The proposed study aims to evaluate a pilot emergency department (ED) digital pain self-management intervention (EDPSI) focused on improving self-efficacy, knowledge, and skills, thus reducing the transition from acute to chronic low back pain in ED patients discharged with axial acute low back pain (aLBP). The proposed research has significant potential to improve self-efficacy (the confidence in one's ability to manage their condition) which is one of the most potent factors for improved health outcomes.
Investigators: Principal Investigator: Alexandria Carey (University of Florida, PhD Candidate) Co-Investigator/ Supervisory Chair: Ann Horgas Supervisory Committee Members: * Laurie Duckworth * Hwayoung Cho * Jason M. Beneciuk Previous Co-Investigator (2022-2024): Angela Starkweather IRB #: 202301946 Study Site: UF Health Emergency Centers, campuses in Gainesville, Florida Study Sponsor: University of Florida Background/Significance: Over 3.4 million acute axial low back pain (aLBP) cases are treated annually in the United States (US) emergency departments (ED). ED patients with aLBP receive varying verbal and written discharge routine care (RC), leading to gaps in patient discharge effectiveness and effective self-management. Ineffective aLBP self-management may increase the risk of transition to chronic low back pain (cLPB), a chief cause of worldwide disability, with associated costs reaching \> $60 million annually. This research will address this significant problem by evaluating an ED digital pain self-management intervention (EDPSI) focused on improving self-efficacy, knowledge, and skills, thus reducing the transition from aLBP to cLBP in ED patients discharged with axial aLBP. The proposed research has significant potential to increase self-efficacy, which is one of the most potent mechanisms of behavior change and improved health outcomes. Due to the focus on accessibility and usability, the intervention may reduce discharge disparities in aLBP self-management, especially among patients with low health literacy. Study Questions: This research will answer the following questions: 1) Will an ED digital pain self-management intervention (EDPSI) focused on improving self-efficacy, knowledge retention, and skills progress patient self-management behaviors and health status? Primary Objective: Primary Aims 1.1.1 Evaluate the feasibility and acceptability of an ED digital pain self-management intervention (EDPSI) for individuals aged 18 years and older presenting to the ED with acute axial low back pain (aLPB). * Feasibility will be measured by appropriateness, relevance to the ED population, recruitment, retention, and engagement percentages using the following criteria: * Of patients who meet eligibility criteria for the study, \>80% will voluntarily consent to participate in the study. * Of patients consented to the study, \>80% will complete the 1-week follow up measures. * Of patients randomized to the intervention group, \>70% will attend booster sessions at 2 and 8 weeks. * Of patients randomized to the intervention group, \>80% will recall the discharge video content during booster sessions at 2 and 8 weeks. * Acceptability of the intervention will be evaluated using the Preference and Satisfaction Questionnaire (EPSQ) and Patient Satisfaction and Healthcare Utilization Questionnaire (PSHU) post-intervention and the following criteria: * Of patients who complete the study, \>80% will rate the intervention as "satisfactory" or "highly satisfactory" * Of patients who complete the study, \>80% would be willing to refer a friend or family member with acute low back pain to the intervention. * Of overall patients who complete the study, \>80% would be satisfied with study participation and be willing to recommend the study. 1.1.2 Evaluate the preliminary clinical efficacy of the EDPSI on participant's self-management, pain self-efficacy, severity, and interference. Self-management, defined as participant engagement in self-management behaviors and integration into lifestyle by acknowledging confidence and demonstrating knowledge retainment and skills in managing to perform everyday activities while in acute pain. Preliminary clinical efficacy would be assessed using estimates of Minimal Clinically Important Difference (MCID), the smallest change in an outcome that patients perceive as meaningful and indicative of improvement. * Self-management (self-efficacy, knowledge, and skills) preliminary clinical efficacy (MCID) will be measured using the 13-item Patient Activation Measure (PAM) at 1-week, 6-weeks, and 12-weeks. * Self-efficacy (confidence) preliminary clinical efficacy (MCID) will be measured using the Pain Self-Efficacy Questionnaire (PSEQ) at 1-week, 6-weeks, and 12-weeks. * Pain severity and interference preliminary clinical efficacy (MCID) will be measured using the Brief Pain Inventory-Short Form (BPI-SF) at 1-week, 6-weeks, and 12-weeks. Methods: The proposed phased study will use a two-group pilot randomized controlled trial design to enroll 30 individuals who have been seen in the ED with aLBP. Participants will be randomized into RC or RC + EDPSI and receive follow-up surveys for 12-weeks post-intervention. The intervention group will also receive Booster sessions via Zoom with the principal investigator to assess and reinforce their knowledge retention of techniques and provide return demonstration reinforcement ergonomics and range of motion movements demonstrated, in weeks two and eight. Outcome Measures: All participants will be followed for 12-weeks assessing self-management and self-efficacy in weeks 1, 6, and 12. Feasibility will be measured by recruitment, enrollment, and retention percentages. Acceptability and education satisfaction will be measured using the Education-Preference and Satisfaction Questionnaire (EPSQ) post-intervention. Self-management sustainment will be measured including PSEQ, PAM, and patient satisfaction and healthcare utilization (PSHU) requesting patient overall satisfaction, additional healthcare utilization, and pain management related to continued back pain or complications post-injury.
The EDPSI is a developed supplemental digital video for patients presenting to the emergency department with acute low back pain (aLBP). The content consists of self-management approaches for diverse adult patient preferences including biopsychosocial contributors to pain and clinical practice guidelines to self-management options. Highlights of the discharge instructions summary include follow-up with provider, red flag warnings, and medication safety. Actor demonstration of ergonomics and range of motion movements provide application of Physical Therapy (PT)-based preventative strategies. Combination therapies including PT counseling, complementary alternative medicine (acupuncture, massage, yoga, or Pilates), and use of and safety with ice or heat thermal therapies. Active participation, stress management, and involvement of support systems are addressed.
Routine Discharge Care
UF Health Emergency Centers
Gainesville, Florida, United States
Improving Self-Management Health Outcomes
Feasibility and Acceptability of the pilot study will assess recruitment, retention, engagement, satisfaction, and willingness to recommend. Acceptability and intervention satisfaction will be assessed using the Education Preference and Satisfaction Questionnaire (EPSQ) and study satisfaction and recommendation using the Patient Satisfaction and Healthcare Utilization Questionnaire (PSHU). Preliminary Clinical Efficacy will be assessed for self-management, self-efficacy, pain severity and interference. Self-management will be assessed using the short 13-item Patient Activation Measure (PAM), self-efficacy using the Pain Self-Efficacy Questionnaire (PSEQ), pain severity and interference using the Brief Pain Inventory Short-Form (BPI-SF). Preliminary clinical efficacy of the EDPSI for adults with aLBP will be evaluated using estimates of Minimal Clinically Important Difference (MCID), the smallest change in an outcome that patients perceive as meaningful and indicative of improvement.
Time frame: 12-weeks
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30