Mission Reconnect- Delivering a Mobile and Web Based Self Directed Complementary And Integrative Health Program to Veterans and Their Partners to Manage Pain and PTSD

PTSD Clinical Trial

— MR  

Official title:

Delivering a Mobile and Web Based Self Directed Complementary And Integrative Health Program to Veterans and Their Partners to Manage Pain and PTSD

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03593772
• Other study ID #: D2775-R
• Status: Completed
• Phase: N/A
• Start date: September 3, 2019
• Est. completion date: October 31, 2022

Study information

• Verified date: January 2023
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This project is responsive to RR&D's current special areas of interest for non-pharmacological activity-based interventions for chronic pain impacting pain reduction, function and quality of life. This project aligns with the VA mandate for complementary and integrative health (CIH) care for Veterans and their families. CIH complements traditional care for Veterans managing chronic conditions, such as chronic pain and PTSD. Mission Reconnect (MR) is a user-driven, dyadic, CIH self-care management program delivered remotely that teaches techniques the Veteran/partner dyad can use to reduce pain, anxiety and stress, promote well-being and improve relationship quality. The research goal is to evaluate MR as an approach to manage chronic pain and PTSD symptoms, for potential subsequent implementation. This study will possibly provide a model for establishing remote access and sustainable implementation of CIH within VA.

Description:

Chronic pain is one of the most prevalent medical conditions in the Veteran population. Pain often presents with comorbid conditions, specifically post-traumatic stress disorder (PTSD). Comorbid chronic pain and PTSD significantly impact the quality of life of Veterans and their families. Multi-faceted therapies leveraging complementary and integrative health (CIH) are mandated within VA to complement clinical practice guidelines improve Veterans' quality of life and ability to function. This research will evaluate a CIH intervention to manage pain and PTSD related outcomes within a bio-psychosocial framework. The proposed intervention, Mission Reconnect (MR), a user-driven, dyadic, self-care management program delivered online and by mobile app that has previously shown to be effective in a non-clinically defined community-based Veteran/military population. This research is needed to test MR's effects in a clinically defined population as a complement to clinical services to assess for potential subsequent implementation within the Department of Veterans Affairs (VA). This proposal resubmission is responsive to Veterans' reported desire for CIH and several VA initiatives, including RR&D's current special areas of interest for non-pharmacological activity-based interventions for chronic pain impacting pain reduction, function and quality of life. The VA Secretary of Health Strategic Priorities and the emerging VA Whole Health Program identify access to CIH for pain and self-care management as a priority to achieve optimal Veteran health. To be responsive to these priorities the 2016 VA State-of-the-Art Conference (SOTA) and Comprehensive Addiction Recovery Act (CARA) mandated VA's commitment to conduct rigorous research to integrate non-pharmacological and CIH approaches into care, with emphasis on pain management. This proposal is also responsive to the VA's Opioid Safety Initiative (OSI) and Pain Care Mission which prioritize the need for nonpharmacological treatment options for pain. The short-term goal of this study is to determine the effects of MR on (1) chronic pain, PTSD and related outcomes and (2) relationship outcomes for Veterans and their partners. The long-term goal is to determine the effectiveness and sustainability of using CIH self-care management programs like MR to improve outcomes for Veterans with chronic pain and PTSD, and their partners. The investigators propose a four-year mixed-methods randomized controlled trial of MR with two arms (treatment & wait-list control) in a clinical sample of Veterans with comorbid pain and PTSD, and their partners (e.g., spouse). The specific aims are to: (Aim 1) Determine MR effectiveness for physical (pain, sleep), PTSD (intrusion, arousal, avoidance, numbing), and psychological (depression, stress, anxiety) symptoms, and global health (quality of life); (Aim 2) Determine MR effectiveness for social (relationship satisfaction, compassion for self/others) outcomes among Veterans and their partners; and (Aim 3) Describe Veteran and partner perceived value of MR in a sub-sample of participants. The sample will consist of Veteran and partner dyads (N = 336) at the Ann Arbor, Puget Sound, and Tampa VA facilities. Aim 1 & 2 data collection will include self-report assessment of 4-data points over a 4-month period to evaluate physical, psychological, and social outcomes. Eight weekly reports will also be collected for the first two months of MR use to assess MR utilization, and pain and stress levels. Aim 3 data collection will include telephone interviews from a randomly selected sub-sample of MR treatment group dyads (n = 42) to examine MR user experiences and their suggestions making MR useful for Veterans and their partners.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 472
• Est. completion date: October 31, 2022
• Est. primary completion date: October 31, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A to 17 Years

Eligibility

Inclusion Criteria:

• English-speaking Veterans with chronic musculoskeletal pain.
• Veteran is considered to have chronic musculoskeletal pain if he or she meeting either

of two validated criteria:

• (1) Having 2+ occurrences of any of targeted musculoskeletal ICD-9-CM codes "likely to represent chronic pain" recorded at visits separated by at least 30 days within past six months
• (2) Having high impact chronic pain = 2+ occurrences of targeted musculoskeletal ICD-9-CM codes separated by at least 30 days within the past six months previous to study recruitment and two or more pain scores greater than or equal to 4 separated by at least 30 days within past six months.
• For pain scores, the investigators will use the 0-10 numeric pain rating scale that is routinely collected at the VA.
• The investigators will count two ICD-9-CM codes or pain scores recorded on the same day as one code/score.
• Veteran is considered to have PTSD if he or she has a flag in his/her record indicating confirmed condition by the VA Compensation and Benefits program, has at least two outpatient visits in the year with the primary diagnosis being listed as PTSD (ICD-9-CM code 309.81) and/or had PTSD listed on the problem list], Veteran must also have PTSD (defined by PTSD diagnosis-ICD-9-CM 309.81), the ability to access and use an electronic platform (e.g. Mobile device, internet, DVD) for MR delivery, with a willing partner to also participate in the study and MR program.

Exclusion Criteria:

• Moderate to severe TBI
• Diagnosis or documented treatment for psychosis in previous 6 months
• Currently in substance use disorder treatment
• Non-English speaking
• Visual, hearing, cognitive impairment that prevent participation or ability to consent
• And/or lack of access to internet service
• These individuals will be excluded due to medical, language, and technology access issues that would prevent safe and full study participation.
• Pain and PTSD treatment will not be factored as an inclusion/exclusion criteria but will be evaluated as covariates.
• Potential participants who screen for aggression or violence will also be excluded from study.

Related Conditions & MeSH terms

• Chronic Musculoskeletal Pain
• Musculoskeletal Pain
• PTSD

Intervention

Behavioral:
• Mission Reconnect
This four-year randomized controlled trial with one intervention arm and one wait-list control arm will utilize mixed methods to evaluate the effectiveness and perceived value of the MR program in relation to physical and psychological symptoms, global health, and social outcomes.

Locations

Country	Name	City	State
United States	VA Ann Arbor Healthcare System, Ann Arbor, MI	Ann Arbor	Michigan
United States	VA Puget Sound Health Care System Seattle Division, Seattle, WA	Seattle	Washington
United States	James A. Haley Veterans' Hospital, Tampa, FL	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
VA Office of Research and Development

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Veteran perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting what are the experiences of participants using MR. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Other	Veteran perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting type of recommendations participants have for promoting use of MR. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Other	Veteran perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting number of domains/taxonomies related to participants' experiences with MR use. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Other	Veterans' partners perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting what are the experiences of participants using MR. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Other	Veterans' partners perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting type of recommendations participants have for promoting use of MR. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Other	Veterans' partners perceived value of Mission Reconnect in a sub-sample of Veteran participants	Measured by collecting number of domains/taxonomies related to participants' experiences with MR use. Scale for satisfaction of MR program will be used, measurements include 1 (strongly disagree ) to 10 (strongly agree).	18 months
Primary	Mission Reconnect effectiveness for physical symptoms	Measured by collecting number of participants that self-report pain outcomes after Mission Reconnect is used. Scale of 0 (no pain) -5 (worst pain) will identify intensity of pain. Activity tracking form will indicate number or participants.	24 months
Primary	Mission Reconnect effectiveness for PTSD symptoms	Measured by collecting number of participants that self-report PTSD symptoms after Mission Reconnect is used. Activity tracking form will indicate number or participants.	24 months
Primary	Mission Reconnect effectiveness for psychological symptoms	Measured by collecting number of participants that self-report psychological symptoms after Mission Reconnect is used. Activity tracking form will indicate number or participants.	24 months
Primary	Mission Reconnect effectiveness for global health	Measured by collecting number of participants that self-report global health stress outcomes after Mission Reconnect is used. Scale of 0 (no stress) to 5 (worst stress) will identify level of stress. Activity tracking form will indicate number or participants.	24 months
Secondary	Mission Reconnect effectiveness for social outcomes among Veterans	Measured by collecting number of participants that self-report social outcomes after Mission Reconnect is used. Activity tracking form will indicate number or participants.	24 months
Secondary	Mission Reconnect effectiveness for social outcomes among Veterans' partners	Measured by collecting number of participants that self-report social outcomes after Mission Reconnect is used. Activity tracking form will indicate number or participants.	24 months