Arvidsdotter Tina, Marklund Bertil, Taft Charles, Kylén Sven
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Research and Development Unit, Primary Health Care Fyrbodal, Vänersborg, Sweden.
BMC Complement Altern Med. 2015 Apr 26;15:132. doi: 10.1186/s12906-015-0654-z.
Psychological distress is associated with impaired health-related quality of life (HRQL) and poor sense of coherence (SOC). In a previous study, we found that therapeutic acupuncture (TA) and an integrative treatment that combined TA with person-centred approach in a salutogenic dialogue (IT) alleviated anxiety and depression significantly more than conventional treatment (CT) in primary care patients. Here, we report on secondary analyses regarding the HRQL and SOC from that previous pragmatic randomised controlled trial (RCT).
Quantitative and qualitative design. One hundred twenty patients were referred for psychological distress. Quantitative analyses were performed at baseline and after 8 weeks of treatment using the SF-36 mental component summary (MCS), physical component summary (PCS) and the Sense of Coherence-13 (SOC) questionnaires. Qualitative manifest content analyses were based on open-ended questions-"Have you experienced any changes since the start of the treatment? Will you describe these changes?"
No baseline differences were found. At 8 weeks, both the IT and TA groups had statistically better scores and greater improvement from baseline on the MCS and SOC than the CT group. The effect sizes were large. No significant differences were found between the IT and TA groups or in relation to the PCS. SOC was highly correlated with the MCS but not with the PCS. Dropout rates were low. The experiences of the intervention resulted in four categories: Being heading back; Status quo; Feeling confirmed; and Feeling abandoned, with 13 related subcategories.
IT and TA seem to improve sense of coherence and mental health status in primary care patients with psychological distress, whereas CT appears to be less beneficial. IT and TA appear to be well-accepted and may serve as useful adjunct treatment modalities to standard primary care. Our results are consistent with much of the previous research in highlighting a strong relationship between SOC and mental health status. The written qualitative data described feeling confirmed and feeling increased self-efficacy, self-care and faith in the future. Those in the CT group, however, described feeling abandoned, missing treatment and experiencing increased emotional and physical problems. More research is needed.
ISRCTN trial number NCT01631500.
心理困扰与健康相关生活质量（HRQL）受损及连贯感（SOC）较差有关。在之前的一项研究中，我们发现治疗性针灸（TA）以及在健康促进对话中将TA与以人为本的方法相结合的综合治疗（IT），在初级保健患者中比传统治疗（CT）能更显著地减轻焦虑和抑郁。在此，我们报告来自之前那项实用随机对照试验（RCT）关于HRQL和SOC的二次分析结果。
采用定量和定性设计。120名因心理困扰前来就诊的患者参与研究。在基线期和治疗8周后，使用SF - 36心理成分总结（MCS）、身体成分总结（PCS）以及连贯感 - 13（SOC）问卷进行定量分析。定性的显性内容分析基于开放式问题——“自治疗开始以来，您是否经历了任何变化？您能描述一下这些变化吗？”
未发现基线差异。在8周时，IT组和TA组在MCS和SOC方面的得分在统计学上均显著高于CT组，且与基线相比改善程度更大。效应量很大。IT组和TA组之间以及与PCS相关方面均未发现显著差异。SOC与MCS高度相关，但与PCS无关。脱落率较低。干预体验分为四类：回归正轨；维持现状；感到被认可；感到被抛弃，并有13个相关子类别。
IT和TA似乎能改善有心理困扰的初级保健患者的连贯感和心理健康状况，而CT的益处似乎较少。IT和TA似乎较易被接受，可作为标准初级保健有用的辅助治疗方式。我们的结果与之前的许多研究一致，均突出了SOC与心理健康状况之间的紧密关系。书面定性数据描述了感到被认可以及自我效能感、自我护理和对未来的信心增强。然而，CT组的患者描述了感到被抛弃、错过治疗以及情绪和身体问题增多。还需要更多研究。
ISRCTN试验编号NCT01631500。
