Greenberg Jonathan, Mace Ryan A, Bannon Sarah M, Kulich Ronald J, Vranceanu Ana-Maria
Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Pain Res. 2021 Feb 5;14:359-368. doi: 10.2147/JPR.S298212. eCollection 2021.
Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood.
To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program.
Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline.
Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=-.14; CI=-25, -.05; medium effect size) and pain resilience (CSIE=-.07; CI=-.16, -.005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=-.11; CI=-23, -.008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function.
Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function.
ClinicalTrials.gov NCT03412916.
改善慢性疼痛患者的身体功能对于降低残疾率和医疗成本至关重要。然而，慢性疼痛患者自我报告的、基于表现的以及动态身体功能改善的潜在机制仍知之甚少。
探讨身心活动项目参与者中，自我报告的、基于表现的以及客观/加速度计测量的身体功能改善的心理社会中介因素。
慢性疼痛患者被随机分为两个相同的为期10周的身心活动干预组之一，旨在通过（GetActive - Fitbit；N = 41）或不使用（GetActive；N = 41）Fitbit设备来改善身体功能。他们在干预前后完成了自我报告（世界卫生组织残疾评定量表2.0版）、基于表现的（6分钟步行测试）以及客观的（加速度计测量的步数）身体功能测量，以及运动恐惧（坦帕运动恐惧量表）、正念（综合正念量表 - 修订版）和疼痛恢复力（疼痛恢复力量表）的测量。我们通过混合效应模型进行二次数据分析以检验中介作用。
运动恐惧（完全标准化间接效应（CSIE）= 0.18；CI = 0.08，0.30；中等偏大效应量）、正念（CSIE = - 0.14；CI = - 0.25， - 0.05；中等效应量）和疼痛恢复力（CSIE = - 0.07；CI = - 0.16， - 0.005；中小效应量）完全且独特地介导了患者自我报告的身体功能改善。基于表现的身体功能改善仅由运动恐惧介导（CSIE = - 0.11；CI = - 0.23， - 0.008；中等效应量）。没有测量指标介导客观的（加速度计测量的）身体功能改善。
旨在改善慢性疼痛患者自我报告身体功能的干预措施可能受益于针对运动恐惧、正念和疼痛恢复力的技能，而专注于改善基于表现的身体功能的措施应主要针对运动恐惧。需要更多研究来了解客观的、加速度计测量的身体功能改善机制。
ClinicalTrials.gov NCT03412916。
