• Pain Med · Dec 2020

    Improving Veteran Access to Integrated Management of Back Pain (AIM-Back): Protocol for an Embedded Pragmatic Cluster-Randomized Trial.

    • Steven Z George, Cynthia J Coffman, Kelli D Allen, Trevor A Lentz, Ashley Choate, Adam P Goode, Corey B Simon, Janet M Grubber, Heather King, Chad E Cook, Francis J Keefe, Lindsay A Ballengee, Jennifer Naylor, Joseph Leo Brothers, Catherine Stanwyck, Aviel Alkon, and Susan N Hastings.
    • Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
    • Pain Med. 2020 Dec 12; 21 (Suppl 2): S62S72S62-S72.

    BackgroundCoordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain treatments. This is an encouraging development; however, what constitutes best practice for nonpharmacologic management of low back pain (LBP) is largely unknown.DesignThe Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) trial is an embedded pragmatic cluster-randomized trial that will examine the effectiveness of two different care pathways for LBP. Sixteen primary care clinics will be randomized 1:1 to receive training in delivery of 1) an integrated sequenced-care pathway or 2) a coordinated pain navigator pathway. Primary outcomes are pain interference and physical function (Patient-Reported Outcomes Measurement Information System Short Form [PROMIS-SF]) collected in the electronic health record at 3 months (n=1,680). A subset of veteran participants (n=848) have consented to complete additional surveys at baseline and at 3, 6, and 12 months for supplementary pain and other measures.SummaryAIM-Back care pathways will be tested for effectiveness, and treatment heterogeneity will be investigated to identify which veterans may respond best to a given pathway. Health care utilization patterns (including opioid use) will also be compared between care pathways. Therefore, the AIM-Back trial will provide important information that can inform the future delivery of nonpharmacologic treatment of LBP.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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