Integrative Health Coaching for Back Pain: An Emergency Department-to-Home Recovery Model
Abstract
Low back pain (LBP) is the leading cause of disability worldwide. Approximately 2.5 million Americans with acute and chronic LBP visit the emergency department (ED) each year. Despite growing support for nonpharmacological strategies as first-line chronic pain treatment, management of patients with acute exacerbation of chronic LBP who present to the ED largely favors medication provision, especially opioids. However, reliance on opioids is associated with suboptimal outcomes and recurring use of the ED as a primary management setting. Patients with chronic LBP present a challenge to ED providers as chronic LBP often co-exists with conditions such as obesity, anxiety, sleep disturbance, and low physical activity. A biopsychosocial management approach that can be integrated within the ED setting is needed for this complex patient population. Integrative health coaching is a self-management intervention that is tailored to patients and effective in improving chronic LBP and disability. Evidence is lacking on the benefits of health coaching as an ED option. Integrative health coaching supports patients in actively managing LBP and associated comorbidities with evidence-based complementary and conventional strategies. We recently tested remote counseling for patients with chronic LBP undergoing spine surgery, physical activity was tracked using wearable monitors. Combining integrative health coaching with wearable monitors for physical activity and sleep offers patients in this project a readily accessible home-based and goal-oriented program after ED discharge. It is critical that ED providers have an evidence-based non-drug strategy that can be offered after ED discharge to improve outcomes that are relevant and meaningful to civilians and Service Members. This 2-year application is directly aligned with the Fiscal Year 2022 Chronic Pain Management Research Program (CPMRP) Focus Area on the effectiveness of novel or untested approaches to chronic pain management. The purpose of this pilot study is to assess feasibility and acceptability of integrative health coaching provided in combination with usual ED care (COACH-ED) for adult patients presenting with an acute exacerbation of chronic LBP. Our study will be a pivotal step in advancing our understanding of a biopsychosocial model of care that could reduce reliance on opioids among ED patients and establishing the methods and infrastructure for our future randomized controlled efficacy trial. This study will include 40 patients presenting to the ED in a civilian academic medical center for an acute exacerbation of chronic LBP. Once enrolled, patients will be randomized to receive usual ED care plus (1) eight sessions of COACH-ED or (2) frequency-matched education calls. The intervention period will last 3 months. Feasibility and acceptability outcomes will be assessed over a 6-month period. The first year of the project will focus on finalizing study procedures and the physical therapy interventions, ensuring regulatory approvals, and starting patient recruitment. The second year will involve patient recruitment, randomization, intervention delivery, and outcome assessment. This study addresses a significant knowledge gap in chronic pain management, aligns with efforts to transform how chronic pain is addressed in an emergent care environment, and offers insight into a new and much needed paradigm of care. Additionally, results from this study will inform on the feasibility of COACH-ED for deployment in military settings. The next step of this pilot work will be to test the efficacy in civilian and military treatment sites in a multicenter trial. In the long term, our COACH-ED intervention lays the groundwork for transitional integrative options that can be offered by providers to patients for improving care after an ED visit.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310911
Entities
People
- Rogelio Coronado
Organizations
- United States Army
- Vanderbilt University