背景:慢性肌肉骨骼疼痛在服务不足社区的老年人中普遍存在且致残。在老年人中,心理社会疼痛管理比药物治疗更有效。然而,服务不足的社区诊所往往缺乏社会心理治疗,部分原因是缺乏训练有素的提供者。共享医疗预约,患者接受简短的医学评估,监测,咨询,和团体支持,是在服务不足的诊所中进行慢性病管理的有效且具有成本效益的方法,减少对专业提供商的需求。然而,共享医疗访问通常对慢性疼痛无效,可能是由于缺乏与老年人最相关的技能(例如,起搏以增加对日常活动的参与度)。
目的:我们已经描述了针对患有慢性疼痛的老年人的GetActive+身心活动干预的开发和初步有效性测试方案。GetActive+改编自GetActive,一项基于证据的干预措施可改善大多数富裕的白人成年人的疼痛结局。我们的目标是建立初步的可行性,可接受性,保真度,以及GetActive+在社区诊所中作为共享医疗预约的一部分交付时的有效性。
方法:我们对慢性疼痛的提供者(n=25)和讲英语的老年人(年龄≥55岁;n=18)进行了定性焦点小组和个人访谈,以了解该人群的疼痛经历。对干预内容的看法,以及在这种情况下参与和实施干预的障碍和促进者。正在对讲西班牙语的老年人进行定性访谈,并将为未来的公开试点提供西班牙语干预的信息。我们目前正在进行一项开放的试点研究,以英语进行离职面试(总共n=30人)。主要结局是可行性(≥75%的患者同意参与),可接受性(≥75%的登记患者完成10个疗程中的8个;定性),和保真度(≥75%的会话组件按预期交付)。次要结果包括身体功能自我报告,基于性能(6分钟步行测试),和客观(步数)和情绪功能(抑郁和焦虑)。其他评估包括推定机制(例如,正念和痛苦灾难化)。
结果:我们于2022年11月开始为定性阶段和2023年5月的开放试点阶段招募参与者。我们与提供者和讲英语的患者完成了定性阶段,结果正在使用混合动力车进行分析,归纳-演绎方法。我们对这些数据进行了快速分析,以在英语开放试点之前开发GetActive+,包括提高语言的可读性和清晰度,减少教授的技能数量,以增加个人入住和团体参与的时间,并增加经验练习以提高技能。
结论:我们为完善社区诊所中患有慢性疼痛的老年人的身心活动干预以及纳入共享医疗就诊提供了蓝图。它将告知未来,充满动力,GetActive+帮助解决老年人慢性疼痛流行的有效性实施试验。
背景:ClinicalTrials.govNCT05782231;https://clinicaltrials.gov/study/NCT05782231。
■DERR1-10.2196/52117。
BACKGROUND: Chronic musculoskeletal pain is prevalent and disabling among older adults in
underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However,
underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in
underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities).
OBJECTIVE: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic.
METHODS: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing).
RESULTS: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake.
CONCLUSIONS: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in
underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults.
BACKGROUND: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231.
UNASSIGNED: DERR1-10.2196/52117.