Spine pain is among the most common musculoskeletal complaints in the workplace, with a high prevalence among racial/ethnic minorities and an estimated annual cost of up to $100 billion in reduced productivity and lost wages. Spine pain also reduces quality of life for affected individuals and their families. Hispanics/Latinos report more frequent and severe episodes of work-related musculoskeletal pain than Caucasians, yet most existing interventions for chronic spine pain have been developed and tested in predominantly Caucasian populations. Consistent with the Department of Human Health National Pain Strategy, our long-term goal is to develop accessible, effective, and culturally informed management strategies for individuals with chronic spine pain to reduce disparities in pain prevention and management. The current application proposes a multi-site randomized controlled clinical trial (RCT) to assess the feasibility, acceptability, and efficacy of a 6-week cognitive-behavioral-based physical therapy (CBPT) tele-rehabilitation intervention for Hispanics/Latinos with chronic spine pain from medically underserved urban and rural communities. In Phase I, we will conduct formative research with focus groups to adapt a CBPT intervention that has proven effective for optimizing rehabilitation outcomes after lumbar spine surgery to the conservative management of chronic spine pain in Hispanics/Latinos. In Phase II, we will conduct a multi-site RCT to assess the efficacy of the adapted CBPT tele-rehabilitation program compared to usual care in Hispanics/Latinos from urban and rural communities. We also will use ecological momentary assessment and wearable sensor technologies to explore psychological, behavioral, and environmental predictors and mediators of treatment response. Together, these aims will inform the design of future studies to determine best practices for dissemination and implementation of the CBPT tele-rehabilitation intervention among Hispanics/Latinos with chronic spine pain with the ultimate goal of reducing health disparities in pain management.
