Jackson Kirsty, Wadley Antonia L, Parker Romy
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
Zithulele Hospital, Eastern Cape Department of Health, Mqanduli, South Africa.
BMC Public Health. 2021 Feb 5;21(1):302. doi: 10.1186/s12889-021-10309-7.
Pain is one of the most prevalent symptoms in people living with HIV/AIDS and is largely undermanaged. Both a peer-led exercise and education Positive Living programme (PL programme) and the PL programme workbook alone were previously found to be effective in reducing pain in urban amaXhosa Women Living With HIV/AIDS (WLWHA). A therapeutic relationship was hypothesised to have contributed to the efficacy of both interventions. The aim of the study was to determine the effectiveness of the PL programme and a therapeutic relationship, compared to a therapeutic relationship alone in managing pain amongst rural amaXhosa WLWHA on pain severity and pain interference, and secondary outcomes, symptoms of depression, health-related quality of life (HRQoL) and self-efficacy.
In this two-group, single-blind, pragmatic clinical trial with stratified convenience sampling, the PL programme and therapeutic relationship, was compared to a therapeutic relationship alone in rural amaXhosa WLWHA. The PL programme was a 6-week, peer-led intervention comprising education on living well with HIV, exercise and goal setting. The therapeutic relationship comprised follow-up appointments with a caring research assistant. Outcome measures included pain severity and interference (Brief Pain Inventory), depressive symptoms (Beck Depression Inventory), HRQoL (EuroQol 5-Dimensional outcome questionnaire) and self-efficacy (Self-efficacy for Managing Chronic Disease 6-Item Scale). Follow-up was conducted at 4, 8, 12, 24, and 48 weeks. Mixed model regression was used to test the effects of group, time, and group and time interactions of the interventions on outcome measures.
Forty-nine rural amaXhosa WLWHA participated in the study: PL group n = 26; TR group n = 23. Both intervention groups were similarly effective in significantly reducing pain severity and interference and depressive symptoms, and increasing self-efficacy and HRQoL over the 48 weeks. A clinically important reduction in pain severity of 3.31 points occurred for the sample over the 48 weeks of the study. All of these clinical improvements were obtained despite low and suboptimal attendance for both interventions.
Providing a therapeutic relationship alone is sufficient for effective pain management amongst rural amaXhosa WLWHA. These findings support greater emphasis on demonstrating care and developing skills to enhance the therapeutic relationship in healthcare professionals working with rural amaXhosa WLWHA.
PACTR; PACTR201410000902600, 30th October 2014; https://pactr.samrc.ac.za .
疼痛是艾滋病毒/艾滋病感染者最普遍的症状之一，且大多未得到有效管理。此前发现，由同伴主导的运动与教育积极生活计划（PL计划）以及单独的PL计划工作手册，在减轻城市科萨族感染艾滋病毒/艾滋病的女性（WLWHA）的疼痛方面均有效果。据推测，治疗关系有助于这两种干预措施发挥功效。本研究的目的是确定PL计划和治疗关系的有效性，并将其与仅靠治疗关系来管理农村科萨族WLWHA的疼痛情况进行比较，评估对疼痛严重程度和疼痛干扰的影响，以及次要结果，即抑郁症状、健康相关生活质量（HRQoL）和自我效能感。
在这项采用分层便利抽样的两组单盲实用临床试验中，将农村科萨族WLWHA的PL计划及治疗关系与仅靠治疗关系进行比较。PL计划是一项为期6周、由同伴主导的干预措施，包括关于艾滋病毒感染者健康生活、运动和目标设定的教育。治疗关系包括与一位有爱心的研究助理进行随访预约。结果测量指标包括疼痛严重程度和干扰（简明疼痛量表）、抑郁症状（贝克抑郁量表）、HRQoL（欧洲五维健康量表）和自我效能感（慢性病管理自我效能感6项量表）。在第4、8、12、24和48周进行随访。使用混合模型回归来测试干预措施的组、时间以及组与时间的交互作用对结果测量指标的影响。
49名农村科萨族WLWHA参与了该研究：PL组n = 26；TR组n = 23。在48周内，两个干预组在显著减轻疼痛严重程度和干扰以及抑郁症状，并提高自我效能感和HRQoL方面同样有效。在研究的48周内，样本的疼痛严重程度在临床上有重要降低，降低了3.31分。尽管两种干预措施的参与率都很低且不理想，但所有这些临床改善都得以实现。
对于农村科萨族WLWHA，仅提供治疗关系就足以有效管理疼痛。这些发现支持更加强调在与农村科萨族WLWHA合作的医护人员中展现关怀并培养技能，以增强治疗关系。
泛非洲临床试验注册平台；注册号PACTR201410000902600，2014年10月30日；https://pactr.samrc.ac.za 。
