初级卫生保健中针对持续性颈部疼痛的自我管理小组干预的9年随访：一项随机对照试验。
A 9-year follow-up of a self-management group intervention for persistent neck pain in primary health care: a randomized controlled trial.
作者信息
Gustavsson Catharina, von Koch Lena
机构信息
Center for Clinical Research Dalarna, Department of Public Health and Caring Science, Uppsala University, Uppsala; School of Education, Health and Social Studies, Dalarna University, Falun.
Center for Clinical Research Dalarna, Department of Public Health and Caring Science, Uppsala University, Uppsala; Department of Neurobiology, Care Science and Society, Karolinska Institutet; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
出版信息
J Pain Res. 2016 Dec 30;10:53-64. doi: 10.2147/JPR.S125074. eCollection 2017.
BACKGROUND AND OBJECTIVE
In previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and health care utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT.
MATERIALS AND METHODS
Of 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and health care utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of "time by group".
RESULTS
Ninety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and health care visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less disability ( = 0.006) and a trend toward better self-efficacy ( = 0.059) than the IAPT group.
CONCLUSION
The favorable effects on pain-related disability of PASS were sustained 9 years after the intervention.
背景与目的
在之前的短期和2年随访中，对于持续性紧张型颈部疼痛患者，疼痛与压力自我管理小组干预（PASS）在疼痛相关残疾、自我效能、灾难化思维以及疼痛控制感方面比单独进行的物理治疗（IAPT）效果更好。评估自我管理方法对持续性颈部疼痛长期影响的研究较少。本研究的目的是比较接受PASS或IAPT治疗9年后，持续性紧张型颈部疼痛患者在疼痛相关残疾、日常生活活动（ADL）自我效能、灾难化思维、疼痛、疼痛控制、镇痛药使用以及医疗保健利用方面的情况。
材料与方法
在最初纳入一项随机对照试验的156人中（PASS组，n = 77；IAPT组，n = 79），129人（PASS组，n = 63；IAPT组，n = 66）符合条件并被纳入9年随访。向他们发送了一份自我评估问卷，包括颈部残疾指数、自我效能量表、应对策略问卷以及关于疼痛、镇痛药和医疗保健利用的问题。使用重复测量分析的混合线性模型或广义估计方程来评估组间以及组内随时间（基线、之前的随访和9年随访）的差异以及“时间×组”的交互作用。
结果
94名参与者（73%）做出了回应（PASS组，n = 48；IAPT组，n = 46）。在9年时，与IAPT组参与者相比，PASS组参与者报告的疼痛相关残疾、最严重疼痛和镇痛药使用更少，并且在自我效能方面有更好的趋势。在残疾、ADL自我效能、灾难化思维、疼痛控制感和医疗就诊次数随时间的变化方面，两组之间存在差异，PASS组更具优势。9年时的简单主效应分析表明，PASS组的残疾程度低于IAPT组（P = 0.006），并且在自我效能方面有更好的趋势（P = 0.059）。
结论
干预9年后，PASS对疼痛相关残疾的有益影响仍然持续。
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