执业护士可为患有慢性疼痛的骨关节炎患者有效提供疼痛应对技能培训：一项随机对照试验。
Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial.
作者信息
Broderick Joan E, Keefe Francis J, Bruckenthal Patricia, Junghaenel Doerte U, Schneider Stefan, Schwartz Joseph E, Kaell Alan T, Caldwell David S, McKee Daphne, Reed Shelby, Gould Elaine
机构信息
Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA School of Nursing, Stony Brook University, Stony Brook, NY, USA Department of Internal Medicine, Rheumatology, Stony Brook University, Stony Brook, NY, USA Department of Radiology, Stony Brook University, Stony Brook, NY, USA.
出版信息
Pain. 2014 Sep;155(9):1743-1754. doi: 10.1016/j.pain.2014.05.024. Epub 2014 May 24.
A multisite, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners provided a 10-session intervention, pain coping skills training (PCST), in patients' doctors' offices (N=129 patients); the control group received usual care (N=127 patients). Primary outcomes assessed at baseline, posttreatment, 6-month follow-up, and 12-month follow-up were: pain intensity, physical functioning, psychological distress, self-efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary ITT and secondary per-protocol analyses were conducted. Attrition was within the expected range: 11% at posttreatment and 29% at 12-month follow-up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared with the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self-efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self-efficacy, were maintained through the 12-month follow-up; effects for self-efficacy degraded over time. Per-protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more vs less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of nurse practitioner delivery of PCST for chronic osteoarthritis pain.
针对患有膝关节或髋关节慢性疼痛的骨关节炎患者进行了一项多中心、随机、对照临床疗效试验。成年健康护士从业者在患者的医生办公室为患者提供了为期10节的干预措施，即疼痛应对技能培训（PCST）（N = 129例患者）；对照组接受常规护理（N = 127例患者）。在基线、治疗后、6个月随访和12个月随访时评估的主要结局包括：疼痛强度、身体功能、心理困扰、自我效能感、灾难化思维、应对策略的使用和生活质量。次要指标包括疲劳、社交功能、健康满意度和止痛药物的使用。采用了有利于外部效度的方法，这些方法与实用的疗效研究一致。进行了主要的意向性分析（ITT）和次要的符合方案分析。失访率在预期范围内：治疗后为11%，12个月随访时为29%；两组之间的失访率没有差异。对所有评估点进行的综合ITT分析表明，与对照组相比，PCST组在疼痛强度、身体功能、心理困扰、疼痛应对策略的使用、自我效能感，以及疲劳、健康满意度和止痛药物使用减少方面有显著改善。治疗效果对协变量（人口统计学和临床地点）具有稳健性。检查了各评估点结局的趋势。除自我效能感外，所有结局在12个月的随访中均得以维持；自我效能感的效果随时间下降。符合方案分析未得出更大的效应量。对PCST治疗依从性较高与较低的患者进行比较，结果表明高依从性患者的疗效更佳。结果支持护士从业者提供PCST对慢性骨关节炎疼痛的有效性。
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