背景:评估是慢性疼痛康复的重要组成部分,应根据当前疼痛的生物心理社会概念化进行评估,以捕捉疼痛的主观性和背景。然而,疼痛评估通常从生物医学框架进行.为脊柱疼痛临床医生提供了接受和承诺疗法(ACT)课程,作为促进更多以人为本和以心理社会为中心的评估以及相关的心理知情实践的框架。这项定性研究的目的是探讨在临床医生参加ACT课程之前和之后,在评估情况下,临床医生与患有脊柱疼痛的患者进行交流的口头内容。
方法:由来自不同专业的6名脊柱疼痛临床医生对慢性下腰痛患者进行的疼痛评估是音频记录和转录的。这是在参加为期八天的ACT课程之前和之后完成的,并进行了四次监督。两位作者对所有材料进行了主题分析,并对课程前和课程后的代码应用数量进行了比较,作为变化的指标。
结果:数据包括23名不同患者(12名患者参与疗程前)的6名临床医生的转录本。通过分析,开发了11个代码,它们集中在三个总体主题上:心理领域,通信技术,干预要素。总的来说,从课前到课后,成绩单中许多代码的应用有所增加,然而,不同的代码有很大的差异。增长主要与生活价值观和基于价值的行动和生活质量的讨论以及镜像的使用有关,挑战信念和假设,解决应对和起搏问题。
结论:虽然并非所有因素都如此,本研究结果表明,在ACT课程后,包括心理因素和人际沟通技巧的使用有所增加。然而,由于设计原因,本研究报告的变化是否反映了临床上有价值的变化,以及它们是否归因于ACT训练本身,目前尚不清楚.未来的研究将提高我们对评估实践中这种干预的有效性的理解。
BACKGROUND: Assessment is an important part of chronic pain rehabilitation and should be conducted in line with the current biopsychosocial conceptualization of pain to capture the subjectivity and context of pain. However, pain assessment is commonly conducted from a biomedical framework. A course in Acceptance and Commitment Therapy (ACT) was provided to spinal pain clinicians as a framework to promote more person-centered and psychosocially focused assessments and related psychologically informed practices. The purpose of this qualitative
study was to explore the verbal content of clinicians\' communication with patients experiencing spinal pain in assessment situations before and after clinicians participated in an ACT course.
METHODS: Pain assessments of patients with chronic low back pain conducted by six spinal pain clinicians from different professions were audio-recorded and transcribed. This was done before and after participation in an eight-day ACT course with four following supervisions. A thematic analysis was carried out by two authors across all material, and a comparison of the applied number of codes pre-course and post-course was carried out as an indicator of change.
RESULTS: Data consisted of transcripts from the six clinicians across 23 different patients (12 before course participation). Through analysis, 11 codes were developed, which were clustered in three overarching themes: Psychological domains, Communication Techniques, and Intervention Elements. Overall, there was an increase in the application of many of the codes in the transcripts from pre-course to post-course, however with large differences across codes. Increases were primary related to the discussion of life values and value-based action and quality of life as well as the employment of mirroring, challenging beliefs and assumptions, and addressing coping and pacing.
CONCLUSIONS: While not the case for all factors, the present findings indicate an increase in including psychological factors and employing interpersonal communication skills after a course in ACT. However, it remains unknown due to the design if the changes reported in this
study reflect a clinically valuable change and whether they are due to the ACT training itself. Future research will improve our understanding of the effectiveness of this type of intervention in assessment practices.