Relationships Between Pain-Related Psychological Factors, Gait Quality, and Attention in Chronic Low Back Pain

慢性腰痛中疼痛相关心理因素、步态质量和注意力之间的关系

• 批准号: 10679189
• 负责人: Anna H Bailes
• 金额: $ 4.96万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2025-11-12
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679189
• 关键词: Accelerometer; Address; Adoption; Adult; Anxiety; Attention; Back; Behavior; Belief; Biomedical Engineering; Biometry; Black race; Chronic low back pain; Clinical; Cognition; Cognitive; Country; Data Set; Development; Doctor of Philosophy; Evaluation; Failure; Fellowship; Fright; Funding; Gait; Goals; Grant; Health; Helping to End Addiction Long-term; Human; Impairment; Individual; Infrastructure; Intervention; Knowledge; Literature; Low Back Pain; Measures; Mentorship; Mission; Movement; Musculoskeletal Equilibrium; Outcome; Pain; Participant; Patients; Pattern; Persistent pain; Physical therapy; Population; Populations at Risk; Psychological Factors; Psychology; Public Health; Questionnaires; Research; Research Methodology; Research Training; Risk; Role; Sample Size; Sampling; Scientist; Solid; System; Testing; Therapeutic Intervention; Thinking; Training; Translational Research; Treatment outcome; United States National Institutes of Health; Universities; Vulnerable Populations; Walking; Work; career; chronic pain management; clinical predictive model; clinical training; cognitive change; cognitive function; design; disability; disability risk; experience; functional decline; gait symmetry; high risk population; improved; improved outcome; novel; pain catastrophizing; programs; recruit

Project Summary/Abstract Poor gait quality in chronic low back pain (cLBP) contributes to decreased mobility and functional decline. Those with cLBP and pain-related psychological factors (e.g., fear-avoidance, pain catastrophizing) are at elevated risk for these poor clinical outcomes. However, the relationships between fear-avoidance/pain catastrophizing and gait quality in cLBP remain unknown, largely due to use of inconsistent gait quality metrics in small samples. To improve clinical outcomes in this at-risk population, there is a critical need to 1) examine relationships between fear-avoidance/pain catastrophizing and gait quality using rigorous metrics, and 2) conduct a mechanistic exploration of contributors to gait quality impairments. As a first step toward the long-term goal of improving physical therapy interventions for cLBP, the overall objective of this proposal is to 1) determine the relationship between fear-avoidance/pain catastrophizing and gait quality, and 2) test the contribution of attention on gait quality in those with heightened fear-avoidance/pain catastrophizing. The rationale is that establishing the ways in which fear-avoidance/pain catastrophizing are related to gait quality may lead to new treatment interventions (e.g., cognitive reframing surrounding movement, attention-shifting strategies) to improve clinical outcomes in this high-risk population. The central hypothesis is that 1) fear-avoidance/pain catastrophizing is associated with worse gait quality, and 2) reduced attention capacity associated with fear/catastrophizing contributes to poor gait quality. Aim 1 is to determine the relationship between fear-avoidance/pain catastrophizing and gait quality in cLBP. Aim 2 is to determine the role of attention in the relationship between fear-avoidance/pain catastrophizing and gait quality. Under Aim 1, accelerometry-based gait quality metrics will be derived from a large, existing raw data set (n=500) collected as part of an ongoing grant (1U19AR076725-01). For Aim 2, 50 participants will be recruited to perform a dual-task assessing the impact of attention on gait quality. The proposed project is significant because it uses rigorous, accelerometry-based metrics to examine relationships between fear- avoidance/pain catastrophizing and gait quality, and it is the first and necessary step toward identification of novel treatment targets (i.e., fear, attention-related deficits) that when prioritized in physical therapy, may improve outcomes in this population. Under this fellowship, the applicant will gain unique opportunities for integration of top-tier research and clinical training through University of Pittsburgh’s DPT/PhD in Bioengineering program. The proposed project will be completed within the University of Pittsburgh NIH-funded BACPAC Consortium Mechanistic Research Center, where the trainee will have unrivaled access to experts across the country, recruitment and biostatistical support, and novel infrastructure to advance her toward a career as an independent clinician-scientist. A mentorship team consisting of experts in chronic low back pain, gait, attention, translational research, and pain psychology will support the applicant’s training goals in research methods/design, gait accelerometry, human movement, professional development, and mentorship.

项目概要/摘要 慢性腰痛 (cLBP) 患者的步态质量差会导致活动能力下降和功能下降。 患有 cLBP 和与疼痛相关的心理因素（例如，恐惧回避、疼痛灾难化）的风险较高 然而，对于这些不良的临床结果，恐惧回避/疼痛灾难化与 cLBP 中的步态质量仍然未知，这主要是由于在小样本中使用了不一致的步态质量指标。 改善这一高危人群的临床结果，迫切需要 1）检查之间的关系 使用严格的指标来避免恐惧/疼痛灾难化和步态质量，以及 2) 进行机械 探索导致步态质量损伤的因素，作为实现改善的长期目标的第一步。 cLBP 的物理治疗干预措施，该提案的总体目标是 1) 确定关系 恐惧回避/疼痛灾难化与步态质量之间的关系，2）测试注意力对步态的贡献 那些患有呼吸恐惧症/疼痛灾难性的人的品质是建立方法的。 其中恐惧回避/疼痛灾难化与步态质量相关可能会导致新的治疗干预措施 （例如，围绕运动的认知重构、注意力转移策略）以改善临床结果 这一高风险人群的中心假设是：1）回避恐惧/痛苦灾难化与以下因素有关。 步态质量较差，2）与恐惧/灾难化相关的注意力能力下降导致步态不佳 目标 1 是确定恐惧回避/疼痛灾难化与步态质量之间的关系。 cLBP。目标 2 是确定注意力在恐惧回避/痛苦灾难化之间的关系中的作用。 在目标 1 下，基于加速度测量的步态质量指标将从大量现有的原始数据中得出。 作为持续拨款 (1U19AR076725-01) 的一部分收集的数据集 (n=500)，将有 50 名参与者。 被招募来执行评估注意力对步态质量的影响的双重任务。 意义重大，因为它使用严格的、基于加速度测量的指标来检查恐惧之间的关系 回避/疼痛灾难性和步态质量，这是识别的第一步也是必要的一步 新的治疗目标（即恐惧、注意力相关缺陷）在物理治疗中优先考虑时可能会改善 在该奖学金下，申请人将获得独特的融入机会。 通过匹兹堡大学生物工程 DPT/PhD 项目进行顶级研究和临床培训。 拟议的项目将在匹兹堡大学 NIH 资助的 BACPAC 联盟内完成 机械研究中心，学员将有机会接触全国各地的专家， 招聘和生物统计支持，以及新颖的基础设施，以推动她走向独立的职业生涯 由慢性腰痛、步态、注意力、转化方面的专家组成的指导团队。 研究和疼痛心理学将支持申请人在研究方法/设计、步态方面的培训目标 加速度测量、人体运动、专业发展和指导。