Development and feasibility of a mind-body intervention to improve physical activity for patients with chronic hip pain

PROJECT SUMMARY Chronic hip pain affects 18.2 million adults annually, with hip-related pain (intra-articular non-arthritic hip pathologies) accounting for 60% of chronic hip pain cases in young- to middle-aged adults. Surgery and non-operative treatments for hip-related pain fail to provide ubiquitous benefit as pain and dysfunction persist for a majority of patients. Individuals with persistent pain often reduce their activity to minimize symptoms despite strong evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychosocial health (i.e., low self-efficacy, high pain catastrophizing, and kinesiophobia) is common among individuals with chronic musculoskeletal pain and further reinforces low participation in physical activity. Mind-body interventions improve psychosocial health, yet to date, have not been implemented to provide comprehensive, psychologically informed care for patients with hip-related pain. I will fill this gap through the development (Aims 1 and 2) and feasibility testing (Aim 3) of Helping Improve PSychosocial Health (HIPS), a novel, multimodal mindbody intervention to improve physical activity for sedentary individuals with hip-related pain and poor psychosocial health. Following the Fear Avoidance Model (FAM) of chronic pain, the multimodal HIPS mind-body intervention will incorporate pain education, mindfulness training, and goal-setting to improve psychosocial health and facilitate focused engagement in rehabilitation. I hypothesize that the HIPS mind-body intervention will improve physical activity among sedentary individuals with hip-related pain and poor psychosocial health. Increased physical activity will improve pain, function and overall well-being. The HIPS mind-body intervention will be delivered by physical therapists in a hybrid in-persontelephone format to reduce geographic barriers and enable the participation of patients without broadband internet access. The incorporation of mind-body interventions into psychologically informed clinical practice has demonstrated preliminary efficacy; however, evidence is lacking to support its’ broad adoption. Findings from this project will directly inform a multisite feasibility study (3-year NCCIH R01) of the HIPS mind-body intervention. Rigorous evidence of the feasibility (this K23 and future multisite feasibility RCT) and efficacy (future R01) of mind-body interventions such as HIPS, and the subsequent embedding of mind-body interventions into physical therapy clinics will provide support for the broad adoption of psychologically informed rehabilitation. The candidate’s long-term goal is to become an independent, NIH-funded scientist advancing psychologically informed rehabilitation by developing and implementing effective mind-body and rehabilitative interventions to optimize clinical outcomes and improve well-being for patients with chronic hip pain. This K23 will support this goal by providing protected time to complete critical training in mindfulness and mind-body intervention development and clinical trials to complement her expertise in physical rehabilitation and biomechanics.