背景:慢性腰背(cLBP)疼痛患者的身体功能和参与社会角色的能力下降,更有可能使用阿片类止痛药。虽然自我管理干预措施已被证明可以支持这些患者,由于患者参与度差,其有效性受到限制。“患者激活”包括技能,知识,以及一个人管理健康的动机。支持患者激活可能会提高cLBP自我管理的有效性。
方法:在这项对患有cLBP的成年人进行的单掩蔽试验研究中,患者被随机分配接受无干预(对照)或每周6次基于证据的网络自我管理计划(SMP),有或没有使用动机性访谈的健康行为改变咨询(HBCC).参与者在基线和12周和26周使用患者激活测量进行评估,Oswestry残疾指数和PROMIS身体功能,社会角色参与,和疼痛干扰。我们根据招聘情况评估了可接受性和可行性,会议出席,和后续行动。
结果:在接受筛查的187个人中,105人符合条件,34人随机进入对照(n=12),SMP(n=4),或SMP+HBCC(n=18)。人口中有19名妇女,22名患者已婚或与其他重要的人生活在一起,13名黑人或非裔美国患者,和4名西班牙裔或拉丁裔患者。参与者的平均(SD)Oswestry残疾指数得分为42(12),身体功能中度受损(40(6.6))和社会角色中度受损(45(10)),和中度重度疼痛干扰(61(6.7))。在接收SMP会话的22名参与者中,20人参加至少1次,15人参加至少3次,7人参加全部6次。在26周的研究中,随访损失为6。在12周时,SMP和SMPHBCC组的参与者在患者激活量测量中至少有中等效应大小的改善,在Oswestry残疾指数评分和身体功能中至少有中等效应大小的改善,以及在社会角色中的大效应大小的改善。SMP+HBCC组在26周时持续改善。
结论:基于网络的SMP在该人群中是可以接受和可行的。接受HBCC增强的参与者在26周时健康结果持续改善。
背景:ClinicalTrials.gov标识符NCT06236529(2/1/2024-回顾性注册)。
方法:
BACKGROUND: Patients with chronic low back (cLBP) pain report reduced physical function and ability to participate in social roles and are more likely to use opioid pain medications. While self-management interventions have been shown to support these patients, their effectiveness has been limited due to poor patient engagement. \"Patient activation\" encompasses the skills, knowledge, and motivation that a person has to manage their health. Supporting patient activation may improve the effectiveness of self-management for cLBP.
METHODS: In this single-masked pilot study of adults with cLBP, patients were randomized to receive either no intervention (control) or 6 weekly sessions of an evidence-based web-based self-management program (SMP) with or without health behavior change counseling (HBCC) using motivational interviewing. Participants were assessed at baseline and at 12 and 26 weeks using the Patient Activation Measure, Oswestry Disability Index and PROMIS physical function, social role participation, and pain interference. We assessed acceptability and feasibility based on recruitment, session attendance, and follow-up.
RESULTS: Of 187 individuals screened, 105 were eligible and 34 were randomized to control (n = 12), SMP (n = 4), or SMP + HBCC (n = 18). The population had 19 women, 22 patients married or living with significant other, 13 Black or African American patients, and 4 Hispanic or Latino patients. Participants had a mean (SD) Oswestry Disability Index score of 42 (12), moderate impairments in physical function (40 (6.6)) and social roles (45 (10)), and moderately severe pain interference (61 (6.7)). Of 22 participants receiving SMP sessions, 20 participated in at least 1, 15 participated in at least 3, and 7 participated in all 6 sessions. Loss to follow-up was 6 over the 26-week study. Participants in the SMP and SMP + HBCC groups had at least medium effect size improvements in Patient Activation Measures and small-to-medium effect size improvements in Oswestry Disability Index scores and physical function and large effect size improvement in social roles at 12 weeks. Improvements persisted in the SMP + HBCC group at 26 weeks.
CONCLUSIONS: A web-based SMP is acceptable and feasible in this population. Participants who received augmentation with HBCC had persistent improvements in health outcomes at 26 weeks.
BACKGROUND: ClinicalTrials.gov Identifier NCT06236529 (2/1/2024 - retrospectively registered).
METHODS: