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2015 HSR&D/QUERI National Conference Abstract

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3195 — Preliminary results of a technology-assisted intervention to promote walking among Veterans with chronic pain

Heapy AA, West Haven COIN; Higgins DM, VA Boston; Buta E, Yale University; Goulet JL, West Haven COIN; Piette JD, Ann Arbor COIN; Krein SL, Ann Arbor; Kerns RD, West Haven COIN;

Objectives:
To describe preliminary results of a pedometer-measured, progressive walking program delivered as part of a randomized non-inferiority trial of interactive voice response-based cognitive behavioral therapy (IVR-CBT) versus in-person CBT for Veterans with chronic low back pain.

Methods:
In the IVR-CBT condition, Veterans were asked to use a self-help manual and received weekly, personalized pre-recorded therapist feedback based on daily IVR-reported symptoms and behaviors. In the in-person CBT condition, Veterans were asked to meet with a therapist weekly for 30 minutes. Both treatments lasted 10 weeks. Beginning in the third week, Veterans in both conditions were given a goal of increasing their average daily step count by 10% over the prior week's average. All Veterans reported their pedometer-measured step counts and information about CBT skill practice via daily automated IVR telephone calls for 11 weeks, beginning one week prior to treatment. We used mixed effect regression for repeated measures to analyze the change from baseline in the average steps per day each week (adjusted for baseline).

Results:
We analyzed data for 60 Veterans (mean age: 56, SD: 11), 65% were Caucasian, and 15% were female. In the week prior to treatment, participants were sedentary (mean of 3631 steps, SD: 2098). There was no significant difference in steps per day between the two conditions at any time after baseline, but there was a significant increase from baseline in both groups. At week 1 the overall least square-mean change from baseline in average steps per day was +412 (95% CI -14 to 839), at week 3 +1279 (675 to 1882), and at week 10 (end of treatment) the mean change was +2294 (1433 to 3156).

Implications:
These preliminary findings suggest that IVR-delivered CBT may result in improvements in physical activity that are similar to those in standard 1-1, face-to-face sessions with a trained therapist. Participants in the IVR-CBT condition achieved these results with minimal therapist contact and reduced travel burden relative to in-person CBT.

Impacts:
Walking has been shown to improve function among people with chronic pain. IVR-based treatment may be a feasible method to enhance the accessibility and convenience of this evidence-based care for chronic pain.