Background/Purpose: Chronic low back pain (cLBP) is the 2^nd most common reason for physician visits; annual related costs exceed $100 billion and are expected to rise with the aging population. Older adults with cLBP experience significant physical, psychological, and social consequences. We also know that depression frequently co-exists with cLBP and complicates management. A feasible, effective behavioral intervention targeting cLBP and comorbid depression in older adults is needed. Existing interventions are not adequate or sufficient, as they have not been specifically focused on older adults, nor have they targeted both cLBP and depression simultaneously.

We developed a novel 8-session, 12-week, telephone delivered behavioral intervention targeting older adults with cLBP and comorbid depression. MOTIVATE (Moving to Improve Chronic Back Pain and Depression in Older Adults) is delivered by a health coach who uses motivational interviewing and value concordant goal setting to capture individual motivations to increase physical activity. The ultimate goal is to improve both back pain-related disability and depression.

Methods: This single-arm pilot study of MOTIVATE was conducted to refine future intervention content, procedures, and delivery based on stakeholder feedback. The PARiHS (Promoting Action on Research Implementation in Health Services) framework was used to develop the discussion guide and facilitate individual in-depth interviews with the following key stakeholder groups: Veteran participants (n=4) over the age of 65 with comorbid cLBP and depression who received MOTIVATE, primary care providers (PCP) (n=4), clinic director (n=1), and health coach (n=1).

Results: We enrolled 8 Veterans in the pilot study who were predominately white (75%), male (87%), with a mean age of 70 years. The mean pain intensity score was 7.3/10; back pain-specific Roland Morris Disability Scale was 16.5/24; and depression (PHQ-9) score was 16.7/27. Upon completion of the intervention, semi-structured interviews with stakeholders provided valuable feedback on how to modify MOTIVATE moving forward (Table 1). Briefly, Veterans who completed MOTIVATE engaged well with the health coach, were motivated to walk with a pedometer and coaching, and felt that being more active reduced pain and depression. Of the four PCPs interviewed, all attributed the success of the intervention to the personal qualities and engagement of the health coach; we also learned about the variability in how PCPs would like results relating to patient-identified values and goals to be communicated to them. The health coach noted that Veterans were able to identify value concordant goals and easily link these to physical activities. All stakeholders stated that the individual health coach plays a critical role in activating and motivating older Veterans with complex medical and psychiatric issues.

Conclusion: This pilot study showed that we were able to effectively recruit older Veterans with cLBP and depression and deliver MOTIVATE via telephone. Feedback from key stakeholders regarding the iterative refinement of recruitment, study procedures, and content will aid the future evaluation and implementation of MOTIVATE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/stakeholder-feedback-on-novel-behavioral-intervention-targeting-comorbid-chronic-back-pain-and-depression-in-older-adults/