Koffel Erin, Vitiello Michael V, McCurry Susan M, Rybarczyk Bruce, Von Korff Michael
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System.
University of Minnesota Medical School, Minneapolis, MN.
Clin J Pain. 2018 Apr;34(4):375-382. doi: 10.1097/AJP.0000000000000546.
Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain.
Data were analyzed from the "Lifestyles" trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance.
Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05).
Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
失眠心理治疗的依从性差很常见，限制了治疗效果。尽管理论上认为依从性对慢性疼痛患者更为关键且更具挑战性，但对于慢性疼痛患者中依从性的预测因素知之甚少。这项二次数据分析考察了接受失眠和疼痛心理治疗的骨关节炎患者中退出治疗和不参加治疗的预测因素。
数据来自“生活方式”试验，这是一项为期6周的随机对照试验，包括一组认知行为疼痛应对技能干预（CBT-P）、一组针对疼痛和失眠的认知行为疗法（CBT-PI）以及一个仅提供教育的注意力控制组（EOC）。当前分析聚焦于从6家初级保健诊所随机分配至CBT-PI组的122名参与者。在基线时收集治疗可接受性、人口统计学和症状的测量数据。采用因子分析来明确这些领域的界限，并采用层次回归来检验这些患者特征对治疗参与度的增量预测能力。
治疗可接受性评分与人口统计学和医学变量以及基线症状不同。治疗可接受性与疗程参与度和退出治疗显著相关（相关系数范围为0.24至0.32），也是疗程参与度最强的预测因素之一（β = 0.20；P < 0.05）。
治疗早期对治疗可接受性的认知是一个潜在的可改变目标，以提高慢性疼痛患者对失眠和疼痛心理治疗的依从性。这项工作是朝着理解如何最好地为该患者群体最大化睡眠治疗迈出的重要一步。
