心理社会干预措施。 该综合干预措施结合了针对重度抑郁症的行之有效的干预措施（问题解决疗法和/或抗抑郁药物，具体取决于患者的喜好）以及针对慢性背痛的简短认知行为干预措施，这些干预措施也被证明是有效的。 目标 2：开发诱导和评估干预保真度的方法。 我们将通过多种方法（提供者评级、患者评级、患者日志和录音带独立评级）评估综合干预措施的实施、接收和实施。 我们将评估录音带独立评级的评级者间可靠性、从不同来源获得的保真度测量的收敛有效性以及干预保真度不同组成部分的相关性。 目标 3：对抑郁性慢性背痛患者进行综合干预试点。 我们将进行综合干预试点测试，其中 50 名干预患者和 50 名常规护理对照患者。 试点随机对照试验将评估筛查完成率和合格率；参与随机分配到干预组的患者的综合干预；提供者提供的保真度和患者接受干预措施的忠诚度；通过衡量患者对药物和行为治疗的依从性来评估患者实施干预措施的水平；参与初级保健医生对综合干预的可接受性；以及 6 个月时对疼痛、抑郁和功能结果的干预效果大小。 我们将评估抑郁症和慢性背痛综合治疗相对于仅针对背痛的短暂认知行为干预的增量益处（通过将干预患者与仅接受慢性背痛认知行为干预的历史对照进行比较）。