1 Department of Anesthesia, Veterans Affairs Health Care System, Integrative Health, Adjunct College of Nursing, University of Utah , Salt Lake City, UT.
J Altern Complement Med. 2010 Aug;16(8):823-35. doi: 10.1089/acm.2009.0510.
The purpose of this longitudinal outcome research study was to determine the effectiveness of the Integrative Health Clinic and Program (IHCP) and to perform a subgroup analysis investigating patient benefit. The IHCP is an innovative clinical service within the Veterans Affairs Health Care System designed for nonpharmacologic biopsychosocial management of chronic nonmalignant pain and stress-related depression, anxiety, and symptoms of post-traumatic stress disorder (PTSD) utilizing complementary and alternative medicine and mind-body skills.
A post-hoc quasi-experimental design was used and combined with subgroup analysis to determine who benefited the most from the program. Data were collected at intake and up to four follow-up visits over a 2-year time period. Hierarchical linear modeling was used for the statistical analysis. The outcome measures included: Health-Related Quality of Life (SF-36), the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Subgroup comparisons included low anxiety (BAI < 19, n = 82), low depression (BDI < 19, n = 93), and absence of PTSD (n = 102) compared to veterans with high anxiety (BAI > or = 19, n = 77), high depression (BDI > 19, n = 67), and presence of PTSD (n = 63).
All of the comparison groups demonstrated an improvement in depression and anxiety scores, as well as in some SF-36 categories. The subgroups with the greatest improvement, seen at 6 months, were found in the high anxiety group (Cohen's d = 0.52), the high-depression group (Cohen's d = 0.46), and the PTSD group (Cohen's d = 0.41).
The results suggest IHCP is an effective program, improving chronic pain and stress-related depression, anxiety, and health-related quality of life. Of particular interest was a significant improvement in anxiety in the PTSD group. The IHCP model offers innovative treatment options that are low risk, low cost, and acceptable to patients and providers.
本纵向结局研究旨在确定综合健康诊所和计划（IHCP）的有效性，并进行亚组分析以调查患者获益。IHCP 是退伍军人事务医疗保健系统内的一项创新临床服务，旨在通过补充和替代医学以及身心技能，对慢性非恶性疼痛和与压力相关的抑郁、焦虑和创伤后应激障碍（PTSD）症状进行非药物的生物心理社会管理。
采用事后准实验设计，并结合亚组分析，以确定谁从该计划中获益最多。数据在 2 年时间内，于入组时和最多 4 次随访时收集。使用分层线性建模进行统计分析。结果测量包括：健康相关生活质量（SF-36）、贝克抑郁量表（BDI）和贝克焦虑量表（BAI）。亚组比较包括低焦虑（BAI<19，n=82）、低抑郁（BDI<19，n=93）和无 PTSD（n=102）与高焦虑（BAI≥19，n=77）、高抑郁（BDI>19，n=67）和 PTSD 患者（n=63）进行比较。
所有比较组的抑郁和焦虑评分均有所改善，一些 SF-36 类别也有所改善。在 6 个月时，观察到最大改善的亚组是高焦虑组（Cohen's d=0.52）、高抑郁组（Cohen's d=0.46）和 PTSD 组（Cohen's d=0.41）。
结果表明 IHCP 是一种有效的计划，可以改善慢性疼痛和与压力相关的抑郁、焦虑和健康相关生活质量。特别有趣的是 PTSD 组的焦虑显著改善。IHCP 模式提供了创新的治疗选择，这些选择风险低、成本低，并且患者和提供者都能接受。
