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针对有疼痛相关残疾风险的工人的早期心理干预:根据个人情况匹配治疗是否能改善结果?

Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?

作者信息

Bergbom Sofia, Flink Ida K L, Boersma Katja, Linton Steven J

出版信息

J Occup Rehabil. 2014 Sep;24(3):446-57. doi: 10.1007/s10926-013-9478-1.

DOI:10.1007/s10926-013-9478-1
PMID:24077863
Abstract

PURPOSE

This randomized controlled trial had two main aims. The first aim was to investigate the effect of early preventive, psychologically informed, interventions for pain-related disability. The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions.

METHODS

A total of 105 participants were recruited from their workplace, screened for psychological risk factors and classified as being at risk for long-term pain-related disability. They were subgrouped into one of three groups based on their psychological profile. Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles. Half of the participants were assigned a matched intervention developed to target their specific profile, and half were assigned an unmatched intervention. After treatment, repeated measure ANOVAs and v2 tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability, sick leave, fear and avoidance, pain catastrophizing and distress, and if matched participants had better outcomes than did unmatched.

RESULTS

Treatments had effects on all outcome variables (effect sizes d ranging between 0.23 and 0.66), but matched participants did not have better outcomes than unmatched.

CONCLUSIONS

Early, preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure. More in-depth research of the process of matching is needed.

摘要

目的

这项随机对照试验有两个主要目标。第一个目标是研究早期预防性的、基于心理学知识的干预措施对疼痛相关残疾的影响。第二个目标是探究与专门针对其心理风险状况的干预措施相匹配的人是否比未匹配干预措施的人有更好的结果。

方法

从工作场所招募了总共105名参与者,对其进行心理风险因素筛查,并归类为有长期疼痛相关残疾风险的人。根据他们的心理状况,将他们分为三组中的一组。针对三种风险状况分别开发了三种以行为为导向的心理干预措施。一半的参与者被分配了一种针对其特定状况开发的匹配干预措施,另一半被分配了一种不匹配的干预措施。治疗后,使用重复测量方差分析和卡方检验来确定治疗是否对包括感知到的残疾、病假、恐惧和回避、疼痛灾难化和痛苦等主要和次要结果有影响,以及匹配的参与者是否比未匹配的参与者有更好的结果。

结果

治疗对所有结果变量都有影响(效应大小d在0.23至0.66之间),但匹配的参与者并没有比未匹配的参与者有更好的结果。

结论

早期预防性干预措施对多个结果变量有影响,但难以实现匹配程序。需要对匹配过程进行更深入的研究。

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