Danny Bonvissuto

First-line options for patients with chronic low back pain are non-drug treatment strategies, including behavioral interventions. The emergency department (ED) setting, however, offers several challenges for implementing these treatments, including a hectic environment, limited time with providers, dedicated space to deliver these interventions and a lack of available behavioral specialists.

A two-year study, funded by a Department of Defense grant, will pilot an eight-session remote integrative health coaching program for patients who visit the ED with acute flare-ups of chronic low back pain.

The multidisciplinary team, comprised of Rogelio Coronado, PT, MPT, PhD, research assistant professor in the Department of Orthopaedic Surgery and Department of Physical Medicine and Rehabilitation; Sean Collins, MD, MSC, professor of Emergency Medicine, director of the Center for Emergency Care Research and Innovation; Ruth Wolever, PhD , NBC-HWC, director of Vanderbilt Health Coaching: Practice, Research & Education; and Kristin Archer, PT, PhD, professor of Orthopaedic Surgery, director of the Vanderbilt Center for Musculoskeletal Research, will assess the helpfulness of the program to refine it for a larger study.

“Through our feasibility work with the ED team, we have developed an approach that we think will overcome these barriers,” Coronado said. “Beginning in the ED, we plan to connect patients with a health coach and extend this intervention beyond the ED setting to help patients self-manage their pain and to make and sustain important lifestyle changes that promote health and well-being.”

Patients who enroll in the study will be randomly assigned to different arms: remotely delivered integrative health coaching or remotely delivered education. According to Wolever, those assigned to the health coaching arm will meet online with their personal coach to explore what matters to them about their back pain across many parts of their lives.

“While there are some global things that most people care about — feeling better, being able to function — what ‘functioning well’ means to one person is different than it is to another,” she said.

The coach will help the patient define what they want for themselves and assist the patient in sorting out what they want to do to move toward their best selves.

“The coach won’t tell patients what to do but will empower them to create small steps that are doable to help themselves, based on what their providers have told them and what they know about themselves,” Wolever said. “Patients can actually have a lot of power over their own healing paths. The coach is a partner to help put them on their own tailored path and keep them moving toward what they care about.”

Each patient will participate in the study for approximately six months. In addition to participating in the intervention, patients will complete measures about their experiences with the programs and their functioning, pain and disability.

“We are testing a pain management strategy using methods that have been successful in many of our other ED interventions,” Collins said. “We have found if we engage the patient during their initial ED encounter as part of a longer-term intervention, there is better patient engagement and an opportunity to provide sustained improvement in their condition. We are hopeful this methodology will see similar success in patients with acute exacerbations of their chronic low back pain. If our intervention is successful, this would provide a care option not previously available in a condition frequently encountered in the ED.”