A pilot study of the RAMP intervention suggests that a multimodal, telehealth-delivered intervention is both feasible and acceptable for rural veterans experiencing chronic pain. The findings demonstrate how mind-body and exercise strategies can be successfully delivered to populations that typically face significant barriers to specialized care.
The article was published online ahead of print in Contemporary Clinical Trials.
RAMP, an NIH Collaboratory Trial, is evaluating the use of a mind-body skills training program for rural veterans with chronic pain within the Department of Veterans Affairs (VA) Whole Health initiative.
Veterans living in rural areas experience a higher prevalence of chronic pain than their urban counterparts but often lack access to nonpharmacologic treatments due to travel distances and a shortage of local providers. While the VA has prioritized nonpharmacologic self-management, these programs remain underused among patients in rural areas and patients from marginalized groups. The RAMP intervention was designed to overcome these obstacles by providing a comprehensive self-management program directly to veterans in their homes.
The pilot study enrolled 40 rural VA patients with moderate to severe chronic pain. The intervention consisted of 12 telehealth sessions facilitated by trained health coaches. The sessions included an initial individual session to set personal health goals; 11 weekly group sessions featuring expert-led educational videos, physical exercises, and mind-body skill-building; and instruction in cognitive behavioral strategies, mindfulness, and pain-specific mobility exercises.
The pilot study met several key milestones for feasibility and acceptability. Ninety percent of participants expressed satisfaction with the intervention, and 82% stated they would recommend the program to other veterans with chronic pain. The facilitators successfully delivered 100% of the planned session activities, demonstrating high fidelity to the RAMP program model.
Participants reported that RAMP enhanced their capabilities, opportunities, and motivation to manage their pain. Specifically, the participating veterans felt more confident in their ability to handle “flare-ups,” manage stress, and incorporate physical activity into their daily lives.
“Pilot results demonstrated that RAMP is feasible and acceptable to rural Veterans with chronic pain,” the authors concluded. Because the program uses nonclinician health coaches, it has the potential to be easily integrated into existing VA clinical workflows to reach millions of rural-dwelling veterans.
The research team identified several strategies to optimize the RAMP intervention for a larger, upcoming randomized trial. To reduce participant burden and improve retention, the team plans to shorten the program from 12 to 9 weeks, provide more examples tailored to the rural veteran experience, and introduce text message reminders.
The RAMP trial is supported within the NIH Pragmatic Trials Collaboratory through the NIH HEAL Initiative by a grant from the National Institute of Nursing Research.