PMID- 33313724
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210701
IS  - 1526-4637 (Electronic)
IS  - 1526-2375 (Print)
IS  - 1526-2375 (Linking)
VI  - 21
IP  - Suppl 2
DP  - 2020 Dec 12
TI  - A Sequential Multiple-Assignment Randomized Trial (SMART) for Stepped Care 
      Management of Low Back Pain in the Military Health System: A Trial Protocol.
PG  - S73-S82
LID - 10.1093/pm/pnaa338 [doi]
AB  - BACKGROUND: The Defense Health Agency has prioritized system-level pain 
      management initiatives within the Military Health System (MHS), with low back 
      pain as one of the key focus areas. A stepped care model focused on 
      nonpharmacologic treatment to promote self-management is recommended. 
      Implementation of stepped care is complicated by lack of information on the most 
      effective nonpharmacologic strategies and how to sequence and tailor the various 
      available options. The Sequential Multiple-Assignment Randomization Trial for Low 
      Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to 
      assess the effectiveness of nonpharmacologic treatments for chronic low back 
      pain. DESIGN: This SMART trial has two treatment phases. Participants from three 
      military treatment facilities are randomized to 6 weeks of phase I treatment, 
      receiving either physical therapy (PT) or Army Medicine's holistic Move2Health 
      (M2H) program in a package specific to low back pain. Nonresponders to treatment 
      in phase I are again randomized to phase II treatment of combined M2H + PT or 
      mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement 
      (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement 
      Information System pain interference computer-adapted test score. SUMMARY: This 
      trial is part of an initiative funded by the National Institutes of Health, 
      Veterans Affairs, and the Department of Defense to establish a national 
      infrastructure for effective system-level management of chronic pain with a focus 
      on nonpharmacologic treatments. The results of this study will provide important 
      information on nonpharmacologic care for chronic LBP in the MHS embedded within a 
      stepped care framework.
CI  - The Author(s) 2020. Published by Oxford University Press on behalf of the 
      American Academy of Pain Medicine. This work is written by US Government 
      employees and is in the public domain in the US.
FAU - Fritz, Julie M
AU  - Fritz JM
AD  - University of Utah, Salt Lake City, Utah.
FAU - Rhon, Daniel I
AU  - Rhon DI
AD  - Brooke Army Medical Center, San Antonio, Texas.
AD  - Uniformed Services University of the Health Sciences, Bethesda, Maryland.
FAU - Teyhen, Deydre S
AU  - Teyhen DS
AD  - Walter Reed Army Institute of Research, Silvers Spring, Maryland.
FAU - Kean, Jacob
AU  - Kean J
AD  - University of Utah, Salt Lake City, Utah.
FAU - Vanneman, Megan E
AU  - Vanneman ME
AD  - University of Utah, Salt Lake City, Utah.
FAU - Garland, Eric L
AU  - Garland EL
AD  - University of Utah, Salt Lake City, Utah.
FAU - Lee, Ian E
AU  - Lee IE
AD  - Defense Health Management Systems, Falls Church, Virginia.
FAU - Thorp, Richard E
AU  - Thorp RE
AD  - Directorate of Program Analysis and Evaluation, Office of the Army Surgeon 
      General, Joint Base San Antonio Fort Sam Houston, San Antonio, Texas, USA.
FAU - Greene, Tom H
AU  - Greene TH
AD  - University of Utah, Salt Lake City, Utah.
LA  - eng
GR  - U24 AT009769/AT/NCCIH NIH HHS/United States
GR  - UH3 AT009763/AT/NCCIH NIH HHS/United States
GR  - UG3 AT009763/AT/NCCIH NIH HHS/United States
PT  - Clinical Trial Protocol
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - England
TA  - Pain Med
JT  - Pain medicine (Malden, Mass.)
JID - 100894201
SB  - IM
MH  - *Chronic Pain/therapy
MH  - Humans
MH  - *Low Back Pain/therapy
MH  - *Military Health Services
MH  - *Mindfulness
MH  - Pain Management
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
PMC - PMC7734656
OTO - NOTNLM
OT  - back pain
OT  - chronic pain
OT  - health coaching
OT  - holistic health
OT  - military health system
OT  - mindfulness
OT  - physical therapy
OT  - pragmatic clinical trial
EDAT- 2020/12/15 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/12/10
CRDT- 2020/12/14 11:02
PHST- 2020/12/14 11:02 [entrez]
PHST- 2020/12/15 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/12/10 00:00 [pmc-release]
AID - 6033496 [pii]
AID - pnaa338 [pii]
AID - 10.1093/pm/pnaa338 [doi]
PST - ppublish
SO  - Pain Med. 2020 Dec 12;21(Suppl 2):S73-S82. doi: 10.1093/pm/pnaa338.