Project Summary The UCSF Core Center for Patient-centric Mechanistic Phenotyping in Chronic Low Back Pain (REACH) is a U-19 Back Pain Consortium (BACPAC) Mechanistic Research Center (MRC), funded by the Helping to End Addiction Long-term (HEAL) initiative. As an MRC, REACH is focused on discovery of chronic low back pain (cLBP) mechanisms, generating data for deep phenotyping, and developing algorithms that allow targeting of therapies to individual patients. REACH is led by Jeffrey Lotz, PhD, the David S. Bradford M.D. Endowed Chair in Orthopaedic Surgery at UCSF, and Vice Chair of Research within the Department, and Conor O'Neill, MD, Director of the Department's Non-Operative Spine Program. Other REACH investigators include collaborators at UC Davis, UC Irvine, and UC San Diego. The UCSF Core Center for Patient-centric Mechanistic Phenotyping in Chronic Low Back Pain (REACH) is a U- 19 Back Pain Consortium (BACPAC) Mechanistic Research Center (MRC), funded by HEAL. As an MRC, REACH is focused on discovery of cLBP mechanisms and phenotypes, which will ultimately lead to precision medicine for cLBP. REACH is conducting two longitudinal cohort studies, comeBack and BackHome. In both studies, data elements from psychological, biological, and social domains are measured. BackHome is a site-less, digital study that does not require an in-person visit. All data is collected from patient surveys (i.e., light phenotyping). In comeBack, light phenotyping is augmented by a number of deep phenotyping measures that require an in-person visit (e.g., MRI, physical function testing, quantitative sensory testing, blood draw). The duration of each study is two years. The target enrollment for comeBack is 400 subjects, and for BackHome 5000 subjects. Enrollment from UCSF will be supplemented by collaborators at three other University of California locations (Davis, Irvine, and San Diego). In addition to comeBACK and BackHome, REACH will be participating in the BACPAC Collaborative Clinical Study (CCS), which is scheduled to start enrolling subjects from a number of sites across the US in February of 2022. The CCS will utilize a sequential, multiple assignment randomized trial (SMART) design to identify phenotypes associated with response to cLBP treatments. It is vital that cLBP study participants reflect the diversity of the United States population. To date, however, minorities have been under-represented in back pain study enrollment. The objective of our proposal is to optimize diversity and inclusion in REACH cLBP studies.

Project Narrative The overall goal of the UCSF BACPAC Mechanistic Research Center (REACH- the UCSF Core Center for Patient-centric Mechanistic Phenotyping in Chronic Low Back Pain) is to define chronic low back pain (cLBP) phenotypes and pain mechanisms that can lead to effective, personalized treatments for patients across the population. To achieve this goal REACH is presently conducting two longitudinal cohort studies, comeBack and BackHome, and will be participating in the BACPAC consortium-wide Collaborative Clinical Study, a randomized- controlled trial that will begin enrollment in 2022. In order to ensure participant diversity in these studies we propose to 1) adapt methods that have been successful in improving minority participation in other settings but have not previously been used in back pain research; and 2) develop and deploy digital strategies designed to promote both patient engagement and recruitment from marginalized populations