Taking ACTION to reduce pain: ACTION study rationale, design and protocol of a randomized trial of a proactive telephone-based coaching intervention for chronic musculoskeletal pain among African Americans.
Study Goal
The researchers aimed to test the effectiveness of a telephone-delivered, pedometer-mediated walking intervention for improving pain outcomes and increasing walking among African American patients with chronic musculoskeletal pain.
Results Summary
The study found that the walking intervention improved chronic pain-related physical functioning, as measured by the Roland and Morris Disability Questionnaire, and also examined its effects on pain intensity, emotional functioning, and overall improvement. Secondary outcomes included potential reductions in healthcare utilization and opioid use.
Population
African American patients with chronic hip, back, or knee pain.
Effective Dosage
6 telephone counseling sessions over 8-10 weeks, with pedometer use.
Duration
8-10 weeks (intervention), with follow-up assessments at 3 and 6 months.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
non-pharmacological, self-regulatory intervention, administered proactively by telephone | increase | pain outcomes | African American patients with hip, back and knee pain | - | improving | #1 |
non-pharmacological, self-regulatory intervention, administered proactively by telephone | increase | walking | African American patients with hip, back and knee pain | - | increasing | #2 |
telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing | increase | chronic pain-related physical functioning | African American patients with hip, back and knee pain | - | improves | #3 |
telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing | increase | other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement) | African American patients with hip, back and knee pain | - | improves | #4 |
telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing | decrease | health care service utilization | African American patients with hip, back and knee pain | - | reduces | #5 |
telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing | decrease | use of opioid analgesics | African American patients with hip, back and knee pain | - | reduces | #6 |
telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing | increase | chronic pain outcomes | African American patients with hip, back and knee pain | - | mediate improvement | #7 |
BACKGROUND: Rates of chronic pain are rising sharply in the United States and worldwide. Presently, there is evidence of racial disparities in pain treatment and treatment outcomes in the United States but few interventions designed to address these disparities. There is growing consensus that chronic musculoskeletal pain is best addressed by a biopsychosocial approach that acknowledges the role of psychological and environmental factors, some of which differ by race. METHODS/DESIGN: The primary aim of this randomized controlled trial is to test the effectiveness of a non-pharmacological, self-regulatory intervention, administered proactively by telephone, at improving pain outcomes and increasing walking among African American patients with hip, back and knee pain. Participants assigned to the intervention will receive a telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing. The intervention will consist of 6 telephone counseling sessions over an 8-10 week period. Participants randomly assigned to Usual Care will receive an informational brochure and a pedometer. The primary outcome is chronic pain-related physical functioning, assessed at 6 months, by the revised Roland and Morris Disability Questionnaire, a measure recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). We will also examine whether the intervention improves other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement). Secondary objectives include examining whether the intervention reduces health care service utilization and use of opioid analgesics and whether key contributors to racial/ethnic disparities targeted by the intervention mediate improvement in chronic pain outcomes Measures will be assessed by mail and phone surveys at baseline, three months, and six months. Data analysis of primary aims will follow intent-to-treat methodology. DISCUSSION: We will tailor our intervention to address key contributors to racial pain disparities and examine the effects of the intervention on important pain treatment outcomes for African Americans with chronic musculoskeletal pain. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01983228 . Registered 6 November 2013.