Higgins Diana M, Buta Eugenia, Williams David A, Halat Allison, Bair Matthew J, Heapy Alicia A, Krein Sarah L, Rajeevan Haseena, Rosen Marc I, Kerns Robert D
Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
Pain Pract. 2020 Apr;20(4):357-370. doi: 10.1111/papr.12861. Epub 2020 Jan 28.
To develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy-based, internet-delivered self-management program for chronic low back pain (cLBP) in veterans.
Phase I included program development, involving expert panel and participant feedback. Phase II was a single-arm feasibility and preliminary efficacy study of the Pain e-health for Activity, Skills, and Education (Pain EASE) program. Feasibility (ie, website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within-subject changes from baseline to 10 weeks post-baseline in pain interference (primary outcome, West Haven-Yale Multidimensional Pain Inventory, scale of 0 to 6), pain intensity, mood, fatigue, sleep, and depression.
Phase I participants (n = 15) suggested modifications including style changes, content reduction, additional "Test Your Knowledge" quizzes, and cognitive behavioral therapy skill practice monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%) and White (60%), and had an average age of 55 years (standard deviation [SD] = 12) and moderate pain (mean score 5.9/10); 41 (71%) completed the post-baseline assessment. Participants (N = 58) logged on 6.1 (SD = 8.6) times over 10 weeks, and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 [95% confidence interval 0.1 to 0.9], P = 0.008). Within-subject improvement also occurred for some secondary outcomes, including mood and depression symptoms.
Veterans with cLBP may benefit from technology-delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet-based self-management program, is feasible and satisfactory for cLBP.
开发并测试一种基于认知行为疗法、通过互联网提供的针对退伍军人慢性下腰痛（cLBP）的自我管理项目的可行性和初步疗效。
第一阶段包括项目开发，涉及专家小组和参与者反馈。第二阶段是针对“活动、技能与教育疼痛电子健康”（Pain EASE）项目的单组可行性和初步疗效研究。使用描述性方法测量可行性（即网站使用情况、治疗可信度、满意度）。采用混合模型评估从基线到基线后10周内疼痛干扰（主要结局，西黑文 - 耶鲁多维疼痛量表，范围为0至6）、疼痛强度、情绪、疲劳、睡眠和抑郁的受试者内平均变化。
第一阶段的参与者（n = 15）建议进行修改，包括样式更改、内容精简、增加“知识测试”小测验以及修订认知行为疗法技能练习监测表以提高可用性。在第二阶段，参与者（n = 58）大多为男性（93%）和白人（60%），平均年龄55岁（标准差[SD] = 12），疼痛程度为中度（平均评分5.9/10）；41名（71%）完成了基线后评估。参与者（N = 58）在10周内登录6.1次（SD = 8.6），85%的人报告对Pain EASE非常或中度满意。疼痛干扰从基线时的平均3.8改善到10周时的3.3（差值0.5[95%置信区间0.1至0.9]，P = 0.008）。一些次要结局，包括情绪和抑郁症状，也出现了受试者内改善。
患有cLBP的退伍军人可能从技术提供的干预措施中受益，这也可能减少疼痛干扰。总体而言，退伍军人发现基于互联网的自我管理项目Pain EASE对cLBP是可行且令人满意的。
