Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a Whole Health Telehealth Intervention - UG3 Pilot Study

Pain is a complex biophysical, psychological, and social condition and there is a growing evidence base to support several complementary and integrative health (CIH) approaches, which can address pain in a more holistic way. While the VA has become a leader in advancing CIH through its Whole Health Initiative, there remain many barriers, especially for rural patients. This pilot study will assess the feasibility of an innovative telehealth evidence-based intervention for rural VA patients with chronic pain: the Reaching Rural Veterans: Applying Mind-Body Skills for Pain Using a Whole Health Telehealth Intervention (RAMP). RAMP was developed with multiple-levels of VA stakeholders (including rural patients). It was designed to deliver multiple CIH self-management strategies (pain education, mindfulness, pain specific exercises, and cognitive behavioral strategies) in one intervention, to overcome existing barriers to care and improve rural Veterans' pain and important biopsychosocial outcomes.

• RAMP program (Behavioral): The RAMP program is a 12-week virtual program consisting of an individual session (50 minutes) with a Whole Health Coach followed by 11 weekly interactive group sessions (90 minutes each) with pre-recorded expert led education videos, mind-body skill training and practice, and facilitated discussions.

Primary outcomes

• Participants Recruited [3 months]: Number of participants recruited
• Female Participants Recruited [3 months]: Percentage of Female Participants Recruited
• Racial/Ethnic Minoritized Participants Recruited [3 months]: Percentage of Racial/Ethnic Minoritized Participants Recruited
• Participant Satisfaction [3 months]: Percentage of Participants Who Report Being "Somewhat Satisfied" or "Very Satisfied" with the Program on a 7-point Scale
• Participant Engagement [3 months]: Percentage of participants who participated in at least 7 out of 12 sessions either by attending the group session (i.e., synchronous participation) or reporting that they completed any of the session activities on their own (i.e., asynchronous participation)
• Fidelity of Intervention Delivery [3 months]: Two experts in developing and delivering mind-body interventions for pain independently observed 10% of sessions via videoconference using a structured checklist.
• Survey Response Rate [3 month]: Percentage of participants completing post-treatment data collection

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Veteran participants must be rural dwelling
* Patient's Veterans Affairs (VA) primary care provider is in the Southeast region of the US
* Email address in the VA electronic health record (EHR)
* Report pain at least most days in the past 3 months
* Brief Pain Inventory (BPI) Pain Interference subscale score of 4 or greater
* Willingness and ability to complete study activities including meeting remotely via videoconferencing when program sessions are held

Exclusion Criteria:

* Participation in a prior project conducted by the study team on mindfulness for pain (NCT0456158) or an engagement activities advisor for the current project
* Current enrollment in a research study for pain
* Current enrollment in a similar facilitated, multi-week, multi-modal CIH program
* Severe, poorly controlled psychiatric or substance use disorder (based on chart review using structured checklists, conducted by trained staff who are trained and supervised by a clinical psychologist)

Participant flow

Outcome results

• Participants Recruited (Primary), Count of participants, Participants: Intervention 40
• Female Participants Recruited (Primary), Count of participants, Participants: Intervention 21
• Racial/Ethnic Minoritized Participants Recruited (Primary), Count of participants, Participants: Intervention 22
• Participant Satisfaction (Primary), Count of participants, Participants: Intervention 26
• Participant Engagement (Primary), Count of participants, Participants: Intervention 27
• Fidelity of Intervention Delivery (Primary), Count of units, sessions: Intervention 6
• Survey Response Rate (Primary), Count of participants, Participants: Intervention 30

Adverse events

Time frame: From consent until 30 days after the last day of study participation (5 months on average).

• Study Protocol and Statistical Analysis Plan (PDF, 2025-08-22)