Kuss Katrin, Leonhardt Corinna, Quint Sabine, Seeger Dagmar, Pfingsten Michael, Wolf Pt Udo, Basler Heinz-Dieter, Becker Annette
*Department of General Practice/Family Medicine, Philipps-University Marburg, Germany
*Department of General Practice/Family Medicine, Philipps-University Marburg, Germany.
Pain Med. 2016 Dec;17(12):2218-2229. doi: 10.1093/pm/pnw062. Epub 2016 Apr 25.
Persistent pain is highly prevalent in older adults and can lead to functional limitations in activities of daily living, and to psychosocial distress. There is a lack of established active therapy programs, especially for older adults with chronic pain.
To develop a graded activity program and to evaluate its feasibility within a pilot study.
Phase I/phase II trial of a complex intervention. A mixed methods design was chosen to evaluate the feasibility, acceptability, and preliminary evidence of effectiveness.
Several experts participated in the program development. Sixteen community-dwelling older adults (73.9 ± 5.9 years on average) with chronic low back pain and three primary care physical therapists attempted the program.
Guided semi-structured interviews were conducted with all patients and therapists and used a content-analytic approach. Measurements of self-rated functional status (HFAQ), average pain (NRS), falls self-efficacy (FES-I), and catastrophizing and avoidance beliefs (CAS-D 65+) were applied at baseline and after the intervention.
The interviews revealed high acceptance, satisfaction, and practicality. Besides improvements in function and pain, patients mentioned more positive attitudes towards pain, activity, and self-confidence. There was a clinically relevant increase in physical function by 20.3%, a decrease in pain intensity, and a reduction in catastrophizing and avoidance behavior.
This graded activity program demonstrated feasibility and high acceptance in aged individuals and therapists. Future studies with larger samples must confirm effectiveness. The principles also appear applicable to other chronic pain conditions. The program could easily be implemented in routine primary care.
持续性疼痛在老年人中极为普遍，可导致日常生活活动功能受限，并引发心理社会困扰。目前缺乏既定的积极治疗方案，尤其是针对患有慢性疼痛的老年人。
制定一个分级活动方案，并在一项试点研究中评估其可行性。
一项复杂干预措施的I期/II期试验。采用混合方法设计来评估可行性、可接受性和有效性的初步证据。
几位专家参与了方案制定。16名社区居住的患有慢性下腰痛的老年人（平均年龄73.9±5.9岁）和3名初级保健物理治疗师尝试了该方案。
对所有患者和治疗师进行了半结构化访谈，并采用内容分析方法。在基线和干预后，应用自我评定功能状态（HFAQ）、平均疼痛（NRS）、跌倒自我效能感（FES-I）以及灾难化和回避信念（CAS-D 65+）等测量指标。
访谈显示该方案具有较高的接受度、满意度和实用性。除了功能和疼痛有所改善外，患者对疼痛、活动和自信心的态度更为积极。身体功能在临床上有20.3%的相关改善，疼痛强度降低，灾难化和回避行为减少。
这个分级活动方案在老年人和治疗师中显示出可行性和高度接受度。未来更大样本量的研究必须证实其有效性。这些原则似乎也适用于其他慢性疼痛状况。该方案可轻松在常规初级保健中实施。
