Characterizing the relationship between objective physical activity and momentary pain in cognitive behavioral interventions for chronic pain

描述慢性疼痛认知行为干预中客观身体活动与瞬时疼痛之间的关系

• 批准号: 10679870
• 负责人: Mara Tynan
• 金额: $ 4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679870
• 关键词: Accelerometer; Address; Attenuated; Automobile Driving; Behavior; Belief; Clinical; Cognitive Therapy; Collection; Data; Data Collection; Ecological momentary assessment; Equation; Fellowship; General Population; Goals; Growth; Health; Individual; Intervention; Interview; Knowledge; Life; Life Expectancy; Literature; Measures; Mental Health; Mentorship; Methods; Modeling; National Center for Complementary and Integrative Health; Occupational; Opioid; Outcome; Outcome Measure; Pain; Pain Measurement; Pain Research; Pain interference; Pain management; Parents; Participant; Patient Self-Report; Pattern; Persons; Physical Function; Physical activity; Population; Public Health; Qualitative Methods; Questionnaires; Randomized; Randomized, Controlled Trials; Recontacts; Research; Research Personnel; Risk; Statistical Data Interpretation; Technology; Therapeutic Intervention; Thinking; Time; Training; Veterans; Walking; Work; actigraphy; biopsychosocial; chronic pain; chronic pain management; cost; design; experience; follow-up; functional improvement; functional outcomes; health goals; improved; improved outcome; innovation; intervention effect; member; novel; post intervention; restoration; secondary analysis; skills; social; social relationships; suicidal risk; tool

PROJECT SUMMARY Chronic pain (CP), a highly prevalent, costly, and disabling biopsychosocial condition, is being increasingly addressed with cognitive behavioral interventions such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT). Such interventions seek to maximize physical, social, and occupational functioning by changing how one manages pain via addressing pain-related thoughts, beliefs, and behaviors. The current CP literature is limited by the use of between-subject designs and self-report measures that lack ecological validity and may be subject to bias. One component of function, physical activity, is able to be objectively measured in an ecologically valid way using accelerometry. In fact, prior research has combined accelerometry and pain ratings collected using ecological momentary assessment (EMA) to better reflect the real-time, real-world relationship between pain and physical activity. Such research has indicated cross- sectionally a dynamic within-person pain-physical activity relationship. We hypothesize that this dynamic relationship is alterable by cognitive behavioral intervention and seek to examine this research question in Veterans with CP, as they represent an underserved and apt population for CP research given disproportionately high rates of this condition. In Aim 1, we model the relationship between EMA-assessed pain and objective physical activity over a 7-day baseline period, within-person, using parallel latent growth curve modelling (LGCM). We hypothesize that at baseline, the growth trajectories of pain and physical activity will be related such that increases in pain will be associated with decreases in physical activity. In Aim 2, we use multigroup analysis to examine if participation in a cognitive behavioral intervention alters the relationship between the growth trajectories of EMA pain and objective physical activity. We hypothesize that, post- intervention, the relationship between the growth trajectories of pain and physical activity will be significantly altered compared to baseline. In our Exploratory Aim, we conduct follow-up interviews to qualitatively explore how treatment impacts how individuals relate to their pain. Therefore, the proposed research will examine the relationship between pain and physical activity and if and how it changes after cognitive behavioral intervention. The use of structural equation modelling (i.e., LGCM) and qualitative methods will be combined to portray a more complete picture of the experience of CP and treatment. Thus, findings from this study will address existing limitations in the understanding and conceptualization of function in CP, provide information on how to improve function in individuals with CP, and promote the improvement and refinement of cognitive behavioral interventions for the treatment of CP. Importantly, this project will advance the applicant’s long-term goal of becoming an independent clinical researcher committed to applying advanced technological and statistical tools to the improvement of treatments for CP.

项目摘要 慢性疼痛（CP）是一种高度普遍，昂贵且残疾的生物心理社会状况，越来越多 通过认知行为干预措施（例如接受和承诺疗法）（法案）和 认知行为疗法（CBT）。这种干预措施旨在最大化身体，社会和职业 通过改变与疼痛相关的思想，相信和行为来管理疼痛的方式来运作。 当前的CP文献受主体间设计和缺乏的自我报告措施的限制 生态有效性，可能会出现偏见。功能的一个组成部分，体育活动，能够成为 使用加速度学以生态有效的方式进行客观测量。实际上，先前的研究结合了 使用生态瞬时评估（EMA）收集的加速度计和疼痛等级，以更好地反映 疼痛与体育锻炼之间的实时，现实世界的关系。这样的研究表明 分段是一个动态的人体内部疼痛运动关系。我们假设这种动态 认知行为干预可以改变关系，并试图在 具有CP的退伍军人，因为他们代表了CP研究的服务欠佳和适当的人群 这种情况的高度不成比例。在AIM 1中，我们对EMA评估之间的关系建模 在7天基线期间，人工内部的疼痛和客观的体育锻炼，使用平行潜在生长 曲线建模（LGCM）。我们假设在基线时，疼痛和体育锻炼的生长轨迹 将与疼痛的增加有关，将与体育锻炼的下降有关。在AIM 2中，我们 使用多组分析检查参与认知行为干预是否改变了关系 在EMA疼痛的生长轨迹与客观体育锻炼之间。我们假设这是 干预，疼痛和体育锻炼的生长轨迹之间的关系将显着 与基线相比有所改变。在我们的探索目标中，我们进行后续采访以定性探索 治疗如何影响个体与疼痛的关系。因此，拟议的研究将研究 疼痛与体育锻炼之间的关系以及认知行为后的关系以及它的变化 干涉。结构方程建模（即LGCM）和定性方法的使用将合并到 描绘了CP和治疗经验的更完整的图片。那是这项研究的发现 解决CP中功能功能的理解和概念化的现有限制，提供信息 关于如何改善CP个体的功能，并促进认知的改善和完善 治疗CP的行为干预措施。重要的是，该项目将推动申请人的长期 成为一名独立临床研究人员的目标，致力于应用高级技术和 统计工具改善了CP的治疗方法。