患者主导的目标设定：一项关于慢性下腰痛管理的有前景方法的试点研究。
Patient-led Goal Setting: A Pilot Study Investigating a Promising Approach for the Management of Chronic Low Back Pain.
作者信息
Gardner Tania, Refshauge Kathryn, McAuley James, Goodall Stephen, Hübscher Markus, Smith Lorraine
机构信息
Faculty of Pharmacy, Sydney University, Sydney, New South Wales, Australia.
Faculty of Health Sciences, Sydney University, Sydney, New South Wales, Australia.
出版信息
Spine (Phila Pa 1976). 2016 Sep 15;41(18):1405-1413. doi: 10.1097/BRS.0000000000001545.
STUDY DESIGN
A prospective, single-arm, pre-postintervention study.
OBJECTIVE
The aim of this study was to test the preliminary effectiveness of a patient-led goal-setting intervention on improving disability and pain in chronic low back pain.
SUMMARY OF BACKGROUND DATA
An effective intervention for the treatment of chronic low back pain remains elusive despite extensive research into the area.An intervention using patient-centered goal setting to drive intervention strategies and encourage self-management for patients suffering chronic low back was developed.
METHODS
A single group longitudinal cohort pilot study was conducted. Twenty participants (male = nine) experiencing chronic low back pain were involved in a patient-led goal-setting intervention, facilitated by a physiotherapist over a 2-month period with two monthly follow-up sessions after treatment conclusion. Participants, guided by the therapist, identified problem areas of personal importance, defined goals, and developed evidence-based strategies to achieve the goals. Participants implemented the strategies independently between sessions. Primary outcome measures of disability and pain intensity were measured at baseline, 2, and 4 months. Secondary measures of quality of life, stress and anxiety, self-efficacy, and fear of movement were also taken.
RESULTS
Significant improvements (repeated analysis of variance P < 0.05) were seen in measures of disability, pain, fear avoidance, quality of life, and self-efficacy over the period of intervention and were maintained for a further 2 months after treatment conclusion.
CONCLUSION
This intervention is novel because the goals set are based on patients' personal preferences, and not on treatment guidelines. Our findings confirm that a patient-centered goal-setting intervention is a potentially effective intervention for the management of chronic low back pain showing significant improvements in both quality of life and pain intensity.
LEVEL OF EVIDENCE
研究设计
一项前瞻性、单组、干预前后对照研究。
目的
本研究旨在测试以患者为主导的目标设定干预措施对改善慢性下腰痛患者残疾状况和疼痛的初步效果。
背景数据总结
尽管对该领域进行了广泛研究，但治疗慢性下腰痛的有效干预措施仍难以捉摸。已开发出一种干预措施，利用以患者为中心的目标设定来推动干预策略，并鼓励慢性下腰痛患者进行自我管理。
方法
进行了一项单组纵向队列试点研究。20名患有慢性下腰痛的参与者（男性9名）参与了以患者为主导的目标设定干预，由一名物理治疗师在2个月内提供协助，治疗结束后每月进行两次随访。参与者在治疗师的指导下，确定个人认为重要的问题领域，定义目标，并制定基于证据的策略以实现目标。参与者在各次治疗期间独立实施这些策略。在基线、2个月和4个月时测量残疾和疼痛强度的主要结局指标。还测量了生活质量、压力和焦虑、自我效能感以及运动恐惧等次要指标。
结果
在干预期间，残疾、疼痛、恐惧回避、生活质量和自我效能感等指标有显著改善（重复方差分析P<0.05），且在治疗结束后还持续改善了2个月。
结论
该干预措施具有创新性，因为设定的目标基于患者的个人偏好，而非治疗指南。我们的研究结果证实，以患者为中心的目标设定干预是一种潜在有效的慢性下腰痛管理干预措施，在生活质量和疼痛强度方面均有显著改善。
证据水平
4级。
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