Miller Jordan, MacDermid Joy C, Richardson Julie, Walton David M, Gross Anita
School of Rehabilitation Therapy, Queen's University, Kingston, 31 George Street, Kingston, Ontario K7L 3N6 Canada.
School of Physical Therapy, Western University, Room 1440, Elborn College, London, Ontario N6G 1H1 Canada.
Arch Physiother. 2017 Apr 20;7:4. doi: 10.1186/s40945-017-0032-x. eCollection 2017.
Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants.
Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment - Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants' goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance.
A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact.
先前的证据表明，针对慢性疼痛患者的自我管理项目可提高知识水平和自我效能，但功能改善甚微或可忽略不计。本多案例研究设计的目的是描述六名参与者对旨在改善功能的新自我管理项目的独特反应，详细说明该项目的每个组成部分，并探讨每个参与者不同轨迹的潜在原因。
纳入了六名经历慢性疼痛至少5年的参与者。所有参与者均参加了为期6周的慢性疼痛自我管理支持项目，该项目包括疼痛科学教育和锻炼（COMMENCE）。参与者在基线、7周（1周随访）和18周（12周随访）时完成评估。每个参与者都有独特的初始表现和目标。评估包括：通过短肌肉骨骼功能评估-功能障碍指数测量的功能、参与者因功能困难而受到的困扰程度、疼痛强度、疲劳、疼痛干扰、与疼痛和残疾相关的认知和心理因素、疼痛神经生理学、自我效能、满意度和感知变化。自我管理项目为期6周，每周包括一次个人就诊和一次小组就诊。该项目纳入了自我管理项目中通常不包括的三个新要素：疼痛神经生理学教育、根据参与者目标确定的个性化锻炼以及额外的认知行为方法。所有参与者对所接受的自我管理支持都很满意。功能变化各不相同，从改善59%到下降17%。讨论了反应差异、出勤率和社会背景的两个潜在原因。参与者确定了几个挑战作为出勤的障碍。
包括疼痛教育和个性化锻炼的初级保健自我管理干预有可能改善一些慢性疼痛患者的功能，尽管可能需要采取策略来提高依从性并减少参与障碍，以优化其影响。
