Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, Massachusetts.
Gerontologist. 2021 Apr 3;61(3):449-459. doi: 10.1093/geront/gnaa084.
Chronic pain (CP) and cognitive decline (CD) often co-occur in older adults, which can reinforce a "disability spiral." Early interventions teaching pain coping skills and gradual increases in activity (walking) are needed to promote overall well-being and potentially delay further decline of cognition and daily functioning. The goal of this mixed-methods study was to guide the development of two mind-body activity programs for CP and CD which focus on increasing walking using time goals (Active Brains) or step count reinforced by a Fitbit (Active Brains-Fitbit).
Older adults with CP and CD (N = 23) participated in a one-time focus group (four total) and completed measures of physical, emotional, and cognitive functioning. Qualitative analyses identified population-specific needs, preferences, and perceptions of proposed program skills. Quantitative analysis compared clinical characteristics to population norms and explored intercorrelations among treatment targets.
Thematic analyses revealed six main themes: (1) challenges living with CP and (2) CD, (3) current walking, (4) technology (Fitbit) to increase walking, (5) perceptions of proposed program skills (e.g., mind-body, pain, and increased walking), and (6) program barriers and facilitators. Quantitative analyses showed that (a) participants had physical function below reference values and (b) higher self-efficacy correlated with higher cognitive, emotional, and physical functioning.
Focus group participants were enthusiastic about the proposed program skills. Current work includes open pilot testing, qualitative interviews, and a small randomized controlled trial to optimize the programs and methodology in preparation for efficacy testing against an educational control.
慢性疼痛（CP）和认知能力下降（CD）常同时发生于老年人，可能会强化“残疾螺旋”。需要早期干预，教授疼痛应对技能并逐渐增加活动（如散步），以促进整体健康，并可能延缓认知和日常功能的进一步下降。本混合方法研究旨在为针对 CP 和 CD 的两项身心活动计划的制定提供指导，这些计划侧重于使用时间目标（活跃大脑）或通过 Fitbit 增强的步数（活跃大脑-Fitbit）来增加步行量。
患有 CP 和 CD 的老年人（N=23）参加了一次焦点小组（共 4 次），并完成了身体、情绪和认知功能的测量。定性分析确定了特定人群的需求、偏好和对拟议计划技能的看法。定量分析比较了临床特征与人群正常值，并探讨了治疗目标之间的相互关系。
主题分析揭示了六个主要主题：（1）与 CP 和 CD 共同生活的挑战，（2）当前的步行情况，（3）技术（Fitbit）以增加步行量，（4）对拟议计划技能的看法（例如身心、疼痛和增加步行量），以及（5）计划的障碍和促进因素。定量分析表明，（a）参与者的身体功能低于参考值，（b）自我效能感越高，认知、情绪和身体功能越好。
焦点小组参与者对拟议的计划技能非常感兴趣。目前的工作包括开放试点测试、定性访谈和小型随机对照试验，以优化计划和方法，为针对教育对照的疗效测试做准备。
