Addressing the chronic pain epidemic among older adults in underserved community center; The GetActive+ study.

解决服务不足的社区中心老年人中流行的慢性疼痛问题；

• 批准号: 10536153
• 负责人: Christine S Ritchie
• 金额: $ 162.03万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536153
• 关键词: Address; Adoption; Adult; Alternative Health; Area; Attention; Behavioral; Boston; Bypass; Caring; Clinic; Clinical; Clinical Nurse Specialists; Cognitive; Communities; Community Health; Compassion; Complementary Health; Disadvantaged; Economically Deprived Population; Economics; Elderly; Enrollment; Epidemic; Feedback; Focus Groups; Fright; Funding; Growth; Health; Healthcare; Helping to End Addiction Long-term; Hybrids; Immigrant; Impaired cognition; Impairment; Intervention; Language; Life; Link; Loneliness; Manuals; Measures; Medical; Methods; Modeling; Morbidity - disease rate; Neighborhood Health Center; Nurse Practitioners; Nurses; Outcome; Pain; Pain intensity; Pain management; Patient Self-Report; Patients; Performance; Persistent pain; Pharmaceutical Preparations; Phase; Physical Function; Population; Primary Health Care; Problem Solving; Procedures; Proctor framework; Provider; Randomized; Resources; Risk; Social support; Thinking; Time; Training Programs; Visit; Walking; Work; acceptability and feasibility; adverse event risk; base; body-mind; care seeking; chronic musculoskeletal pain; chronic pain; chronic pain management; community center; community clinic; community engaged research; coping; cost; disadvantaged background; disadvantaged population; effectiveness evaluation; effectiveness implementation trial; effectiveness outcome; emotional functioning; ethnic minority; evidence base; experience; falls; health equity; high risk; implementation evaluation; implementation facilitators; implementation outcomes; improved; low socioeconomic status; mindfulness; mortality; multiple chronic conditions; pain outcome; patient population; programs; racial and ethnic; racial diversity; racial minority; resilience; response; sedentary; side effect; skills; social; treatment as usual; underserved community

PROJECT SUMMARY: Chronic musculoskeletal pain (pain > 3 months) is prevalent, costly, challenging to treat and a national priority area. Older adults have the highest rates of chronic pain, and these are expected to increase given the growth of the older adult population over the next three decades. Older adults from underserved communities (low SES, racial and ethnic minorities, immigrants) are at the highest risk for negative pain related health consequences such as lower physical and emotional function and morbidity and mortality. We lack evidence based non-pharmacological treatments to address chronic pain within community health clinics that serve this older adult patient population. GetActive is an evidence-based mind-body activity program that directly targets improvement in pain outcomes by combining cognitive behavioral and mindfulness skills with gradual increase in walking (preferred and safe activity for older adults) linked to valued activities. In direct response to RFA-NS- 22-002 we have partnered with the MGH-Revere HealthCare Center which serves >5,000 disadvantaged older adults, to optimize GetActive to bypass socioecological barriers and effectively engage this population into non-pharmacological pain management strategies. In the R61 phase, we will: 1) develop GetActive+ (optimized GetActive), 2) evaluate its feasibility and acceptability; and 3) refine and finalize training, program manual, measures, and procedures. In the R33 phase, we will conduct a randomized, hybrid type 1 effectiveness-implementation trial (N=200) to evaluate effectiveness and implementation of GetActive+ versus treatment as usual on the following outcomes: 1) self-reported physical function (primary), 2) performance based (6MWT) and objective (step count) physical function, emotional function, pain, social support, loneliness (secondary); and 3) feasibility, acceptability, fidelity and adoption at patient, provider and organization levels (implementation). Through this project we aim to solve the problem of lack of evidence based nonpharmacological treatments for older adults in underserved communities. GetActive+ delivered by clinic staff can be routinely incorporated into group visits (already available at MGH-Revere HealthCare Center and other similar community centers) which are billable, thus providing a sustained model of care for older adults with chronic pain from disadvantaged backgrounds. Because GetActive incorporates mind-body skills with activity (e.g., walking), there is potential for improvement in other outcomes (e.g., decreased risk for morbidity and mortality) over and above pain.

项目概要： 慢性肌肉骨骼疼痛（疼痛 > 3 个月）普遍存在，治疗费用高，治疗难度大，是国家优先领域。年长的 成年人患慢性疼痛的比例最高，而且随着老年人口的增长，慢性疼痛的发病率预计还会增加 在接下来的三十年里。来自服务不足社区的老年人（社会经济地位低、种族和民族、移民） 遭受与疼痛相关的负面健康后果的风险最高，例如身体和情绪功能下降， 发病率和死亡率。我们缺乏基于证据的非药物治疗方法来解决社区内的慢性疼痛 为老年患者群体提供服务的健康诊所。 GetActive 是一项基于证据的身心活动计划， 通过将认知行为和正念技能与循序渐进相结合，直接改善疼痛结果 步行（老年人首选且安全的活动）的增加与有价值的活动相关。直接回应 RFA-NS- 22-002 我们与 MGH-Revere 医疗保健中心合作，该中心为超过 5,000 名弱势老年人提供服务， 优化 GetActive 以绕过社会生态障碍并有效地让该人群陷入非药物疼痛 管理策略。在R61阶段，我们将：1）开发GetActive+（优化的GetActive），2）评估其可行性 和可接受性； 3) 细化并最终确定培训、计划手册、措施和程序。在R33阶段，我们将 进行随机、混合 1 型有效性实施试验 (N=200) 以评估有效性和 实施 GetActive+ 与照常治疗相比，获得以下结果：1) 自我报告的身体功能 （初级），2）基于表现（6MWT）和目标（步数）身体功能、情绪功能、疼痛、社交 支持、孤独（次要）； 3) 患者、提供者和组织的可行性、可接受性、忠诚度和采用 级别（实施）。通过这个项目，我们旨在解决缺乏基于证据的非药理学证据的问题 为服务欠缺社区的老年人提供治疗。诊所工作人员提供的 GetActive+ 可以定期纳入 进行团体访问（麻省总医院里维尔医疗保健中心和其他类似的社区中心已经提供） 可计费，从而为来自弱势背景的患有慢性疼痛的老年人提供持续的护理模式。 由于 GetActive 将身心技能与活动（例如步行）结合起来，因此在其他方面还有改进的潜力 除了疼痛之外的结果（例如，发病率和死亡率风险降低）。