ABSTRACT
Methods: Veterans completed the 8-week MBSR incorporated with Integrative Health interventions, including health coaching and other wellbeing services at a VA Medical center. Participants received objective assessments at baseline and after the 8-week course for PHQ-9,GAD-7, PSS, and SF-36. At the end of the program, participants completed a qualitative survey to evaluate their motivation and program experiences. Results: Among the fifty-seven participants who completed the MBSR between 2019 and 2020, thirty-nine participants completed the course in traditional face-to-face format, and seventeen enrolled throughWebEx platformduring pandemic. Across all MBSR participants, statistically significant changes were found at completion, including lower levels of perceived stress (d = 1.018 [0.672, 1.357]), improvements to anxiety (d = 1.161 [0.818, 1.498]), and depression (d = 0.926, [0.609, 1.237]) symptoms. Similarly, perceptions of health also showed meaningful improvements in the categories of SF-General Health (d = -0.692, [-1.015, -0.363]), SF-Vitality (d = -0.549, [-0.860, -0.233]), SF-Social Functioning (d = -0.766, [-1.095, -0.429]), SF-Role Emotional (d = -0.657, [-0.976, -0.331]), SFMental Health (d = -1.740, [-1.067, -0.406]). There was no statistical difference between outcomes for participants who utilized telehealth and face-to-face format, suggesting that Telehealth MBSR within an IHC setting is plausible. Four major clusters of themes were identified: improve isolation and loneliness, improve stress from pandemic, endorse course content and structure, and technical challenging of telehealth. Background: Determine if mindfulness-based stress reduction (MBSR) in an integrative healthcare (IHC) clinical setting can improve patients' depression, stress, anxiety, quality of life, and other wellbeing during COVID 19 pandemic. Conclusion: Participating in the MBSR within an integrative healthcare setting can be successfully delivered through telehealth and in person, resulting in clinical improvements of depression, anxiety, perceptions of stress, and quality-of-life. Face-to-face and Telehealth MBSR with IHC focus have promising potential to improve Veterans' mental health burden and overall wellbeing.
ABSTRACT
Methods: Target enrollment in the wHOPE (Whole Health Options in Pain Education) trial is 750 veterans with moderate to severe chronic pain from five geographically diverse VA facilities across the U.S. We are creating an inclusive and generalizable sample through few exclusion criteria, over-sampling and stratified randomization, prioritizing women veterans and those prescribed opioids, while closely monitoring racial and ethnic diversity. The primary aim of the trial is to determine whether a Whole Health Team (WHT) (interdisciplinary Whole Health/integrative pain team) is superior to Primary Care Group Education (PC-GE, abbreviated group Cognitive Behavioral Therapy for Chronic Pain), and whether both are superior to Usual Primary Care (UPC) in decreasing pain interference and secondarily, in improving quality of life and use of non-pharmacological modalities to manage chronic pain. An implementation evaluation and budget impact analysis will provide information about feasibility, maintenance, and sustainability. Descriptive statistics characterized wHOPE study participants including COVID-19-related impacts. Results: To date, of 248 randomized participants, mean age is 60.2 (SD+/-12.3) years;39% women;23% Black or African American and 9.2% Hispanic/Latinx;27% were prescribed opioids. Roughly half endorsed moderate to severe depression, moderate PTSD symptoms, and 58% reported sleep difficulties. Roughly 20% engaged in hazardous drinking and 10% problem drug use. At baseline, veterans reported high rates of non-pharmacological and CIH pain management, e.g., mindfulness (42%);spinal manipulation (32%). As a result of COVID, wHOPE participants reported worsening: mental and emotional health (73%);access to healthcare (59%);pain intensity (48%) and use of tobacco (44%) and cannabis products (36%). Background: To conduct a pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Conclusion: This ongoing multi-site pragmatic trial in a diverse group of veterans with chronic pain and high rates of comorbidity indicates high baseline use of CIH and substantial negative COVID-related impacts.