不同类型慢性疼痛患者客观的、基于表现的及患者报告的身体功能的心理社会相关因素
Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain.
作者信息
Greenberg Jonathan, Mace Ryan A, Popok Paula J, Kulich Ronald J, Patel Kushang V, Burns John W, Somers Tamara J, Keefe Francis J, Schatman Michael E, Vranceanu Ana-Maria
机构信息
Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
出版信息
J Pain Res. 2020 Sep 10;13:2255-2265. doi: 10.2147/JPR.S266455. eCollection 2020.
BACKGROUND
Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures.
PURPOSE
To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement.
METHODS
Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function.
RESULTS
Performance-based and objective physical function were significantly interrelated (=0.48, <0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (=0.68, <0.001), adaptive coping (=-0.65, <0.001) and social-emotional dysfunction (=0.65, <0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1).
CONCLUSION
Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03412916.
背景
改善身体功能的各个方面是慢性疼痛管理的一个重要目标。很少有研究遵循近期指南，通过患者报告、基于表现以及客观/动态测量等方式全面评估身体功能。
目的
检验1）三种身体功能测量类型之间的相互关系，以及2）心理社会因素与每种身体功能测量类型之间的关联。
方法
慢性疼痛患者（N = 79）完成了以下测量：1）身体功能（患者报告的残疾情况；基于表现的6分钟步行测试；客观加速度计步数计数）；2）疼痛和非适应性应对方式（休息和活动时的疼痛、疼痛灾难化、运动恐惧）；3）适应性应对方式（正念、一般应对、疼痛恢复力）；4）社会情感功能障碍（焦虑、抑郁、社会隔离和情感支持）。首先，我们检验了身体功能三个方面之间的相互关系。其次，我们使用结构方程模型来检验心理社会因素（疼痛和非适应性应对方式、适应性应对方式以及社会情感功能障碍）与每种身体功能测量之间的关联。
结果
基于表现的身体功能和客观身体功能显著相关（= 0.48，< 0.001），但与患者报告的残疾情况不相关。疼痛和非适应性应对方式（= 0.68，< 0.001）、适应性应对方式（= -0.65，< 0.001）以及社会情感功能障碍（= 0.65，< 0.001）与患者报告的残疾情况相关，但与基于表现的或客观的身体功能不相关（p值> 0.1）。
结论
结果表明，患者报告的身体功能可能只能提供关于患者身体能力或动态活动的有限信息。虽然疼痛及其非适应性反应、适应性应对方式以及社会情感功能障碍可能会潜在地改善患者报告的身体功能，但可能需要其他目标来改善功能能力和动态活动。
试验注册
ClinicalTrials.gov NCT03412916。
Zotero 插件