Postoperative Telehealth Mindfulness Intervention to Improve Pain-related Outcomes and Reduce Opioid Use after Lumbar Spine Surgery

术后远程医疗正念干预可改善腰椎手术后疼痛相关的结果并减少阿片类药物的使用

• 批准号: 10700889
• 负责人: Carrie Elizabeth Brintz
• 金额: $ 12.66万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700889
• 关键词: 3-Dimensional; Academic Medical Centers; Address; Adult; Affect; Age; Anxiety; Area; Award; Behavior Therapy; Belief; Clinical Investigator; Clinical Research; Clinical Trials; Clinical Trials Design; Complex; Data; Data Analyses; Data Collection; Development; Education; Enrollment; Feedback; Future; Goals; Grant; Growth; Home; Hour; Individual; Information Dissemination; Infrastructure; Intervention; Intervention Trial; Interview; Knowledge; Measures; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Mind-Body Intervention; National Center for Complementary and Integrative Health; Neuronal Plasticity; Operative Surgical Procedures; Opioid; Orthopedic Surgery; Orthopedics; Outcome; Pain; Pain Measurement; Pain intensity; Pain interference; Pain management; Participant; Patient Outcomes Assessments; Patients; Persistent pain; Persons; Physical Function; Population; Postoperative Pain; Postoperative Period; Practice Management; Prediction of Response to Therapy; Procedures; Prospective Studies; Protocols documentation; Psychophysics; Psychosocial Factor; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Research; Research Project Grants; Research Training; Resources; Risk Factors; Science; Self Efficacy; Spine pain; Spine surgery; Structure; Surveys; System; Testing; Time; Training; Treatment outcome; United States; Vertebral column; Work; Writing; acceptability and feasibility; arm; biopsychosocial; career; career development; central sensitization; chronic pain; clinically relevant; design; disability; emotional distress; experience; functional improvement; group intervention; high risk; improved; intervention participants; intervention refinement; learning strategy; meetings; mindfulness; mindfulness intervention; multidisciplinary; negative affect; online delivery; opioid epidemic; opioid use; pain outcome; pain processing; pain sensitivity; patient oriented; patient population; patient subsets; post intervention; prescription opioid; programs; psychological distress; psychosocial; randomized, clinical trials; research data dissemination; satisfaction; skills; telehealth; videoconference

Modified Project Summary/Abstract Section This K23 award will support the candidate’s growth toward an independent clinical research career focused on developing and testing psychosocially-oriented mind-body interventions to improve the quality-of-life and treatment outcomes of chronic pain and postsurgical pain populations. Lumbar spine pain affects over 50 million individuals in the United States (US). The rate of spine surgeries performed in the US is the highest in the world. Yet, up to 40% of patients experience poor pain-related, functional, or quality of life outcomes after surgery. Despite the limited efficacy and high risks associated with long term opioid use, up to 50% of patients are prescribed opioids for up to 12 months following lumbar spine surgery. Nonpharmacological approaches addressing psychosocial risk factors for poor post-surgical outcomes are understudied and underutilized during postsurgical recovery. The proposed project aims to 1) adapt and refine a mindfulness-based intervention (MBI) for one-on-one telehealth delivery (live videoconference) to patients recovering from lumbar spine surgery by conducting a preliminary test of the MBI and collecting patient feedback using mixed methods; 2) conduct a two-arm pilot randomized controlled trial (RCT) of the postsurgical telehealth MBI vs. an education control to evaluate the feasibility and acceptability of the interventions and research procedures; and 3) summarize trajectories of pain-related outcomes (pain interference, opioid usage) and treatment targets (pain-related beliefs, mindfulness, psychophysical measures), within intervention groups and within key patient subgroups (levels of preoperative negative affect and opioid use status). The proposal targets career development in several areas: 1) developing and testing mind-body interventions utilizing mixed methods and longitudinal data collection and analysis; 2) randomized clinical trial design and methodology; 3) psychophysical testing of pain modulatory systems; 4) content knowledge in postoperative orthopaedic pain and opioid use; and 5) grant-writing skills. The candidate’s training goals will be achieved with the support of a multidisciplinary team of accomplished mentors and contributors, through targeted course work and seminars, culminating in completion of the proposed research project and dissemination of results. Training will take place in a resource-rich academic medical center with a top-performing surgical center and existing infrastructure for the prospective study of patients undergoing lumbar spine surgery. The findings will help tailor a telehealth MBI for an orthopaedic postsurgical population and provide preliminary data to optimize a well-powered RCT. This K23 award will promote the early career candidate in establishing an independent research program focused on optimizing telehealth mindfulness interventions in postsurgical and pain populations to inform the science and delivery of personalized pain management practices. The goals of this project are strongly aligned with NCCIH scientific priorities to address the widespread burden of chronic pain and the ongoing opioid epidemic.

修改后的项目摘要/摘要部分 该 K23 奖项将支持候选人朝着独立临床研究职业发展，专注于开发和测试以社会心理为导向的身心干预措施，以改善慢性疼痛和腰椎疼痛人群的生活质量和治疗结果。美国有 5000 万人接受脊柱手术，然而，高达 40% 的患者术后疼痛相关、功能或生活质量较差。尽管条件有限由于与长期使用阿片类药物相关的疗效和高风险，多达 50% 的患者在腰椎手术后长达 12 个月内服用阿片类药物，以解决手术后不良结果的心理社会风险因素的非药物方法在术后恢复期间尚未得到充分研究和利用。拟议项目旨在 1) 通过进行初步的研究，调整和完善基于正念的干预 (MBI)，用于一对一远程医疗服务（实时视频会议），以帮助腰椎手术后康复的患者测试 MBI 并使用混合方法收集患者反馈；2) 对术后远程医疗 MBI 与教育控制进行双组试点随机对照试验 (RCT)，以评估干预措施和研究程序的可行性和可接受性； 3) 总结干预组内和关键患者亚组内疼痛相关结果（疼痛干扰、阿片类药物使用）和治疗目标（疼痛相关信念、正念、心理物理措施）的轨迹（术前负面情绪水平和阿片类药物使用状态） 。该提案针对几个领域的职业发展：1）利用混合方法和纵向数据收集和分析来开发和测试身心干预措施；2）随机临床试验设计和方法；3）疼痛调节系统的心理物理学测试；术后骨科疼痛和阿片类药物的使用；以及 5) 候选人的培训目标将在由多学科导师和贡献者组成的团队的支持下，通过有针对性的课程和研讨会来实现，最终完成拟议的任务。研究项目和结果传播。培训将在资源丰富的学术医疗中心进行，该中心拥有一流的外科中心和现有基础设施，用于对接受腰椎手术的患者进行前瞻性研究。研究结果将有助于为腰椎手术患者量身定制远程医疗 MBI。该 K23 奖项将促进早期职业候选人建立一个独立的研究项目，重点是优化术后和疼痛人群的远程医疗正念干预，为科学和疼痛提供信息。该项目的目标与 NCCIH 的科学优先事项高度一致，以解决慢性疼痛和持续存在的阿片类药物流行问题。

项目成果

A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients' Expectations, Experiences, and Satisfaction.

脊柱手术恢复的概念模型：患者期望、体验和满意度的定性研究。

• 发表时间: 2023-07-15
• 影响因子: 3
• 作者: Brintz, Carrie E;Coronado, Rogelio A;Schlundt, David G;Haug Jenkins, Christine;Bird, Mackenzie L;Bley, Jordan A;Pennings, Jacquelyn S;Wegener, Stephen T;Archer, Kristin R
• 通讯作者: Archer, Kristin R