Telehealth Therapy for Chronic Pain

慢性疼痛的远程医疗治疗

• 批准号: 7750166
• 负责人: Julie L Wetherell
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7750166
• 关键词: Ambulatory Care Facilities; Anxiety; Appointment; Area; Automobile Driving; Benign; Biological Markers; Chronic; Clinic; Cognitive; Conflict (Psychology); Data; Disabled Persons; Distant; Distress; Economics; Family; Feeling; Freedom; Funding; Health; Health Services Accessibility; Home environment; Income; Individual; Inferior; Injury; Intervention; Life; Measures; Medical center; Mental Depression; Mental Health; Methods; Mission; Nature; Neuropsychological Tests; Non-Malignant; Outcome; Pain; Pain management; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Price; Procedures; Psychotherapy; Quality of life; Randomized; Rehabilitation Research; Rehabilitation therapy; Research; Rural Community; Sampling; Schools; Services; Site; Sleep; Source; Stress; Symptoms; Technology; Testing; Time; Traumatic Brain Injury; Travel; Veterans; Videoconferences; Videoconferencing; Visit; actigraphy; base; chronic pain; cognitive function; cost; disability; disability payment; experience; health administration; improved; metropolitan; operation; physical conditioning; programs; psychologic; psychosocial; public health relevance; rehabilitation service; research and development; response; satisfaction; social; telehealth; treatment effect

DESCRIPTION (provided by applicant): Project Summary Chronic pain is common, disabling, and costly among veterans and often co-occurs with other conditions such as traumatic brain injury and posttraumatic stress disorder (PTSD). Developing methods to enhance rehabilitation of patients with these conditions is a high priority within the Veterans Health Administration. The proposed study is the next step in the program of research we began with F4306I, "Acceptance-based Therapy for Chronic Pain" (10/1/06-9/30/09), funded by the VA RR&D Service. Although preliminary data suggest that a brief psychosocial intervention, Acceptance and Commitment Therapy (ACT), is effective at reducing distress and improving quality of life for veterans with chronic pain, and ACT is one of the empirically supported psychotherapies the VA is rolling out nationwide, multiple barriers exist to its dissemination. Many veterans live in rural communities at a distance from a VA medical center, and patients with chronic pain often have mobility limitations or financial or time constraints that make travel difficult. Telehealth can help overcome these barriers. By allowing veterans to access state-of-the-art pain treatment in CBOCs or Vet Centers closer to their homes, the VA can provide rehabilitation services to a larger number of patients who need them. We propose a non-inferiority trial to test the hypothesis that ACT for chronic pain delivered by videoconferencing technology is not inferior to ACT for pain delivered in person. Patients (N = 196) with chronic nonmalignant pain for at least six months will be randomized to receive eight individual sessions of ACT either via telehealth or in person. We hypothesize that: 1) improvement in pain interference associated with ACT delivered via telehealth will not be inferior to that associated with ACT delivered in person; 2) improvements in depression, anxiety, PTSD symptoms, quality of life, activity levels, and sleep quality associated with ACT delivered via telehealth will not be inferior to those associated with ACT delivered in person; and 3) attrition rates will be lower and satisfaction higher for individuals receiving ACT via telehealth than for those receiving ACT in person. We will also conduct exploratory analyses to investigate the impact of cognitive function on treatment and the effect of the intervention on biomarkers of stress and health. PUBLIC HEALTH RELEVANCE: Project Narrative Chronic pain is a serious, disabling, and costly problem among veterans. Although psychosocial interventions that can reduce disability and improve quality of life exist, multiple barriers to access limit their dissemination. Telehealth can help overcome those barriers. We propose to compare a brief form of psychosocial pain treatment delivered in person to the same therapy delivered by videoconferencing technology. We anticipate that telehealth delivery of our acceptance-based pain intervention will provide similar benefits to those obtained with in-person delivery while reducing attrition and increasing satisfaction in a sample of 196 veterans with chronic pain.

描述（由申请人提供）： 在退伍军人中，项目摘要慢性疼痛是常见的，残疾和昂贵的，并且通常与其他疾病（例如脑损伤和创伤后应激障碍（PTSD））共同存在。在退伍军人卫生管理局中，开发增强患有这些疾病的患者康复的方法是很高的优先事项。拟议的研究是我们从F4306i开始的研究计划的下一步，“基于慢性疼痛的接受疗法”（10/1/1/06-9/30/09），由VA RR＆D服务资助。尽管初步数据表明，简短的社会心理干预，接受和承诺疗法（ACT）有效地减少了慢性疼痛的退伍军人的痛苦和改善生活质量，而ACT是VA的经验支持的心理治疗之一，VA正在全国范围内滚动，因此存在多个障碍。许多退伍军人居住在距离VA医疗中心的距离的农村社区中，慢性疼痛的患者通常会受到行动限制或经济限制或时间限制，这使旅行变得困难。远程医疗可以帮助克服这些障碍。通过允许退伍军人在CBOC或兽医中心更靠近房屋的最新疼痛治疗，VA可以为需要它们的更多患者提供康复服务。我们提出了一项非效率试验，以检验以下假设：通过视频会议技术提供的慢性疼痛行为不如亲自分娩疼痛。至少六个月患有慢性非恶性疼痛的患者（n = 196）将随机通过远程医疗或亲自接受八个单独的ACT。我们假设：1）改善与通过远程医疗交付的行为相关的疼痛干扰的改善将不如与亲自交付的行为相关的疼痛干扰； 2）改善抑郁症，焦虑症，PTSD症状，生活质量，活动水平和与通过远程医疗交付的行为相关的睡眠质量不如与亲自交付的行为相关的行为； 3）与亲自接受法案的人相比，通过远程医疗的个人的损耗率将较低，并且满意度更高。我们还将进行探索性分析，以研究认知功能对治疗的影响以及干预对压力和健康生物标志物的影响。 公共卫生相关性： 项目叙事慢性疼痛是退伍军人的严重，残疾和昂贵的问题。尽管可以减少残疾并改善生活质量的社会心理干预措施，但访问的多个障碍限制了它们的传播。远程医疗可以帮助克服这些障碍。我们建议将亲自提供的一种简短的心理疼痛治疗形式与视频会议技术提供的相同疗法进行比较。我们预计，基于验收的疼痛干预的远程医疗交付将与亲自交付获得的远程医疗相似，同时减少流失损耗和增加的满意度，并在196名患有慢性疼痛的退伍军人样本中。