A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults

针对老年人慢性肌肉骨骼疼痛的低强度认知行为自我管理干预

• 批准号: 9903177
• 负责人: Mary Rose Janevic
• 金额: $ 11.6万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903177
• 关键词: Accelerometer; Address; Adherence; Adult; Advocacy; Affect; Affective; Age; American; Americas; Analgesics; Anesthesiology; Anxiety; Area; Attention; Award; Behavior Therapy; Behavioral; Bioethics; Biological; Caring; Chronic Disease; Clinical; Cognitive; Cognitive Therapy; Collaborations; Computerized Cognitive Behavioral Therapy; Control Groups; Data; Data Analyses; Data Collection; Data Set; Development; Devices; Diabetes Mellitus; Educational process of instructing; Educational workshop; Elderly; Environment; Epidemic; Ethicists; Ethics; Facial Pain; Fatigue; Feedback; Focus Groups; Foundations; Functional disorder; Geriatrics; Gerontology; Goals; Health; Heart Diseases; Improve Access; Influentials; Institute of Medicine (U.S.); Institutes; Internet; Intervention; Intervention Trial; K-Series Research Career Programs; Libraries; Link; Manuals; Mediator of activation protein; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Michigan; Modeling; Monitor; Outcome; Pain; Pain intensity; Pain management; Participant; Patients; Pattern; Persistent pain; Physical Medicine; Physical Rehabilitation; Pilot Projects; Polypharmacy; Process; Program Development; Psychiatry; Psychology; Public Health; Public Health Schools; Randomized; Reaction; Recommendation; Reporting; Research; Research Activity; Research Design; Research Personnel; Research Support; Research Training; Resources; Risk; Self Management; Series; Services; Social Functioning; Specialist; Symptoms; System; Telephone; Testing; Therapeutic Intervention; Therapy trial; Time; Touch sensation; Training; Training Activity; Training Programs; United States; United States National Institutes of Health; Universities; Validity and Reliability; Waiting Lists; Work; age group; base; behavior test; biopsychosocial; career; chronic musculoskeletal pain; chronic pain; chronic pain management; clinical center; cognitive function; comorbidity; coping; cost; daily functioning; design; disability; eHealth; evidence base; experience; fitbit; group intervention; improved; individual patient; intervention effect; mHealth; older patient; pain patient; pain relief; pain self-management; patient oriented; pilot trial; pragmatic trial; preference; programs; psychologic; public health relevance; recruit; secondary analysis; side effect; skills; social; symposium; tool; training opportunity; usability; young adult

 DESCRIPTION (provided by applicant): A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults In an influential 2011 report entitled Relieving Pain in America, the Institute of Medicine called attention to the epidemic of chronic pain in the United States, and to the urgent need to improve access to effective pain treatments. Responding to the priorities set in this report, I am seeking to lay the foundation for an independent research program with the goal of increasing the accessibility of evidence-based, cognitive-behavioral interventions for chronic pain management among older adults. This application for a Mentored Career Development Award (K01) proposes training and research activities over a 5-year period that will enable me to launch this research program. To this end, I have formed an interdisciplinary team of mentors and consultants that includes researchers representing Geriatrics, Anesthesiology, Psychology, Physical Medicine and Rehabilitation, Public Health and Psychiatry at the University of Michigan, as well as a prominent pain ethicist from the independent Center for Practical Bioethics. This additional support will build on my strong foundation in conducting behavioral and chronic illness self-management support research among older adults. The training and research aims in this proposal are closely linked. The training goals include acquiring skills and expertise in the areas that are essential for my planned research program: 1) The pathophysiology and management of chronic pain in older adults and cognitive-behavioral approaches to treating chronic pain in this group; 2) Symptom and activity monitoring in older adults, which enables the use of accurate and timely information about patients' progress as part of behavioral interventions, while identifying potential mediators of intervention effects; and 3) Emerging study designs for testing behavioral interventions, with an emphasis on pragmatic, adaptive and patient-centered designs that increase the relevance of research findings. These topics will be mastered through coursework, clinical observations, and self-study under the guidance of the mentorship team. I will also attend relevant seminars, workshops, and scientific conferences throughout the award period. Following the training program, I will develop and pilot-test a low-intensity pain CBT intervention for older adults. The intervention will use a high tech/high touch approach. Using an evidence-based internet CBT intervention for chronic pain management as a starting point, I will develop two additional components that will enhance the appeal and potential efficacy of this program for older adults: a) a series of telephone CBT sessions by non-specialist practitioners to support use of the electronic modules, and b) symptom and activity monitoring using mobile health tools to better tailor the intervention to individual patients' needs. The development and pilot-testing of this program will be accomplished via three sequential research aims. To aid in the development of program content, in Aim 1, I will conduct secondary analysis of data from two recent RCTs of pain CBT interventions to test the hypothesis that there are significant age group differences in pain coping strategies and choice of CBT goals, and to identify the CBT skills that are most appealing and most challenging to older adults. I will also conduct focus groups to obtain feedback from target intervention users on the acceptability and design of the proposed facilitator and monitoring components. In Aim 2, I will conduct usability testing with older pain patients to test our assumption that using a FitBit-type device to automatically- upload accelerometer data results in markedly greater adherence to data collection than manual upload via IVR calls. We will also evaluate the reliability, validity and acceptability of both automated and manual upload to inform the final choice of monitoring strategy used in the pilot study. In Aim 3, I will recruit 50 older adults with chronic musculoskeletal pain and conduct a randomized pilot trial of the intervention with waitlist controls to assess its feasibility and effects on Pai Impact. If successful, results from the pilot study will serve as preliminary work for a larger pragmatic trial to be proposed in the final year of the K01. The University of Michigan, the School of Public Health, and the Center for Managing Chronic Disease provide the ideal environment for carrying out the proposed activities. These units offer opportunities for training, collaboration, and cross-disciplinary pollination. A wide array of resources will facilitate my wor during the award period; e.g., the Geriatrics Center and Institute of Gerontology, the Chronic Pain and Fatigue Research Center, the Michigan Center for Clinical and Health Research, as well as world-class computing, library, and statistical support services. This resource-rich environment, along with a committed team of mentors, will facilitate my transition to an independent research career.

 描述（由申请人提供）：针对老年人慢性肌肉骨骼疼痛的低强度认知行为自我管理干预措施 在 2011 年题为《缓解美国疼痛》的颇具影响力的报告中，医学研究所呼吁关注慢性疼痛在老年人中的流行。为了响应本报告中确定的优先事项，我正在寻求制定以下目标： 一个独立研究项目的基础，旨在提高老年人慢性疼痛管理的循证认知行为干预措施的可及性。本指导职业发展奖（K01）申请提出了超过 5-5 年的培训和研究活动。为此，我组建了一个由导师和顾问组成的跨学科团队，其中包括代表老年病学、麻醉学、心理学、物理医学和康复、公共卫生和医学领域的研究人员。密歇根大学精神病学以及独立实用生物伦理学中心的一位著名疼痛伦理学家将建立在我在老年人中进行行为和慢性疾病自我管理支持研究的坚实基础上。该提案中的目标密切相关，培训目标包括获得各领域的技能和专业知识。 这对于我计划的研究项目至关重要：1）老年人慢性疼痛的病理生理学和治疗以及治疗该群体慢性疼痛的认知行为方法；2）老年人的症状和活动监测，这使得能够使用准确的数据作为行为干预的一部分，及时提供有关患者进展的信息，同时确定干预效果的潜在中介因素；以及 3) 用于测试行为干预的新兴研究设计，重点是实用、适应性和以患者为中心的设计，以提高行为干预的相关性；这些主题将在导师团队的指导下通过课程作业、临床观察和自学来掌握。在整个培训计划结束后，我还将参加相关的研讨会、讲习班和科学会议。为老年人开发和试点测试低强度疼痛 CBT 干预措施 该干预措施将使用高科技/高接触方法以用于慢性疼痛管理的循证互联网 CBT 干预为起点，我将开发另外两种方法。增强吸引力的组成部分该计划对老年人的潜在功效：a) 由非专业从业者进行的一系列电话 CBT 课程，以支持电子模块的使用，以及 b) 使用移动健康工具监测症状和活动，以更好地根据个体患者的情况制定干预措施该项目的开发和试点测试将通过三个连续的研究目标来完成，为了帮助开发项目内容，在目标 1 中，我将对最近两项疼痛 CBT 干预措施的数据进行二次分析。假设存在显着的年龄组差异疼痛应对策略和 CBT 目标的选择，并确定对老年人最有吸引力和最具挑战性的 CBT 技能。我还将开展焦点小组活动，以获取目标干预使用者对拟议的促进者和监测的可接受性和设计的反馈。在目标 2 中，我将对老年疼痛患者进行可用性测试，以测试我们使用 FitBit 型设备自动上传的假设。 与通过 IVR 呼叫手动上传相比，加速计数据对数据收集的遵守程度明显更高。我们还将评估自动和手动上传的可靠性、有效性和可接受性，以便为试点研究中使用的监控策略的最终选择提供信息。 ，我将招募 50 名患有慢性肌肉骨骼疼痛的老年人，并进行一项随机试点试验，以评估其可行性和对 Pai Impact 的影响。如果成功，试点研究的结果将作为更大规模的初步工作。密歇根大学、公共卫生学院和慢性病管理中心提议在 K01 的最后一年进行务实试验，这些单位为开展拟议的活动提供了机会。 合作和跨学科授粉将促进我在获奖期间的工作，例如老年病学中心和老年学研究所、慢性疼痛和疲劳研究中心、密歇根临床和健康研究中心，以及世界一流的计算、图书馆和统计支持服务，以及忠诚的导师团队，将促进我向独立研究职业的过渡。