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CDA 14-425 – HSR&D Study

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CDA 14-425
Improving Outcomes for Older Veterans with Chronic Back Pain and Depression
Una E. Makris MD MSc
VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX
Dallas, TX
Funding Period: October 2016 - September 2021

BACKGROUND/RATIONALE:
Depression and chronic low back pain (cLBP) co-exist and result in challenging, complex management dilemmas. A feasible, effective behavioral intervention targeting cLBP and comorbid depression, using a biopsychosocial approach, in older Veterans is sorely needed. Existing interventions are not adequate or sufficient as they have not been specifically focused on older Veterans, nor have they targeted both cLBP and depression simultaneously.

OBJECTIVE(S):
The goal of this CDA-2 proposal is to develop, in an iterative process, a health coach-telephone-delivered, behavioral intervention that will ultimately improve outcomes of disability and depression in older Veterans with cLBP and depression. This research has 3 interrelated aims: SA1) develop a behavioral intervention for the target population of older Veterans with cLBP and depression; SA2) pre-test and refine the intervention in an iterative process; and, SA3) conduct a pilot randomized control trial to evaluate feasibility of study procedures and outcome measurement.

METHODS:
This intervention builds on prior interventions for chronic pain and mental illness (promoting self-management, goal setting, patient activation) used in medically complex older adults. Specifically, we focus on how older Veterans are uniquely motivated to make behavioral change and integrates motivational interviewing throughout the sessions. SA1 involves interviews with experts, Veterans and other stakeholder groups. This feedback is critical to ensure this intervention is relevant, feasible, and ultimately implemented within the VA. In SA2, the intervention is delivered to 7 older Veterans who, along with other stakeholders, will provide feedback on intervention content and delivery. The manual content and recruitment/intervention process was refined based on this feedback. In SA3 a pilot RCT will assess feasibility (enrollment rates, adherence, retention) for older Veterans with cLBP and depression assigned to receive the intervention (n=30) versus the comparator group (n=30). Feasibility outcomes, along with outcomes related to cLBP and depression, will be critical as I plan for the multi-center IIR effectiveness RCT.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The products and outcomes resulting from this CDA will have tremendous potential to improve outcomes for medically complex older Veterans with cLBP and comorbid depression. Telephone delivery has potential to enhance access and reach of this intervention for many older Veterans who are mobility impaired. As a rheumatologist focused on aging research, and committed to improving outcomes in older Veterans, this award is preparing me to lead efforts nationally to develop non-pharmacologic management approaches to improve outcomes in chronic musculoskeletal pain conditions and comorbid mental health.

PUBLICATIONS:

Journal Articles

  1. Makris UE, Weinreich MA, Fraenkel L, Han L, Leo-Summers L, Gill TM. Restricting Back Pain and Subsequent Disability in Activities of Daily Living Among Community-Living Older Adults. Journal of aging and health. 2018 Oct 1; 30(9):1482-1494.
  2. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, Carlson NL, Nevitt MC, Osteoporotic Fractures in Men Study (MrOS) Research Group. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. The journals of gerontology. Series A, Biological sciences and medical sciences. 2017 Sep 1; 72(9):1264-1269.
  3. Makris UE, Alvarez CA, Wei W, Mortensen EM, Mansi IA. Association of Statin Use With Risk of Back Disorder Diagnoses. JAMA internal medicine. 2017 Jul 1; 177(7):1044-1046.
  4. Makris UE, Higashi RT, Marks EG, Fraenkel L, Gill TM, Friedly JL, Reid MC. Physical, Emotional, and Social Impacts of Restricting Back Pain in Older Adults: A Qualitative Study. Pain medicine (Malden, Mass.). 2017 Jul 1; 18(7):1225-1235.
  5. Makris UE, Misra D, Yung R. Gaps in Aging Research as it Applies to Rheumatologic Clinical Care. Clinics in geriatric medicine. 2017 Feb 1; 33(1):119-133.
  6. Makris UE, Edwards TC, Lavallee DC, Bauer Z, Comstock BA, Jarvik JG, Patrick DL, Lotfi M, Friedly JL. Patient Priority Weighting of the Roland Morris Disability Questionnaire Does Not Change Results of the Lumbar Epidural Steroid Injections for Spinal Stenosis Trial. Spine (Philadelphia, Pa. : 1986). 2017 Jan 1; 42(1):42-48.
  7. Marcum ZA, Duncan NA, Makris UE. Pharmacotherapies in Geriatric Chronic Pain Management. Clinics in geriatric medicine. 2016 Nov 1; 32(4):705-724.
  8. Marshall LM, Litwack-Harrison S, Cawthon PM, Kado DM, Deyo RA, Makris UE, Carlson HL, Nevitt MC, Study of Osteoporotic Fractures (SOF) Research Group. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women. The journals of gerontology. Series A, Biological sciences and medical sciences. 2016 Sep 1; 71(9):1177-83.
  9. Makris UE, Paul TM, Holt NE, Latham NK, Ni P, Jette A, Leveille SG, Bean JF. The Relationship Among Neuromuscular Impairments, Chronic Back Pain, and Mobility in Older Adults. PM & R : the journal of injury, function, and rehabilitation. 2016 Aug 1; 8(8):738-47.


DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Musculoskeletal Disorders
DRE: Treatment - Observational, Technology Development and Assessment
Keywords: none
MeSH Terms: none