Self-Administered Acupressure for Veterans with Chronic Back Pain: A Multisite Evaluation of Effectiveness and Implementation

患有慢性背痛的退伍军人的自我穴位按摩：有效性和实施的多站点评估

• 批准号: 10414362
• 负责人: Sarah Krein
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414362
• 关键词: Acupressure; Acupuncture Therapy; Address; Adherence; Age; Ambulatory Care Facilities; Analgesics; Back Pain; Caring; Characteristics; Chinese Traditional Medicine; Chronic; Chronic low back pain; Clinical Practice Guideline; Clinical effectiveness; Communities; Complementary Health; Complex; Control Groups; Country; Education; Educational Curriculum; Effectiveness; Evaluation; Evidence based intervention; Fatigue; Female; Fill-It; Geography; Goals; Health; Health Services Accessibility; Health system; Healthcare; Home; Infrastructure; Integrative Medicine; Intervention; Interview; Knowledge; Low Back Pain; Measures; Medical; Medical center; Mental Depression; Methodology; Methods; Michigan; Opioid; Outcome; Overdose; Pain; Pain interference; Pain management; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Primary Health Care; Process; Protocols documentation; Provider; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Resources; Risk; Self Administration; Self Management; Site; Sleep; Sleep disturbances; Statutes and Laws; Structure; System; Techniques; Testing; Time; Training; Veterans; Veterans Health Administration; Waiting Lists; Work; arm; base; biopsychosocial; care seeking; chronic back pain; chronic pain; chronic pain management; chronic painful condition; common treatment; cost; design; disability; effectiveness evaluation; effectiveness implementation study; efficacy study; ethnic minority population; evidence base; experience; future implementation; high risk; implementation barriers; implementation determinants; implementation efforts; implementation facilitators; improved; innovation; interest; intervention cost; intervention effect; knowledge base; member; multimodality; non-drug; non-opioid analgesic; opioid epidemic; opioid user; pain outcome; pain relief; pain symptom; post intervention; preference; racial and ethnic; recruit; response; sex; side effect; sleep quality; symptom treatment; symptomatic improvement; systematic review; treatment risk; uptake; virtual

Background: It is estimated that about half of the 9 million Veterans who receive care at Veterans Health Administration (VHA) have chronic pain, of which chronic low back pain (CLBP) is a major type. Veterans with CLBP are high healthcare utilizers and are experiencing a dramatic shift in care – from a medical approach that relied on medications like opioids for pain management to a biopsychosocial approach in which evidence - based, lower risk non-pharmacological options are favored. Non-pharmacological interventions, which include complementary and integrative health (CIH) treatments, are now a first line of care. Consequently, Veterans need to be able to access these treatments, but they are complex to deliver and difficult to provide in real-world settings. Thus, non-pharmacological treatments for CLBP need to not only be effective, but also low cost, easy-to-administer, accessible, and acceptable to Veterans and to their providers. Significance: Our long-term goal is to improve chronic pain management for Veterans with CLBP by integrating an effective self-administered acupressure intervention into VHA using current structures that support Veteran-centered care. The proposed project is a crucial first step. It directly addresses priorities from VA, HSR&D, and CARA legislation that seek to provide greater access to non-opioid options for chronic pain, including CIH treatments like acupressure. Innovation and Impact: This project leverages the unique infrastructure within VHA to test and deliver interventions that could have system-wide uptake. Self-administered acupressure is an ideal intervention to test using the existing VHA support structure for CIH treatments, the Whole Health System. Self-administered acupressure is a promising candidate for uptake at VHA given its low risk and ability to be performed at home at any time. In addition to providing evidence that can inform VA clinical practice guidelines for low back pain on effectiveness of self-administered acupressure for CLBP, this project will also inform on how to begin to implement this treatment at VHA, which would support the recent CIH Directive that outlines processes for how to integrate CIH treatments for Veterans. Specific Aims: Aim 1: Determine effectiveness of a 6-week self-administered acupressure protocol on pain interference, disability, fatigue, and sleep post intervention, and [sustained effects at 10 weeks] and 2) Evaluate supports and barriers for implementation of self -administered acupressure to Veterans with CLBP. Methodology: A Type 1 effectiveness-implementation hybrid study will be conducted at three VA sites: Ann Arbor VA Medical Center, Toledo Community-Based Outpatient Clinic, and Flint Community-Based Outpatient Clinic. There will be 300 Veterans recruited from providers at these sites and through classes offered through the Whole Health System, an initiative designed to teach Veterans how to self-manage aspects of their health. Participants who are randomized into the stimulating acupressure arm will be compared to participants randomized into a wait list control group and implementation factors will be measured quantitatively and qualitatively. This work is guided by dissemination frameworks, engaging stakeholders, measuring fidelity, considering site characteristics, and assessing facilitators and barriers to implementation. Next Steps/Implementation: This study contributes to the knowledge base of self -administered acupressure as a treatment for symptoms in CLBP, extending the state of the research beyond efficacy studies. It fills a gap in knowledge about effectiveness and how to best implement self-administered acupressure. This project will provide critical information that can increase the ability to access a patient-preferred, non-opioid pain treatment. If self-administered acupressure is effective, next steps would be to test implementation across several VA sites in different regions and more comprehensively examine facilitators and barriers considering geographical and cultural differences in Veterans across the country.

背景：据估计，在退伍军人健康的900万退伍军人中，约有一半 给药（VHA）患有慢性疼痛，其中慢性下腰痛（CLBP）是主要类型。退伍军人 CLBP是很高的医疗保健利用者，并且正在经历急剧的护理转变 - 从医疗方法 这依赖于阿片类药物等药物用于疼痛管理 基于较低的风险非药物选择受到青睐。非药理学干预措施，其中包括 完全和综合的健康（CIH）治疗，现在是一条护理。因此，退伍军人 需要能够访问这些治疗方法，但是它们很复杂，可以在现实世界中提供很难提供 设置。这是，对CLBP的非药物治疗不仅需要有效，而且还需要低成本， 退伍军人及其提供者易于使用，可访问且可以接受。 意义：我们的长期目标是改善与CLBP退伍军人的慢性疼痛管理 使用当前的结构将有效的自我管理穴干预整合到VHA中 支持以退伍军人为中心的护理。拟议的项目是至关重要的第一步。它直接解决了优先级 VA，HSR＆D和CARA立法，试图为慢性疼痛提供更多的非阿片类药物选择， 包括CIH治疗，例如穴位。 创新和影响：该项目利用VHA内部的独特基础架构进行测试和交付 可能在全系统吸收的干预措施中。自我管理的穴位压是理想的干预措施 使用现有的VHA支持结构进行CIH治疗，整个卫生系统进行测试。自我管理 鉴于VHA的低风险和在家中表演的能力，启动是在VHA吸收的承诺候选人 随时。除了提供可以告知VA临床实践指南的腰痛的证据。 关于自我管理的CLBP的效力，该项目还将告知如何开始 在VHA实施此处理，该处理将支持最近的CIH指令，该指令概述了如何 整合退伍军人的CIH治疗方法。 具体目的：目标1：确定疼痛的6周自加工穴位规定的有效性 干预后干扰，残疾，疲劳和睡眠，[10周时持续影响]和2） 评估用CLBP向退伍军人实施自助式穴位的支持和障碍。 方法论：将在三个VA地点进行1型有效性 - 实现混合研究：ANN Arbor VA医疗中心，托莱多社区的门诊诊所和基于弗林特社区的门诊 诊所。这些网站和通过提供的课程将有300名退伍军人从提供者招募 整个卫生系统是一项旨在教退伍军人如何自我管理其健康方面的倡议。 将随机分为刺激的穴位臂的参与者将与参与者进行比较 随机分为等待列表对照组，实现因子将进行定量测量，并 定性。这项工作以传播框架，吸引利益相关者的衡量范围为指导，衡量忠诚度， 考虑场地特征，并评估促进者和实施障碍。 下一步/实施：本研究有助于自我管理的知识基础 作为CLBP症状的治疗方法，将研究状态扩展到效率研究之外。它填补了空白 在有关有效性以及如何最好地实施自我管理的穴位的知识中。这个项目将 提供关键信息，以增加访问患者偏爱的非阿片类药物疼痛的能力 治疗。如果自我管理的穴位压力有效，下一步将是测试实施 不同地区的几个VA站点，并更全面地检查了促进者和障碍 全国退伍军人的地理和文化差异。