Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Ann Fam Med. 2020 Jan;18(1):15-23. doi: 10.1370/afm.2469.
Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain.
In this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Attention control participants received a peer-delivered general health advice program. Outcomes were changes in functional status and pain (Western Ontario and McMaster Universities Osteoarthritis Index), QOL (Short Form 12), and physiologic measures (hemoglobin A, systolic blood pressure, body mass index); physical activity was the explanatory outcome.
Of 195 participants with follow-up data, 80% were women, 96% African Americans, 74% had annual income <$20,000, and 64% had high school education or less. At follow-up, compared with controls, intervention participants had greater improvement in functional status (-10 ± 13 vs -5 ± 18, = .002), pain (-10.5 ± 19 vs -4.8 ± 21, = .01), and QOL (4.8 ± 8.8 vs 3.8 ± 8.8, = .001). Physiologic measures did not change significantly in either group. At 3 months, a greater proportion of intervention than control participants reported no pain or did other forms of exercise when pain prevented them from walking for exercise.
This peer-delivered CBT-based intervention improved functioning, pain, QOL, and self-reported physical activity despite pain in individuals with diabetes and chronic pain. Trained community members can deliver effective CBT-based interventions in rural and under-resourced communities.
由经过培训的社区成员提供的基于认知行为疗法（CBT）的项目可以改善无法获得此类项目的个体的功能和疼痛。我们测试了一种由同伴提供的糖尿病自我管理计划的有效性，该计划整合了 CBT 原则，以改善患有糖尿病和慢性疼痛的个体的身体活动、功能状态、疼痛、生活质量（QOL）和健康结果。
在这项基于社区的、集群随机对照试验中，干预组参与者接受了为期 3 个月的、由同伴提供的、电话管理的项目。对照组参与者接受了由同伴提供的一般健康咨询计划。结果是功能状态和疼痛（西安大略和麦克马斯特大学骨关节炎指数）、生活质量（简短表格 12）和生理测量（血红蛋白 A、收缩压、体重指数）的变化；身体活动是解释性结果。
在有随访数据的 195 名参与者中，80%是女性，96%是非裔美国人，74%的年收入<20000 美元，64%的人接受过高中教育或以下教育。随访时，与对照组相比，干预组在功能状态（-10 ± 13 对-5 ± 18， =.002）、疼痛（-10.5 ± 19 对-4.8 ± 21， =.01）和生活质量（4.8 ± 8.8 对 3.8 ± 8.8， =.001）方面的改善更大。两组的生理指标均无明显变化。在 3 个月时，与对照组相比，更多的干预组参与者报告没有疼痛，或者在疼痛阻止他们进行锻炼时进行其他形式的运动。
尽管患有糖尿病和慢性疼痛的个体存在疼痛，但这种由同伴提供的基于 CBT 的干预措施改善了功能、疼痛、生活质量和自我报告的身体活动。经过培训的社区成员可以在农村和资源匮乏的社区提供有效的 CBT 干预措施。
