O le atuatuvale o se mea moni o le olaga i aso nei. I totonu o se sosaiete lea o loʻo faʻatupulaʻia ai itula faigaluega ma o le aufaasālalau o lo o faʻatuputeleina pea o tatou lagona i le sili ona leaga o faʻalavelave, e leitioa le mafuaʻaga o le tele o tagata e sili atu le maualuga o le atuatuvale i taimi masani. O le mea e laki ai, e sili atu le soifua maloloina o tagata faʻapitoa i le soifua maloloina o loʻo faʻaaogaina metotia o le faʻamalosi ma metotia e avea o se vaega o togafitiga o se maʻi. E ui lava o le atuatuvale o se tali masani lea e fesoasoani e saunia ai le tino mo tulaga lamatia, o le faʻavaivai faifai pea e mafai ona i ai aʻafiaga leaga i le tino, e faʻaalia ai faʻamaʻi o tua ma tiga sciatica. Ae, aiseā e aʻafia ai le tino o le tagata ona o le tele o popolega?

 

Muamua, e taua le malamalama pe faʻapefea ona iloa e le tino le atuatuvale. E tolu "auala" e tolu lea tatou te iloa ai le faigata: siosiomaga, tino, ma lagona. O le popole i le siosiomaga o le faʻamalamalamaina e le tagata lava ia; afai o loʻo e savali i lalo o se auala filemu ma e te faʻalogo i se leo tele le latalata ane, o le a iloa e lou tino o se lamatiaga vave. O se mea faigata lea i le siosiomaga. O le faʻaleagaina e mafai ona avea ma se isi faʻataʻitaʻiga o le faʻafitauli o le siosiomaga ona o fafo atu e aʻafia ai le tino o le sili atu lea e faʻaalia ai.

 

Faʻamalosi i totonu o le tino e aofia ai faʻamaʻi, le lava o moe ma / poʻo meaʻai e le talafeagai. O le atuatuvalega o lagona e itiiti lava le eseese, aua e aofia ai le auala e faamatalaina ai e lo tatou mafaufau nisi o mea. Mo se faʻataʻitaʻiga, afai o se tasi o loʻo e galulue faatasi o loʻo soona osofaʻia, atonu e ono faʻamaualugaina oe. O mafaufauga e pei o, "e ita ia te aʻu mo nisi mafuaaga" po o le "e tatau ona i ai se taeao faigata", e mafai ona manatu o se lagona atuatuvale. O le mea e tulaga ese e uiga i le faʻalavelave faʻalagona, peitaʻi, o le a tatou pule i le tele o mea tatou te iloa, sili atu nai lo le siosiomaga poʻo le tino.

 

I le taimi nei ua tatou malamalama i le auala e mafai ai e le tino ona iloa le faigata i ni auala eseese, e mafai ona tatou talanoaina po o a aʻafiaga o faʻalavelave e mafai ona maua i luga o le soifua maloloina atoa ma le soifua manuia. Pe a tuʻuina le tino i le atuatuvale, e ala i soʻo se auala ua taʻua i luga, o le a faʻailoa le taua a le tino poʻo le vaalele. O le popole popole popole, po o le SNS, e faʻafefeteina, lea o le a mafua ai ona vave le fatu ma o lagona uma o le tino e atili malosi. O se faʻaaogaina lea o le puipuiga mai taimi anamua; o le mafuaʻaga lea ua tatou ola ai i aso nei, nai lo le avea uma ma malologa mo tagata fiaaai i fafo atu o le vao.

 

O le mea e leaga ai, o le mea moni o le faʻalapotopotoga faʻaonaponei, e masani ona faʻavaivaia tagata ma e le mafai e le tino o le tagata ona vavalalata i le va o se taufaʻamataʻu lata mai ma se mataupu faʻavae faigofie. I le gasologa o tausaga ua tele suʻesuʻega suʻesuʻega na faʻatautaia e fuafua ai le aʻafiaga o le faʻalavelave masani i le tino o le tagata, faatasi ai ma aʻafiaga e pei o le maualuga o le toto, faateleina le aʻafiaga mo maʻi o le fatu ma faʻaleagaina ai le tino maso ma faʻamaoniga o tua ma tiga.

 

E tusa ai ma nisi suʻesuʻega suʻesuʻega, o le tuʻufaʻatasia o metotia mo le puleaina o popolega ma metotia e tele togafitiga togafitiga e mafai ona sili atu le faaleleia atili o faʻamaoniga ma e mafai ona faʻateleina le toe faʻaleleia. O le togafitiga o le faʻafefeteina o se togafitiga faʻapitoa e togafiti ai togafitiga e faʻaaogaina e togafitia ai le tele o manua ma / poʻo tuutuuga o le masukalokele ma le faʻalavelave. Talu ai ona o le togafitiga faafomaʻi e taulai i luga o le tui, o le aʻa o le tino, o le fomaʻi e mafai foi ona fesoasoani i le atuatuvale. Faatasi ai ma aʻafiaga o le atuatuvale o le faʻalavelave, lea e mafai ona iu i le taʻitaʻiina o le faʻavaivai poʻo le faʻamaoniaina o le vaʻa. O le fetuunaiga o le vavae ma le faʻaaogaina o le tusi lesona e mafai ona fesoasoani e faʻamafanafanaina ai le maso o le musika, lea e faʻaitiitia ai le faʻalavelave i vaega patino o le vaʻalaʻau ma fesoasoani e faʻamalosi le subluxation. O se siaki paleni o se itu taua o le taulimaina o le popolega patino. E pei ona taʻua i le taimi muamua, o le lelei ma le lava o le moe, o se vaega taua foi o le puleaina o popolega, o le togafitiga faafomaʻi e ofoina atu fautuaga mo le fesuiaiga o le olaga e faaleleia atili ai le tulaga o le maʻi ma le faaitiitia o latou faailoga.

 

O le faʻamoemoe o le tusiga o loʻo i lalo, o le faʻaalia lea o le suʻesuʻega o suʻesuʻega ua atinaʻe e faʻatusatusa faʻapitoa ma isi vailaau faʻapitoa faʻatasi ai ma togafitiga masani-tino faʻapitoa mo le tiga masani o tua. Sa faʻatinoina ma le faʻaeteete le faʻataʻitaʻiga faʻapitoa faʻataʻitaʻiina, ma o faʻamatalaga i tua o le suʻesuʻega suʻesuʻe ua faʻamaumauga i lalo. E pei o isi suʻesuʻega suʻesuʻega, e ono manaʻomia nisi faʻamatalaga faʻamaoniga e faʻamoemoe lelei ai le aʻafiaga o le faʻamalosia o faʻamalosi ma togafitiga mo le tiga.

 

Comparison of Complementary and Alternative Medicine with Conventional Mind�Body Therapies for Chronic Back Pain: Protocol for the Mind�Body Approaches to Pain (MAP) Randomized Controlled Trial

 

lē faʻatino

 

tua

 

O le soifua maloloina o le tagata lava ia ua lipotia mai o le soifua maloloina ma le gaioiga o tulaga o tagata ua i ai le tiga i le Iunaite Setete ua teena i tausaga talu ai nei, e ui lava i le tele o tupe faʻaalu a le fomaʻi ona o lenei faafitauli. E ui o faʻamaoniga o le mafaufau o le mafaufau e pei o talitonuga o le tiga, mafaufauga ma amio taulima na faʻaalia e aʻafia ai pe faapefea ona tali atu tagata gasegase i togafitiga mo le tiga, e toʻaitiiti tagata gasegase latou te mauaina togafitiga e faʻaalia ai nei mea. O togafitiga-amio faʻaleleia (CBT), lea e faʻamatalaina ai vaega o le mafaufau, ua maua e aoga mo tiga, ae le gata i le agavaa o le au togafitiga. O se isi togafitiga e mafai ai ona faʻafesoʻotaʻi faafitauli faʻale-mafaufau, faʻaititia o le faʻavaivai mafaufau (MBSR), ua faateleina le avanoa. Ua maua le MBSR e aoga tele mo tulaga faʻalemafaufau ma le faaletino, ae e lei lelei ona suʻesuʻeina mo le faʻaaogaina o maʻi gasegase tumau. I lenei faʻataʻitaʻiga, o le a matou taumafai e fuafua pe o le MBSR o se togafitiga lelei ma aoga mo togafitiga mo tagata e maua le tiga i taimi uma, faʻatusatusa lona lelei ma le taugata pe a faatusatusa i le CBT ma sailiili i suiga faʻafesootai e mafai ona faʻatalanoa aafiaga ole MBSR ma CBT i luga o faʻatonuga.

 

Metotia / Fuafuaga

 

I lenei faʻataʻitaʻiga, o le a tatou faʻafaifaʻatasiina le 397 tagata matutua ma faʻamaʻi tigaina tumau i le CBT, MBSR poʻo togafitiga masani (99 per group). O nei faʻasalalauga o le a aofia ai vasega faʻavaomalo e valu vaiaso vaiaso e faʻaleleia e le fale. O le protocise MBSR e aofia ai foi ma le faʻaiʻuga o le 2-itula. Tagata faʻatalanoaina masked i tofitofiga togafitiga o le a iloilo ai taunuuga o 6, 5, 10 ma 26 vaiaso faʻatautaia. O taunuʻuga autū o le a avea ma faʻatapulaʻa galueaina (e faʻavae i luga o le Roland Disability Questionnaire) ma faʻafitauli faʻafitauli (faʻavasegaina i luga o le 52 i le 0 numera fua faʻatatau) i 10 vaiaso.

 

Talanoaga

 

Afai e maua le MBSR o se togafitiga lelei ma aoga-togafiti togafitiga mo tagata gasegase e tigaina i le taimi mulimuli, o le a avea ma se faʻaopoopoga aoga i togafitiga faatapulaa e maua e tagata maʻi ma le tele o mea e fesoasoani i le mafaufau i mea tiga.

 

Faamauina o le Faamasinoga

 

Clinicaltrials.gov Faailoaina: NCT01467843.

 

uputatala: Paʻu tua, Suʻega-amio faʻaleleia, Mindfulness meditation

 

tua

 

O le faʻamalamalamaina o togafitiga taugata mo le maualalo o tiga maualalo maualalo (CLBP) o loʻo tumau pea le luʻitau mo fomaʻi, tagata suʻesuʻe, tagata totogi ma tagata gasegase. Pe a ma le $ 26 piliona e faʻaalu i tausaga taʻitasi i le Iunaite Setete i tau tuusaʻo o togafitiga faafomaʻi mo le tiga i tua [1]. I le 2002, o le tau fuafuaina o le leiloa o le au faigaluega na mafua ona o tiga toega na $ 19.8 piliona [2]. E ui lava i le tele o filifiliga mo le iloiloga ma togafitiga o tiga, faapea foi ma le faateleina o le soifua maloloina o punaoa ua tuuto atu i lenei faafitauli, o le soifua maloloina ma le tulaga galue o tagata ua i ai le tiga i le Iunaite Setete ua faateteleina [3]. E le gata i lea, e le o faamalieina uma i latou o loʻo tuʻuina atu ma tagata gasegase i le status quo [4-6] ma faʻaauau pea ona sailia mo filifiliga lelei togafitiga.

 

There is substantial evidence that patient psychosocial factors, such as pain-related beliefs, thoughts and coping behaviors, can have a significant impact on the experience of pain and its effects on functioning [7]. This evidence highlights the potential value of treatments for back pain that address both the mind and the body. In fact, four of the eight nonpharmacologic treatments recommended by the American College of Physicians and the American Pain Society guidelines for persistent back pain include �mind�body� components [8]. One of these treatments, cognitive-behavioral therapy (CBT), includes mind�body components such as relaxation training and has been found to be effective for a variety of chronic pain problems, including back pain [9-13]. CBT has become the most widely applied psychosocial treatment for patients with chronic back pain. Another mind�body therapy, mindfulness-based stress reduction (MBSR) [14,15], focuses on teaching techniques to increase mindfulness. MBSR and related mindfulness-based interventions have been found to be helpful for a broad range of mental and physical health conditions, including chronic pain [14-19], but they have not been well-studied for chronic back pain [20-24]. Only a few small pilot trials have evaluated the effectiveness of MBSR for back pain [25,26] and all reported improvements in pain intensity [27] or patients� acceptance of pain [28,29].

 

Further research on the comparative effectiveness and cost-effectiveness of mind�body therapies should be a priority in back pain research for the following reasons: (1) the large personal and societal impact of chronic back pain, (2) the modest effectiveness of current treatments, (3) the positive results of the few trials in which researchers have evaluated mind�body therapies for back pain and (4) the growing popularity and safety, as well as the relatively low cost, of mind�body therapies. To help fill this knowledge gap, we are conducting a randomized trial to evaluate the effectiveness, comparative effectiveness and cost-effectiveness of MBSR and group CBT, compared with usual medical care only, for patients with chronic back pain.

 

Fuafuaga Tatau

 

O a tatou sini ma a latou faʻatusatusaga tutusa o loʻo otooto atu i lalo.

 

• 1. Le fuafuaina pe o le MBSR o se fetuutuunaiga lelei i togafitiga faafomaʻi masani mo tagata ei ai le CLBP
• Vaʻaiga 1: O tagata taʻitoʻatasi e le o iai i le MBSR vasega o le a faʻaalia ai le umi o taimi (8 ma 26 vaiaso) ma le umi o le taimi (52 vaiaso) faʻagata i mea e aʻafia ai le tiga, tiga faʻalavelave ma isi taunuʻuga tau soifua maloloina nai lo i latou e faʻaauau ile tausiga masani .
• 2. To compare the effectiveness of MBSR and group CBT in decreasing back pain�related activity limitations and pain bothersomeness
• Vaʻaiga 2: MBSR will be more effective than group CBT in decreasing pain-related activity limitations and pain bothersomeness in both the short term and long term. The rationale for this hypothesis is based on (1) the modest effectiveness of CBT for chronic back pain found in past studies, (2) the positive results of the limited initial research evaluating MBSR for chronic back pain and (3) growing evidence that an integral part of MBSR training (but not CBT training)�yoga�is effective for chronic back pain.
• 3. Le faailoaina o le aufaasālalau o soʻo se aafiaga o le MBSR ma le vaega CBT i luga o aʻafiaga o gaioiga faʻaleagaina ma tiga faʻalavelave
• Malosiaga 3a: O aʻafiaga o le MBSR i faʻamalosiaga o galuega ma tiga faʻalavelave o le a faʻatalanoaina e le faateleina o le mafaufau ma le taliaina o le tiga.
• Vaʻaiga 3b: O aʻafiaga o le CBT i luga o galuega ma faʻalavelave faʻalavelave o le a faʻatalanoaina e suiga i le faʻaaogaina o le cognition (faʻaitiitia i le faʻalavelave, talitonu o le tasi e le atoatoa e tiga ma talitonuga e faʻaleagaina ai le tiga, faʻapea foi le faateleina o le pulea lelei o tiga ma oe lava -o le faʻamalosi mo le puleaina o tiga) ma suiga i le faʻafetauiina o amio (faʻateleina le faʻaogaina o le malologa, tumau le galulue ma le faʻafetaui o manatu o le tagata lava ia ma faʻaititia le faʻaaogaina o le malologa).
• 4. E faʻatusatusa le taugofie o le MBSR ma le CBT vaega e faʻaopoopo i le tausiga masani mo tagata e maua i taimi uma le tiga
• Vaʻaiga 4: O le MBSR ma le vaega o le CBT o le a avea ma faʻafeiloaʻiga taugofie i le tausiga masani.

 

O le a tatou suʻesuʻeina foi pe o iai ni uiga faʻapitoa o le maʻi faʻapitoa poʻo le togafitiga faʻaleagaina. Mo se faʻataʻitaʻiga, o le a matou suʻeina pe o maʻi e maualuga atu le faʻafitauli o le atuatuvale e le mafai ona faʻaleleia i le CBT ma le MBSR pe o nei tagata gasegase e sili atu ona manuia mai le CBT nai lo le MBSR (o lona uiga, pe o le tulaga o le atuatuvale o se faʻataʻitaʻiga o togafitiga ).

 

Metotia / Fuafuaga

 

lagona

 

We are conducting a randomized clinical trial in which individuals with CLBP are randomly assigned to group CBT, a group MBSR course or usual care alone (Figure 1). Participants will be followed for 52 weeks after randomization. Telephone interviewers masked to participants� treatment assignments will assess outcomes 4, 8, 26 and 52 weeks postrandomization. The primary outcomes we will assess are pain-related activity limitations and pain bothersomeness. Participants will be informed that the study researchers are comparing �two different widely used pain self-management programs that have been found helpful for reducing pain and making it easier to carry out daily activities�.

 

 

O le maliega mo lenei faamasinoga ua faamaonia e le Komiti o Iloiloga a Tagata mo le Cooperative Group Health Cooperative (250681-22). O i latou uma e auai o le a manaomia le tuuina atu o la latou maliega faʻamaonia ao lei lesitalaina i lenei suʻesuʻega.

 

Suʻesuʻega ma le Faʻatulagaga

 

O le punavai autu o tagata auai mo lenei faamasinoga o le Cooperative Group Health Cooperative (GHC), o se vaega, o le vaega o le soifua maloloina e le o le tupe maua e pulea le 600,000 e ala i ona lava nofoaga tausi fale i Washington. Aʻo manaʻomia le ausia o sini faʻapipiʻi, o le a tuʻuina atu meli i tagata 20 i 70 o tausaga o loʻo soifua i nofoaga na tautuaina e le GHC.

 

Faʻasalaga ma Faʻasalaga Taʻiala

 

O loʻo matou suʻesuʻeina tagata taʻitoʻatasi mai le 20 i le 70 tausaga le matutua o latou tua tua na tumau pea mo le itiiti ifo i le 3 masina. O le tuʻufaʻatasia ma tuʻufaʻatasia aiaiga na atiaeina e faʻateleina ai le lesitalaina o tagata talafeagai aʻo suʻesuʻeina tagata mamaʻi e maualalo tua tiga o se faʻapitoa natura (mo se faʻataʻitaʻiga, stenosis tuʻimomomo) poʻo se faigata natura poʻo ai e ono faigata faʻauma le suʻesuʻega fua poʻo faʻalavelave ( mo se faʻataʻitaʻiga, psychosis). Mafuaʻaga mo le faʻateʻaina o sui o le GHC na faʻamaonia i luga o le faavae o (1) otometi faʻamaumauga faʻamaumauga (faʻaaogaina o le Faavasega Faʻavaomaloina o Faʻamaʻi, Iva Faʻavasega coding system), i taimi o asiasiga uma i le gasologa o le tausaga talu ai ma (2) agavaʻa faʻatalanoaga faia e telefoni. Mo tagata e leʻo le GHC, o mafuaʻaga o le faʻateʻa ese na faʻamaonia luga o faʻavae o faʻatalanoaga i luga ole telefoni. Laulau 1 ma? 2 lisiina le aofia ai ma le tuʻu eseʻesega faʻavae, faʻatulagaina, faʻapea foi ma le mafuaʻaga mo criterion taʻitasi ma faʻamatalaga punaoa.

 

 

 

E le gata i lea, matou te manaʻomia le auai ma le mafai ona auai i vasega o le CBT poʻo le MBSR i le vaitaimi o le 8-vaiaso pe afai e tofia i se tasi o na togafitiga, ma ia tali atu i fesili e fa mulimuli mai ina ia mafai ona matou iloiloina taunuʻuga.

 

Faiga Faʻavae

 

Because the study intervention involves classes, we are recruiting participants in ten cohorts consisting of up to forty-five individuals each. We are recruiting participants from three main sources: (1) GHC members who have made visits to their primary care providers for low back pain and whose pain has persisted for at least 3 months, (2) GHC members who have not made a visit to their primary care provider for back pain but who are between the ages of 20 and 70 years and who respond to our nontargeted GHC mailing or our ad in GHC�s twice-yearly magazine and (3) community residents between the ages of 20 and 70 years who respond to a direct mail recruitment postcard.

 

For the targeted GHC population, a programmer will use GHC�s administrative and clinical electronic databases to identify potentially eligible members with a visit in the previous 3 to 15 months to a provider that resulted in a diagnosis consistent with nonspecific low back pain. These GHC members are mailed a letter and consent checklist that explains the study and eligibility requirements. Members interested in participating sign and return a statement indicating their willingness to be contacted. A research specialist then calls the potential participant to ask questions; determine eligibility; clarify risks, benefits and expected commitment to the study; and request informed consent. After informed consent has been obtained from the individual, the baseline telephone assessment is conducted.

 

Mo le faitau aofaʻi o le GHC e leai se aʻafiaga (o lona uiga, o le GHC e aunoa ma ni asiasiga e maua ai le tiga o le maʻi na maua i totonu ole 3 i le 15 masina ae atonu e maualalo le tiga), e faʻaaogaina e le komipiuta faamaumauga faʻamaumauga eletise e iloa ai sui auai e le o aofia ai i le faʻataʻitaʻiga ua faʻatatauina i le parakalafa muamua. O lenei faitau aofaʻi e aofia ai sui o le GHC e tali atu i se faʻaliga i le mekasini a le GHC. O metotia lava e tasi e faʻaaogaina mo tagata faʻatulagaina e faʻaaogaina e faʻafesoʻotaʻi ai ma matamata i tagata e ono auai, maua a latou maliega faʻamaonia ma aoina faʻamaumauga o fuataga.

 

E tusa ai ma tagata nonofo i le afioaga, ua tatou faatauina lisi o igoa ma tuatusi o se faʻataʻitaʻiga faʻapitoa o tagata o loʻo ola i totonu o la tatou vaega o le aufaigaluega o loʻo i ai i le va o 20 ma 70 tausaga. O tagata i luga o le lisi e lafoina meli meli tuusaʻo e faʻamatalaina le suʻesuʻega e aofia ai faʻamatalaga e uiga ile auala e faʻafesoʻotaʻi ai tagata faigaluega suʻesuʻe pe a fiafia e auai. O le taimi lava e faʻafesoʻotaʻi ai e se tagata fiafia le 'au suʻesuʻe ia tutusa le faʻasologa o loʻo faʻamatalaina i luga.

 

Ina ia mautinoa o tagata suʻesuʻe uma e suʻesuʻeina muamua, e tumau le agavaa i le taimi e amata ai vasega, oi latou e malilie i le sili atu i le 14 aso ao lei amataina vasega faʻapitoa o le a toe faʻaleleia pe tusa o le 0 i le 14 aso aʻo lumanaʻi le vasega muamua e toe faʻamaonia lo latou agavaa. O le mea e sili ona popole ai o le vavaeeseina lea o tagata e le o toe i ai ni fua faatatau talafeagai o le tiga o le faʻalavelave ma le faʻalavelave faʻafefe i gaioiga. O na tagata o loʻo tumau pea le agavaa ma tuʻuina atu a latou faʻatagaga faʻamaonia mulimuli o le a faʻatinoina le fesili autu.

 

Faʻamatalaga

 

A maeʻa le suʻega faʻavae, o sui o le a faʻasolosoloina i tutusa tutusa i le MBSR, CBT poʻo le tausiga masani kulupu. O i latou e faʻasolosolo i le MBSR poʻo le CBT kulupu o le a le faʻailoaina atu ia latou ituaiga togafitiga seʻia oʻo ina taunuʻu i vasega muamua, lea e tupu faʻatasi i le fale e tasi. O le vaega faʻatosina o le a tofia i luga o le faʻavae o le komupiuta-faia faʻasologa o soʻo numera numera faʻaaogaina o se polokalame e mautinoa ai o le faʻasoaga e le mafai ona suia pe a maeʻa faʻavasega. Ina ia mautinoa le paleni i luga o le autu laina vavalalata mea moni, o le a fua faʻasolosolo faʻavae faʻavae i luga o la tatou autu faʻatinoina o mea faigaluega: o le faʻavasega faʻamatalaga o le Roland Disability Questionnaire (RDQ) [30,31]. O le a matou faʻailoaina sui auai i ni vaega faʻatapulaʻaina o gaioiga: feololo (RDQ togi? 12 i le 0 i le 23 fua) ma maualuga (RDQ togi? 13). O sui auai o le a faʻasolosolo i totonu o nei laupepa i poloka o fesuiaʻiga tele (tolu, ono pe iva) e faʻamautinoa ai se paleni ae le fuafuaina le tofiaina o tagata auai. I le taimi o le faʻafaigaluegaina, o le suʻesuʻega biostatistician o le a mauaina tuʻufaʻatasia numera o tagata auai faʻasolosolo i kulupu taʻitasi e faʻamautinoa ai o le preprogrammed randomization algorithm o loʻo galue lelei.

 

Suesuega Fomaʻi

 

O le vasega CBT ma le MBSR vasega vasega e valu vaiaso o le 2-itula e faʻaopoopoina i gaoioiga a le fale.

 

Mafuaʻaga Faʻavaivai Faʻavaivai Mafaufau

 

Mindfulness-based stress reduction, a 30-year-old treatment program developed by Jon Kabat-Zinn, is well-described in the literature [32-34]. The authors of a recent meta-analysis found that MBSR had moderate effect sizes for improving the physical and mental well-being of patients with a variety of health conditions [16]. Our MBSR program is closely modeled on the original one and includes eight weekly 2-hour classes (summarized in Table 3), a 6-hour retreat between weeks 6 and 7 and up to 45 minutes per day of home practice. Our MBSR protocol was adapted by a senior MBSR instructor from the 2009 MBSR instructor�s manual used at the University of Massachusetts [35]. This manual permits latitude in how instructors introduce mindfulness and its practice to participants. The handouts and home practice materials are standardized for this study.

 

 

Participants will be given a packet of information during the first class that includes a course outline and instructor contact information; information about mindfulness, meditation, communication skills and effects of stress on the body, emotions and behavior; homework assignments; poems; and a bibliography. All sessions will include mindfulness exercises, and all but the first will include yoga or other forms of mindful movement. Participants will be given audio recordings of the mindfulness and yoga techniques, which will have been recorded by their own instructors. Participants will be asked to practice the techniques discussed in each class daily for up to 45 minutes throughout the intervention period and after classes end. They will also be assigned readings to complete before each class. Time will be devoted in each class to a review of challenges that participants have had in practicing what they learned in previous classes and with their homework. An optional day of practice on the Saturday between the sixth and seventh classes will be offered. This 6-hour �retreat� will be held with the participants in silence and only the instructor speaking. This will provide participants an opportunity to deepen what they have learned in class.

 

Faʻamālōlō-Faʻamālōlōina togafitiga

 

O le CBT mo le tiga masani e lelei ona faʻamatalaina i tusitusiga ma ua maua e tauagafau le lelei tele i le faʻaleleia o faafitauli ogaoga o le tiga [9-13]. E leai se tasi e faʻamaonia le CBT mo le tigaina masani, e ui o faʻatalatalanoaga uma a le CBT e faʻavae i luga o le talitonuga o le cognition ma le amio e faʻaosofia ai le fetuʻunaʻi i le tiga masani ma e mafai ona iloa ma suia le cognition ma le amio e faʻaleleia ai le galue o le 36. O loʻo faʻamalosia e le CBT auala faʻapitoa e aʻoaʻoina ai tagata gasegase pe faapefea ona iloa, mataʻituina ma sui mafaufauga, lagona ma amio, ma le taulaʻi i le fesoasoani i tagata gasegase e maua tomai e mafai ona latou faʻaaogaina i le tele o faafitauli ma le galulue soosootauau i le va o le tagata maʻi ma le fomaʻi. O le tele o auala ua aʻoaʻoina, e aofia ai aʻoaʻoga i tiga e faʻafetaui ai tomai (mo se faʻataʻitaʻiga, faʻaaogaina o le faʻataʻitaʻiga o le tagata lava ia, faʻasoesa, malologa ma le foia o faafitauli). O le CBT foʻi e faʻateleina le faʻatulagaga ma le galue agai i sini o amioga.

 

Ua faʻaaogaina faʻapitoa taʻitasi ma vaega i le CBT. O le kulupu o le CBT e masani lava o se vaega tāua o polokalama tele o togafitiga o faʻamaʻi pipisi. O le a matou faʻaaogaina le faʻapipiʻi o le CBT ona ua maua le aoga [37-40], e sili atu le lelei-faʻaleleia nai lo togafitiga faʻapitoa ma tuʻuina atu i tagata gasegase aoga e maua mai le fesoʻotaʻi ma, ma lagolago ma faʻamalosi mai, isi e tutusa aafiaga ma faafitauli. E le gata i lea, o le faʻaaogaina o faʻavae vaega mo le MBSR ma le CBT o le a faʻaaogaina le faʻasalalauga e avea o se faʻamatalaga talafeagai mo soʻo se eseesega na matauina i le va o togafitiga e lua.

 

For this study, we developed a detailed therapist�s manual with content specific for each session, as well as a participant�s workbook containing materials for use in each session. We developed the therapist�s manual and participant�s workbooks based on existing published resources as well as on materials we have used in prior studies [39-47].

 

The CBT intervention (Table 3) will consist of eight weekly 2-hour sessions that will provide (1) education about the role of maladaptive automatic thoughts (for example, catastrophizing) and beliefs (for example, one�s ability to control pain, hurt equals harm) common in people with depression, anxiety and/or chronic pain and (2) instruction and practice in identifying and challenging negative thoughts, the use of thought-stopping techniques, the use of positive coping self-statements and goal-setting, relaxation techniques and coping with pain flare-ups. The intervention will also include education about activity pacing and scheduling and about relapse prevention and maintenance of gains. Participants will be given audio recordings of relaxation and imagery exercises and asked to set goals regarding their relaxation practice. During each session, participants will complete a personal action plan for activities to be completed between sessions. These plans will be used as logs for setting specific home practice goals and checking off activities completed during the week to be reviewed at the next week�s session.

 

Tausiga masani

 

The usual care group will receive whatever medical care they would normally receive during the study period. To minimize possible disappointment with not being randomized to a mind�body treatment, participants in this group will receive $50 compensation.

 

Lisi o Nofoaga

 

O vasega o le CBT ma le MBSR o le a faia i nofoaga e lata i faʻasalalauga o le GHC i le setete o Uosigitone (Bellevue, Bellingham, Olympia, Seattle, Spokane ma Tacoma).

 

Faiaʻoga

 

O aʻoaʻoga uma a le MBSR o le a maua uma aʻoaʻoga aloaia i le aʻoaʻoina o le MBSR mai le Nofoaga Tutotonu mo le Mindfulness i le Iunivesite o Massachusetts poʻo se aʻoaʻoga tutusa. O le a avea i latou o ni lōia o le mafaufau ma se faʻataʻitaʻiga o le tino (mo se faʻataʻitaʻiga, yoga), o le a latou aʻoaʻoina le MBSR muamua ma o le a avea le mafaufau o se vaega taua oo latou olaga. O le faʻamaoniga a le CBT o le a faʻatautaia e fomaʻi o le fomaʻi o le fomaʻi ma le poto masani i le tuʻuina atu o le CBT i tagata gasegase e maua ai le tiga tumau.

 

Aoaoga ma le Mataituina o Faiaoga

 

All CBT instructors will be trained in the study protocol for the CBT intervention by the study�s clinical psychologist investigators (BHB and JAT), who are very experienced in administering CBT to patients with chronic pain. BHB will supervise the CBT instructors. One of the investigators (KJS) will train the MBSR instructors in the adapted MBSR protocol and supervise them. Each instructor will attend weekly supervision sessions, which will include discussion of positive experiences, adverse events, concerns raised by the instructor or participants and protocol fidelity. Treatment fidelity checklists highlighting the essential components for each session were created for both the CBT and MBSR arms. A trained research specialist will use the fidelity checklist during live observation of every session. The research specialist will provide feedback to the supervisor to facilitate weekly supervision of the instructors. In addition, all sessions will be audio-recorded. The supervisors will listen to a random sample and requested portions of sessions and will monitor them using the fidelity checklist. Feedback will be provided to the instructors during their weekly supervision sessions. Treatment fidelity will be monitored in both intervention groups by KJS and BHB with assistance from research specialists. In addition, they will review and rate on the fidelity checklist a random sample of the recorded sessions.

 

Tagata Taofi Auai ma Tausiga i le Faiaoga o Aiga

 

O le a maua e tagata o le vasega se valaau faamanatu i luma o le vasega muamua ma soo se taimi latou te misia ai se vasega. O le a talosagaina i latou e faʻamaumau a latou faigamalo i aso taitasi i ogaoga faʻavaiaso. Fesili e uiga i a latou fale i le vaiaso muamua o le a aofia ai i faʻatalatalanoaga mulimuli uma. Ina ia faatumauina le faatalanoaina o faatalanoaga, o le a fesiligia fesili pe a maeʻa ona faamaumauina uma faamaumauga.

 

Fua

 

We will assess a variety of participant baseline characteristics, including sociodemographic characteristics, back pain history and expectations of the helpfulness of the mind�body treatments for back pain (Table 4).

 

 

O le a tatou iloiloina se faʻavae autu o taunuʻuga mo tagata mamaʻi e iai ni faʻafitauli o le vaomalo (galuega toe foʻi, tiga, tulaga lautele o le soifua maloloina, le malosi o le galue ma le faamalieina o le maʻi) [48] e ogatasi ma le Initiative on Methods, Measurement, and Pain Assessment in Clinical Faʻataʻitaʻiga o tofotofoga mo faʻataʻitaʻiga faʻapitoa o togafitiga tumau o tiga tiga ma le lelei [49]. O le a tatou fuaina taunuʻuga pupuu e lua (8 ma 26 vaiaso) ma taunuʻuga umi-taimi (52 vaiaso). O le a matou aofia ai foi sina otootoga, 4-vaiaso, iloiloga o le vaeluagaina e faatagaina ai auiliiliga o le aufaasālalau manatu o aafiaga o le MBSR ma le CBT i luga o taunuʻuga autu. O le suʻesuʻega pito sili ona taua o 26 vaiaso. O le a totogiina tagata auai $ 20 mo faʻatalatalanoaga mulimuli e mulimulitaia e faʻatele ai le tali o tali.

 

Co�Primary Outcome Measures

 

The co�primary outcome measures will be back-related activity limitations and back pain bothersomeness.

 

Back-related activity limitations will be measured with the modified RDQ, which asks whether 23 specific activities have been limited due to back pain (yes or no) [30]. We have further modified the RDQ to ask a question about the previous week rather than just �today�. The original RDQ has been found to be reliable, valid and sensitive to clinical changes [31,48,50-53], and it is appropriate for telephone administration and use with patients with moderate activity limitations [50].

 

Back pain bothersomeness will be measured by asking participants to rate how bothersome their back pain has been during the previous week on a 0 to 10 scale (0?=?�not at all bothersome� and 10?=?�extremely bothersome�). On the basis of data compiled from a similar group of GHC members with back pain, we found this bothersomeness measure to be highly correlated with a 0 to 10 measure of pain intensity (r?=?0.8 to 0.9; unpublished data (DCC and KJS) and with measures of function and other outcome measures [54]. The validity of numerical rating scales of pain has been well-documented, and such scales have demonstrated sensitivity in detecting changes in pain after treatment [55].

 

We will analyze and report these co�primary outcomes in two ways. First, for our primary endpoint analyses, we will compare the percentages of participants in the three treatment groups who achieve clinically meaningful improvement (?30% improvement from baseline) [56,57] at each time point (with 26-week follow-up being the primary endpoint). We will then examine, in a secondary outcome analysis, the adjusted mean differences between groups on these measures at the time of follow-up.

 

Maualuga Maualuga Fua o Galuega

 

O taunuʻuga lona lua o le a tatou fuatiaina o ni faʻalavelave faʻafitauli, popolega, faʻalavelave faʻalavelave faʻalavelave, faʻaleleia atili o le lalolagi ma togafitiga, faʻaaogaina o vailaau mo tiga, tigaina o le soifua maloloina ma taunuʻuga agavaa.

 

O faʻafitauli faʻafitauli o le a iloiloina i le Questionnaire Health Questionnaire-8 (PHQ-8) [58]. Faʻatasi ai ma le faʻaumatiaina o se fesili e uiga i le suicidal ideation, o le PHQ-8 e tutusa lelei ma le PHQ-9, lea ua maua le faatuatuaina, aloaia ma tali atu i suiga [59,60].

 

O le popolega o le a fuaina i le 2-mea Generalized Disorder Disorder (GAD-2), lea na faʻaalia ai le maualuga o le lagona ma le faʻamautinoa i le sailia o le faʻafitauli o le atuatuvale i tagata tausi maʻi matua [61,62].

 

Pain-related activity interference with daily activities will be assessed using three items from the Graded Chronic Pain Scale (GCPS). The GCPS has been validated and shown to have good psychometric properties in a large population survey and in large samples of primary care patients with pain [63,64]. Participants will be asked to rate the following three items on a 0 to 10 scale: their current back pain (back pain �right now�), their worst back pain in the previous month and their average pain level over the previous month.

 

Global improvement with treatment will be measured with the Patient Global Impression of Change scale [65]. This single question asks participants to rate their improvement with treatment on a 7-point scale that ranges from �very much improved� to �very much worse,� with �no change� used as the midpoint. Global ratings of improvement with treatment provide a measure of overall clinical benefit from treatment and are considered one of the core outcome domains in pain clinical trials [49].

 

Faʻaaogaina o vailaau ma faamalositino mo tiga i tua o le vaiaso talu ai o le a iloiloina i fesili 8-, 26- ma 52-vaiaso.

 

O le tulaga o le soifua maloloina lautele o le a iloiloina i le 12-item Short Progression Health Survey (SF-12) [66], o se mea masani e faʻaaogaina e maua ai ni aotelega tuʻufaʻatasiga mo le soifua maloloina o le tino ma le mafaufau. O le SF-12 o le a faʻaaogaina foi e fuafua ai le olaga-faʻalelei-tausaga (QALYs) i le faʻaaogaina o le Suʻega o le Soifua Maloloina i Pepa o 6 i le taugofie o iloiloga [67].

 

Qualitative outcomes will be measured with open-ended questions. We have included open-ended questions in our previous trials and found that they yield valuable insights into participants� feelings about the value of specific components of the interventions and the impact of the interventions on their lives. We therefore will include open-ended questions about these issues at the end of the 8-, 26- and 52-week follow-up interviews.

 

Fuataga o loʻo Faʻaaogaina i Suʻesuʻega Faufautua

 

I le armature MBSR, o le a tatou iloiloina faʻamatalaga o faʻasalalauga o le faateleina o le mafaufau (fuaina i le Nonreactivity, Observation, Faʻaauau ma le Faalauiloaina, ma le Faʻaaogaina o le Fa Faetusi Mindfulness Questionnaire puupuu [68-70]) ma le faateleina o le taliaina o tiga (fuaina ma le Questionnaire Acceptance Questionnaire [71,72]) i luga o taunuʻuga autu. I le vaega o le CBT, o le a tatou iloiloina le aafiaga o le aufaasālalau o le faʻaleleia atili o talitonuga o le tiga ma / poʻo le iloiloga (fuaina i le Suʻega o le Faʻataʻitaʻiga Fesili Fesili [73]; -2]; ma le Pain Catastrophizing Scale [74-76]) ma suiga i le faʻaaogaina o metotia o le taulimaina o tiga (fuaina i le Chronic Pain Coping Inventory 77 ma le numera atoa o le Faʻatulagaga o Gaoioiga [80]) i luga o le matua taunuuga. E ui lava matou te faʻamoemoe o aʻafiaga o le MBSR ma le CBT i luga o taunuʻuga e faʻatalanoaina e eseese fesuiaiga, o le a matou suʻesuʻeina aafiaga o tagata faufautua uma e mafai ona maua i taunuʻuga i vaega uma e lua.

 

Fuataga o loʻo Faʻaaogaina i Suʻega Tau-Taugofie

 

O tau faʻatatau o le a fuafuaina e faʻaaoga ai faʻamatalaga tau o loʻo faʻaaogaina mai faʻamaumauga faʻaletoroni faʻapitoa mo auaunaga i tua e tuʻuina atu pe totogiina e le GHC ma mai lipoti faʻamaʻi o le tausiga e le aofia ai le GHC. O tau e le faʻaaogaina o le a fuafuaina e faʻaaoga ai le fesili o le Faʻataunuʻuina o Gaoioiga ma Gaioiga o Mea Faigofie [83]. O le lelei o le faʻaaogāina o le a mafua mai i le SF-12 tulaga lautele o le soifua maloloina [84].

 

Faʻamaumauga o Faʻamaumauga, Puleaina o le Atoatoa ma le Le Faalauaitele

 

O faʻamaumauga o le a aoina mai i tagata auai e ala i le faʻatautaia o telefoni i le faʻaaogaina o se telefoni feaveaʻi telefoni feaveai (CATI) o fesili tusi e faʻaitiitia ai mea sese ma misi faamaumauga. Fesili e uiga i aafiaga ma ni vaega patino o faʻasalalauga (mo se faʻataʻitaʻiga, yoga, mafaufau loloto, faʻataʻitaʻiga i le faʻaaogaina o taʻiala) o le a faʻasalaina tagata faʻatalanoa i vaega o togafitiga o le a fesiligia i taimi taʻitasi pe a uma ona iloiloina isi taunuʻuga. O le a matou taumafai e maua mai faʻamatalaga o faʻamatalaga mai i latou uma e auai i le faamasinoga, e aofia ai i latou e le auai pe toesea mai vasega, oi latou ua le toe lesitala i le fuafuaga o le soifua maloloina ma i latou o loʻo o ese atu. O sui auai e le tali atu i taumafaiga faifai pea e maua ni faʻamatalaga mulimuli mai telefoni, o le a lafoina i luga o le telefoni se fesili e aofia ai na o mea autu e lua o fuataga ma ofo atu $ 10 mo le tali atu.

 

O le a matou aoina mai faʻamatalaga i taimi uma o le faʻatulagaina, faʻaleaogaina ma togafitiga ina ia mafai ai ona matou lipotia le tafe o le maʻi e tusa ai ma taiala o le CONSORT (Faʻatulagaina Tulaga Faʻatulagaina o Tofotofoga) [85]. Ina ia tausisia le le faalauaiteleina o faamatalaga e faatatau i le onosai i le nofoaga autu, o numera numera o tagata auai o le a faaaogaina e faailoa ai taunuuga o le maʻi ma faamaumauga o togafitiga. O suʻesuʻega o loʻo i ai ina ia faʻamautinoa ai o le a taofia pea tagata faigaluega masked i vaega o togafitiga.

 

Puipuiga o Tagata Auai ma Iloiloga o le Saogalemu

 

Puipuiga o Tagata Auai

 

Na faamaonia e le Komiti Faatino o Iloiloga a le GHC (IRB) lenei suʻesuʻega.

 

Mataituina o le Saogalemu

 

O lenei suega o le a mataituina mo le saogalemu e le Komiti Tutoatasi o Faamatalaga ma le Saogalemu (DSMB), e aofia ai se fomaʻi tausi maʻi muamua e masani i le mafaufau, o se tagata poto faapitoa o le soifua maloloina ma se tagata suesue i le mafaufau ma le poto masani i le togafitia o tagata mamaʻi tigaina tumau.

 

Aafiaga Mataga

 

We will collect data on adverse experiences (AEs) from several sources: (1) reports from the CBT and MBSR instructors of any participants� experiences of concern to them; (2) the 8-, 26- and 52-week CATI follow-up interviews in which the participants are asked about any harm they felt during the CBT or MBSR treatment and any serious health problems they had had during the respective time periods; and (3) spontaneous reports from participants. The project coinvestigators and a GHC primary care internist will review AE reports from all sources weekly. Any serious AEs will be reported promptly to the GHC IRB and the DSMB. AEs that are not serious will be recorded and included in regular DSMB reports. Any identified deaths of participants will be reported to the DSMB chair within 7 days of discovery, regardless of attribution.

 

Taofi Tulafono

 

Ole faamasinoga ole a taofia pe a fai e talitonu le DSMB e iai se tulaga le talafeagai o AE ogaoga i se tasi poo le sili atu foi o lima togafitiga. I lenei tulaga, e mafai e le DSMB ona filifili e faamuta se tasi o lima o le faamasinoga poo le faamasinoga atoa.

 

Faʻamaumauga Faʻamaumauga

 

Lautele ma le Faʻamatalaga Eseesega

 

Our sample size was chosen to ensure adequate power to detect a statistically significant difference between each of the two mind�body treatment groups and the usual care group, as well as power to detect a statistically significant difference between the two mind�body treatment groups. Because we considered patient activity limitations to be the more consequential of our two co�primary outcome measures, we based our sample size calculations on the modified RDQ [30]. We specified our sample size on the basis of the expected percentage of patients with a clinically meaningful improvement measured with the RDQ at the 26-week assessment (that is, at least 30% relative to baseline) [57].

 

Because of multiple comparisons, we will use Fisher�s protected least significant difference test [86], first analyzing if there is any significant difference among all three groups (using the omnibus ?2 likelihood ratio test) for each outcome and each time point. If we find a difference, we will then test for pairwise differences between groups. We will need 264 participants (88 in each group) to achieve 90% power to find either mind�body treatment different from usual care on the RDQ. This assumes that 30% of the usual care group and 55% of each mind�body treatment group will have clinically meaningful improvement on the RDQ at 26 weeks, rates of improvement that are similar to those we observed in a similar back pain population in an evaluation of complementary and alternative treatments for back pain [87]. We will have at least 80% power to detect a significant difference between MBSR and CBT on the RDQ if MBSR is at least 20 percentage points more effective than CBT (that is, 75% of the MBSR group versus 55% of the CBT group).

 

Our other co�primary outcome is the pain bothersomeness rating. With a total sample size of 264 participants, we will have 80% power to detect a difference between a mind�body treatment group and usual care on the bothersomeness rating scale, assuming that 47.5% of usual care and 69.3% of each mind�body treatment group have 30% or more improvement from baseline on the pain bothersomeness rating scale. We will have at least 80% power to detect a significant difference between MBSR and CBT on the bothersomeness rating scale if MBSR is at least 16.7 percentage points more effective than CBT (that is, 87% of the MBSR group versus 69.3% of the CBT group).

 

When analyzing the primary outcomes as continuous measures, we will have 90% power to detect a 2.4-point difference between usual care and either mind�body treatment on the modified RDQ scale scores and a 1.1-point difference between usual care and either mind�body treatment on the pain bothersomeness rating scale (assumes normal approximation to compare two independent means with equal variances and a two-sided P?=?0.05 significance level with standard deviations of 5.2 and 2.4 for RDQ and pain bothersomeness measures, respectively [88]. Assuming an 11% loss to follow-up (slightly higher than that found in our previous back pain trials), we plan to recruit a sample of 297 participants (99 per group).

 

Both of the co�primary outcomes will be tested at the P?<?0.05 level at each time point because they address separate scientific questions. Analyses of both outcomes at all follow-up time points will be reported, imposing a more stringent requirement than simply reporting a sole significant outcome.

 

Iloiloga Faʻamaumauga

 

Iloiloga a le Peraimeri

 

I a tatou faatusatusaga o togafitiga e faʻavae i luga o fua faʻatatau, o le a tatou iloiloina auiliiliga ua fuafuaina i taimi uma e tulitatao ai i se faʻataʻitaʻiga se tasi, fetuutuunai mo faʻamaoniaga talafeagai i totonu o tagata taʻitoʻatasi ma togafitiga o togafitiga e faʻaaoga ai faʻataʻitaʻiga faʻatusatusaga lautele [89]. Talu ai ona e le mafai ona tatou faia i se mafuaaga tatau se masalosaloga e uiga i eseesega eseese o kulupu i taimi uma, o le a aofia ai se fesoʻotaʻiga vavalalata i va o togafitiga ma taimi. Matou te fuafua e faʻafetaui mo tulaga taua o le iuga o le tau, feusuaiga ma le matua, faʻapea foʻi ma isi faʻamaumauga faavae e matua ese lava i vaega togafitiga poʻo taunuʻuga mulimuli, e faʻaleleia ai le saʻo ma le malosi oa matou suʻesuʻega fuainumera. O le a matou faia le faʻavasegaga o faʻataʻotoga mo le faʻaauau pea o le taunuuga o le taunuuga ma le maualalo o le iuga (suiga ogaoga mai le faavae), e aofia ai ma taimi uma o taimi e tulitatao ai (4, 8, 26 ma 52 vaiaso). O togafitiga MBSR o le a faʻamanuiaina pe afai o le 26-vaiaso le taimi e faʻatusatusa ai faʻatusatusaga. O isi taimi o manatu o le a iloiloina o iloiloga maualuga.

 

O le a tatou faʻaaogaina se faʻaaogaina o le loto-i-togafitiga uma; o lona uiga, o le iloiloga o tagata taitoatasi o le a suʻeina e ala i le faʻalapotopotoga, e tusa lava poʻo le a le auai i soʻo se vasega. O lenei auʻiliʻiliga e faʻaitiitia ai le faʻaleagaina e masani ona tupu pe a le aofia ai tagata e le mauaina ia togafitiga ua tofiaina. O le faʻataʻitaʻiga o le faigamalo o le ai ai i le faiga masani lenei:

 

 

o le tali i le taimi e tulitata ai, o le amataga o le aoga muamua lea o le iʻuga o le iʻuga, o togafitiga e aofia ai ma isi suiga mo vaega a le MBSR ma le CBT, o le taimi o se faʻasologa o suiga e faʻaalia ai taimi e mulimulitaʻi ai ma o le z o se vector o covariates faʻatusalia isi fesuiaʻiga fetuunai mo. (Manatua lena? 1,? 2,? 3 ma le? 4 o fusi.) O le vaega faʻasino i lenei faʻataʻitaʻiga o le vaega masani mo tausiga. Mo binary ma faifai pea taunuʻuga, o le a matou faʻaaogaina talafeagai fesoʻotaiga gaioiga (mo se faʻataʻitaʻiga, logit mo binary). Mo taimi e siaki ai taimi e suʻe ai le omnibus? 2 e taua tele, o le a matou suʻesuʻe pe iai se eseʻesega i le va o le MBSR ma le tausiga masani e faʻailoa ai le sini 1 ma le eseʻesega i le va o le MBSR ma le CBT e faʻatatau ai le faʻamoemoe 2. O le a matou lipotia foi le faʻatusatusaga o le CBT i le tausiga masani. A filifilia pe o le MBSR o se togafitiga lelei mo tua tiga, o le a tatou manaʻomia lena sini 1, o le faʻatusatusaga o le MBSR i le tausiga masani, e tatau ona maitauina.

 

E tusa ai ma a tatou tuai o tiga i tua, tatou te faʻamoemoe e le itiiti ifo i le 89% mulimuli, ma, afai e saʻo lena mea, o le tatou suʻesuʻega muamua o le a avea ma se suʻesuʻega atoa, e aofia ai taunuʻuga mulimuli uma. Ae ui i lea, o le a tatou fetuʻutuʻunai mo faʻasalalauga taʻiala uma o loʻo vaʻaia i le taunuʻuga, o latou tulaga o le le o iai ma eseesega i le va o togafitiga. I le fetuʻutuʻunai mo nei laupepa, matou te manatu ai o loʻo misi i le taimi o faʻataʻitaʻiga faamaumauga o loʻo misi i la matou faʻataʻitaʻiga (tuʻuina atu o faʻamaumauga autu o loʻo taulaʻi i le leiloloa o mamanu o faʻamaumauga) nai lo le leiloloa atoa i le leai. O le a tatou faia foi le suʻesuʻeina o lagona faʻapitoa e faʻaaogaina ai se auala faʻaaogaina mo tali e le mafaamatalaina e iloilo ai pe o a tatou taunuuga e malosi tele e totogi ai mafaufauga sese o loʻo misi [90].

 

Fautuaga Faufautua Afai e maua le MBSR poʻo le CBT e lelei (e fesoʻotaʻi ma le masani masani ma / poʻo le tasi i le isi) i le faʻaleleia o taunuʻuga autu i 26 poʻo 52 vaiaso, o le a matou taumafai e faʻamoemoe 3 e faʻamatalaina le aufaasālalau o aafiaga o le MBSR ma le CBT vaega luga o le RDQ ma le vevela o le vevela. O le a matou faia le faasologa o suʻega faufautua ile eseesega mo taunuʻuga autu e lua (RQQ ma le maualuga o le faʻaleagaina) ma mo faʻataʻitaʻiga eseese o le faʻapitoa (tausiga faʻapitoa i le CBT, tausiga masani ma le MBSR ma le CBT i le MBSR). O le a matou faia ni suʻesuega vaʻavaʻavaʻavaʻaiga mo taunuʻuga o le 26- ma le 52-vaiaso (pe a maua le MBSR poʻo le CBT e aoga i na taimi).

 

Next, we describe in detail the mediator analysis for the 26-week time point. A similar analysis will be conducted for the 52-week time point. We will apply the framework of the widely used approach of Baron and Kenny [91]. Once we have demonstrated the association between the treatment and the outcome variable (the �total effect� of the treatment on the outcome), the second step will be to demonstrate the association between the treatment and each putative mediator. We will construct a regression model for each mediator with the 4- or 8-week score of the mediator as the dependent variable and the baseline score of the mediator and treatment indicator as independent variables. We will conduct this analysis for each potential mediator and will include as potential mediators in the following step only those that have a P-value ?0.10 for the relationship with the treatment. The third step will be to demonstrate the reduction of the treatment effect on the outcome after removing the effect of the mediators. We will construct a multimediator inverse probability weighted (IPW) regression model [92]. This approach will allow us to estimate the direct effects of treatment after rebalancing the treatment groups with respect to the mediators. Specifically, we will first model the probability of the treatment effects, given the mediators (that is, all mediators that were found to be associated with treatment in step 2), using logistic regression and adjusting for potential baseline confounders. Using this model, we will obtain the estimated probability that each person received the observed treatment, given the observed mediator value. We will then use an IPW regression analysis to model the primary outcomes on treatment status while adjusting for the baseline levels of the outcome and mediator. Comparing the weighted model with the unweighted model will allow us to estimate how much of the direct effect of treatment on the associated outcome can be explained by each potential mediator. The inclusion in step 3 of all mediators found to be significant in step 2 will enable us to examine whether the specific variables that we hypothesized would differentially mediate the effects of MBSR versus CBT in fact mediate the effects of each treatment independently of the effects of the other �process variables�.

 

Iloiloga Taugofie-Iloiloga

 

A societal perspective cost�utility analysis (CUA) will be performed to compare the incremental societal costs revealed for each treatment arm (direct medical costs paid by GHC and the participant plus productivity costs) to incremental effectiveness in terms of change in participants� QALYs [93]. This analysis will be possible only for study participants recruited from GHC. This CUA can be used by policymakers concerned with the broad allocation of health-related resources [94,95]. For the payer perspective, direct medical costs (including intervention costs) will be compared to changes in QALYs. This CUA will help us to determine whether it makes economic sense for MBSR to be a reimbursed service among this population. A bootstrap methodology will be used to estimate confidence intervals [96]. In secondary analyses conducted to assess the sensitivity of the results to different cost outcome definitions, such as varying assumptions of wage rates used to value productivity and the inclusion of non-back-related health-care resource utilization [97] in the total cost amounts, will also be considered. In cost-effectiveness analyses, we will use intention to treat and adjust for health-care utilization costs in the one calendar year prior to enrollment and for baseline variables that might be associated with treatment group or outcome, such as medication use, to control for potential confounders. We expect there will be minimal missing data, but sensitivity analyses (as described above for the primary outcomes) will also be performed to assess cost measures.

 

Dr. Alex Jimenez's Insight

O le aʻafiaga o le tali a le tino i le malosi o le tino poʻo le mafaufau. O le tele o mea e mafai ona mafua ai le atuatuvale, ma o le mea lea e gaoioi ai le tali "tau ma le feʻaveaʻi", o se puipuiga puipui lea e saunia le tino mo mea matautia matautia. Pe a faʻavauvau, e faʻaosofia le faʻalavelave popole popole ma faʻamaloloina se faʻalavelave tuʻufaʻatasi o hormones ma vailaau. E ono mafai ona fesoasoani le faʻafitauli faʻapipiʻi, e tusa lava po o le a le tele o taimi faigata e fesootaʻi atu i le tele o mataupu tau soifua maloloina, e aʻafia ai le tiga ma sikisi sciatica. E tusa ai ma suesuega o suʻesuʻega, ua avea le pulega o popolega ma se faʻaopoopoga taua mo le tele o togafitiga faʻapitoa ona o le faʻaititia o le mamafa e mafai ona fesoasoani e faʻaleleia ai metotia o togafitiga. O le togafitiga faʻamaʻi e faʻaogaina fetuunaiga o le ogatotonu ma faʻaaogaina tusi faʻatasi ma le faʻaleleia o le olaga e togafitia ai le tui, le aʻa o le tino, ma le faʻaleleia o le faʻaititia o le mamafa o le mamafa e ala i le lelei o meaʻai, malosi ma le moe.

 

Talanoaga

 

In this trial, we will seek to determine whether an increasingly popular approach for dealing with stress�mindfulness-based stress reduction�is an effective and cost-effective treatment option for persons with chronic back pain. Because of its focus on the mind as well as the body, MBSR has the potential to address some of the psychosocial factors that are important predictors of poor outcomes. In this trial, we will compare the effectiveness and cost-effectiveness of MBSR with that of CBT, which has been found to be effective for back pain but is not widely available. The study will also explore psychosocial variables that may mediate the effects of MBSR and CBT on patient outcomes. If MBSR is found to be an effective and cost-effective treatment option for persons with chronic back pain, it will be a valuable addition to the treatment options available for patients with significant psychosocial contributors to this problem.

 

Tulaga o le Faamasinoga

 

O le faʻatupeina na amata mai i le masina o Aukuso 2012 ma na maeʻa ia Aperila 2014.

 

faapuupuuga

 

AE: Adverse event; CAM: Complementary and alternative medicine; CATI: Computer-assisted telephone interview; CBT: Cognitive-behavioral therapy; CLBP: Chronic low back pain; CUA: Cost�utility analysis; DSMB: Data and Safety Monitoring Board; GHC: Group Health Cooperative; ICD-9: International Classification of Diseases Ninth Revision; IPW: Inverse probability weighting; IRB: Institutional Review Board; MBSR: Mindfulness-based stress reduction; NCCAM: National Center for Complementary and Alternative Medicine; QALY: Quality-adjusted life-year.

 

Faʻateleina Tauiloa

 

Fai mai tusitala e leai ni a latou tauvaga.

 

Tusitala 'Saofaga

 

DC ma KS na mafaufau i le faamasinoga. DC, KS, BB, JT, AC, BS, PH, RD ma le RH na auai i le toe teuteuina o le suʻesuʻega ma le faʻatinoga o faʻatinoga ma le filifilia o fua faʻatatau. AC na atiae fuafuaga mo suʻesuʻega fuainumera faamaumauina. JT ma AC na atiae fuafuaga mo le aufaasālalau iloiloga. BS, BB ma JT na atiae mea mo le intervention a le CBT. AT fuafuaga fuafuaina mo le iloiloga o tau-aoga. DC tusia le tusitusiga. O tusitala uma sa auai i le tusiaina o tusitusiga ma faitau ma faamaonia le tusitusiga mulimuli.

 

Faʻafetai

 

The National Center for Complementary and Alternative Medicine (NCCAM) provided funding for this trial (grant R01 AT006226). The design of this trial was reviewed and approved by NCCAM�s Office of Clinical and Regulatory Affairs.

 

I le faaiuga, environmental, bodily and emotional stressors can trigger the “fight or flight response” in charge of preparing the the human body for danger. Although stress is essential to increase our performance, chronic stress can have a negative impact in the long-run, manifesting symptoms associated with back pain and sciatica. Chiropractic care utilizes a variety of treatment procedures, along with stress management methods and techniques, to help reduce stress as well as improve and manage symptoms associated with injuries and/or conditions of the musculoskeletal and nervous systems.�Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

 

Faʻailoina e Dr. Alex Jimenez

 

 

Aʻoaʻoga Faʻaopoopo: Paʻu Paʻa

 

E tusa ai ma fuainumera, e tusa ma le 80% o tagata o le a oʻo i faʻamaoniga o tiga i tua e le itiiti ifo ma le tasi i o latou olaga atoa. O le tiga mulimuli o se faasea masani lea e mafai ona mafua ona o le tele o manuaga ma / poo tuutuuga. O le tele o taimi, o le faʻaleagaina masani o le vaʻai ma le matutua e ono mafua ai le tiga. Faiga faʻamaʻi e tupu pe a tuleia le nofoaga tutotonu, pei o le gel o se pusa faʻafefefebral e ala i se loimata i lona taamilosaga, pito i fafo o le cartilage, faʻamalosi ma faʻafefe ai aʻa aʻa. O faʻasalaga faʻasalalau e masani lava ona tutupu i le pito i lalo, poʻo le lumine spine, ae e mafai foi ona tupu i luga o le tui o le au, poo le ua. O le afaina o neura e maua i le maualalo ona o le manua ma / poʻo se tulaga faʻateleina e mafai ona oʻo atu ai i faailoga o le sciatica.

 

FAʻAALIGA TOPIC: TUʻUʻU FAʻATASI: O Oe Lelei Oe!

 

 

AUTU TULAGA FAATINO: FAʻAALIGA: Taʻaloga Taʻaloga? | Vincent Garcia | Patient | El Paso, TX Chiropractor