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（由适用提供）：在2011年有影响力的2011年有影响力的报告中，老年人的慢性肌肉骨骼疼痛的低强度，认知行为自我管理干预措施，标题为“缓解美国的疼痛”，该研究所被称为美国慢性疼痛的关注，以及迫切需要改善有效疼痛治疗的慢性疼痛。为了回应本报告中设定的优先级，我正在寻求建立 独立研究计划的基础，目的是提高老年人对慢性疼痛管理的循证，认知行为干预措施的可及性。该指导职业发展奖（K01）的提案申请在5年内培训和研究活动，这将使我能够启动该研究计划。为此，我组成了一个由导师和顾问组成的跨学科团队，其中包括代表密歇根大学的老年医学，麻醉，心理学，物理医学和康复，公共卫生和精神病学的研究人员，以及独立生物ethicics独立中心的重要痛苦伦理学家。这种额外的支持将以我在进行行为和慢性疾病自我管理支持老年人研究的基础为基础。该提案中的培训和研究目的密切相关。培训目标包括在该领域获得技能和专业知识 这对于我计划的研究计划至关重要：1）老年人的慢性疼痛的病理生理学和管理以及治疗该组慢性疼痛的认知行为方法； 2）老年人的症状和活动监测，这可以使用有关患者进步作为行为干预措施的一部分的准确和及时信息，同时确定潜在的干预效果介体； 3）用于测试行为干预措施的新兴研究设计，重点是实用，适应性和以患者为中心的设计，以增加研究结果的相关性。这些主题将在心态团队的指导下通过课程，临床观察和自学来掌握。在整个奖项期间，我还将参加相关的半人选，讲习班和科学会议。在培训计划之后，我将为老年人开发和试验低强度的疼痛CBT干预。干预将采用高科技/高触摸方法。我将使用基于证据的Internet CBT干预进行慢性疼痛管理作为起点，我将开发两个其他组件，以增强该计划对老年人的外观和潜在有效性：a）非专家实践者的一系列电话CBT会议，支持使用电子模块的使用，以支持使用移动健康工具的症状和活动工具，以改善级别的患者，以使各个级别的患者介入互助。该计划的开发和试点测试将通过三个顺序研究目的完成。为了帮助开发程序内容，在AIM 1中，我将对最近两种疼痛CBT干预措施的数据进行辅助分析，以检验以下假设：疼痛应对策略和CBT目标的选择存在很大的年龄段差异，并确定CBT技能对老年人最吸引人和最具挑战性的CBT技能。我还将进行焦点小组，以获取目标干预用户的反馈，以了解拟议的促进器和监视组件的可接受性和设计。在AIM 2中，我将对老年疼痛患者进行可用性测试，以测试我们的假设，即使用Fitbit型设备自动上传 与通过IVR调用相比，加速度计数据显着遵守数据收集。我们还将评估自动化和手动上传的可靠性，有效性和可接受性，以告知试点研究中使用的监视策略的最终选择。在AIM 3中，我将招募50名患有慢性肌肉骨骼疼痛的老年人，并通过候补名单控制措施进行干预的随机试验试验，以评估其对PAI影响的可行性和影响。如果成功的话，试点研究的结果将是在K01的最后一年提出的更大务实试验的初步工作。密歇根大学，公共卫生学院和管理慢性病中心为开展拟议活动提供了理想的环境。这些单位提供了培训的机会， 协作和跨学科授粉。在颁奖期间，各种各样的资源将有助于我的战争；例如，老年中心和老年研究所，慢性疼痛与疲劳研究中心，密歇根州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。这个资源丰富的环境以及一个坚定的导师团队将有助于我过渡到独立的研究职业。