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2023 HSR&D/QUERI National Conference Abstract

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4148 — Tailoring Chronic Pain Care for Rural-Dwelling Women Veterans: A Feasibility Pilot

Lead/Presenter: Katherine Hadlandsmyth,  COIN - Iowa City
All Authors: Hadlandsmyth K (Center for Access & Delivery Research and Evaluation, Iowa City), Garvin LA (University of Iowa, Carver College of Medicine) Steffensmeier KS (Center for Access & Delivery Research and Evaluation, Iowa City) Johnson, NL (Center for Access & Delivery Research and Evaluation, Iowa City) Adamowicz JL (Center for Access & Delivery Research and Evaluation, Iowa City) Obrecht AA (Center for Access & Delivery Research and Evaluation, Iowa City) Rothmiller SJ (Center for Access & Delivery Research and Evaluation, Iowa City) Sibenaller Z (University of Iowa, Carver College of Medicine) Stout L (University of Iowa, Carver College of Medicine) Driscoll MA (Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System)

Objectives:
This study is part of an ongoing effort to optimize pain care and functioning while reducing overreliance on potentially risky or ineffective pain management strategies among rural-dwelling women Veterans with chronic pain. This population has experienced unique challenges to receiving adequate chronic pain management. Specifically, the current mixed-methods pilot aims to evaluate the feasibility and acceptability of a group intervention in rural women Veterans with chronic pain.

Methods:
The current study is a non-randomized pilot feasibility trial of a tailored behavioral pain self-management intervention. The intervention was designed following a needs assessment study with this population and in conjunction with local Veteran’s Engagement Panels and clinical experts in women’s chronic pain. To reduce previously identified barriers (time, distance, harassment) and enhance facilitators (e.g., support), the intervention leverages technology to deliver care virtually in a women identified group setting. The 8-week intervention is a telehealth group-based design that includes core components: mindful movement and a graduated walking program; individualized feedback; peer connection and accountability including optional between-session peer support; and behavioral pain self-management training (based on cognitive and behavioral therapies for chronic pain). All participants received a manual and pedometer.

Results:
This ongoing pilot has consented 21 participants to date (target N = 30). Preliminary qualitative findings (N = 10) indicate that rural women Veterans particularly valued group sessions for the social and emotional support and appreciated the convenience of meeting virtually. Veterans were split on the utility of mindful movement. To date, most participants endorsed being ‘satisfied’ (60%) to ‘very satisfied’ (30%) overall with the group intervention. On a global impression of change scale, 80% of participants reported improvement. Additional feasibility findings will be presented on rates of willingness to participate, retention (including number of sessions), assessment completion, and engagement (completion of each aspect of the intervention), and perceived credibility of the intervention.

Implications:
This intervention has the potential to significantly improve chronic pain care for an under-served population: rural-dwelling women Veterans with chronic pain.

Impacts:
Maintaining partnership with VA’s Women’s Health Services, next steps include examining the effectiveness of this intervention embedded in local women’s health clinics.