Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
Pain Med. 2022 Dec 1;23(12):1965-1978. doi: 10.1093/pm/pnaa468.
African American older adults living in disadvantaged communities are disproportionately burdened by disabling pain. To address their needs, we tested the feasibility and potential effects of a cognitive-behavioral chronic pain self-management program delivered by community health workers.
A single-group, pre-post evaluation of the STEPS-2 (Seniors using Technology to Engage in Pain Self-management) intervention, in which participants learned pain-management skills through web-based videos. They were also given wearable activity trackers to facilitate incremental increases in walking. In weekly telephone calls, community health workers helped participants apply skills and set goals.
SUBJECTS/SETTING: Thirty-one adults in Detroit, Michigan (97% African American, 97% female, mean 68.7 years), with chronic musculoskeletal pain.
Participants completed telephone surveys at baseline and eight weeks. We measured changes in PROMIS pain interference and pain intensity, as well as Patient Global Impression of Change in pain and functioning. Feasibility indicators included participant engagement and satisfaction, and fidelity to session protocols by community health workers.
Participants on average completed 6.6/7 sessions, and 100% agreed or strongly agreed that they improved their understanding of pain management. Average community health worker fidelity score was 1.79 (0 to 2 scale). Pain interference decreased from baseline to post-program (T-score 61.6 to 57.3, P=.000), as did pain intensity (0 to 10 scale, 6.3 to 5.1, P=.004). Approximately 90% of participants reported that pain and function were at least "a little better" since baseline.
An intervention combining mobile health tools with support from community health workers holds promise for improving pain outcomes among underserved older adults.
生活在贫困社区的非裔美国老年人群体承受着不成比例的致残性疼痛负担。为满足他们的需求，我们测试了由社区卫生工作者提供的认知行为慢性疼痛自我管理计划的可行性和潜在效果。
一项针对 STEPS-2（老年人使用技术参与疼痛自我管理）干预措施的单组前后评估，参与者通过基于网络的视频学习疼痛管理技能。他们还配备了可穿戴活动追踪器，以促进步行量的逐步增加。在每周的电话通话中，社区卫生工作者帮助参与者应用技能和设定目标。
研究对象/地点：密歇根州底特律的 31 名成年人（97%为非裔美国人，97%为女性，平均年龄 68.7 岁），患有慢性肌肉骨骼疼痛。
参与者在基线和八周时完成电话调查。我们测量了 PROMIS 疼痛干扰和疼痛强度的变化，以及患者对疼痛和功能变化的总体印象。可行性指标包括参与者的参与度和满意度，以及社区卫生工作者对会议方案的遵守情况。
参与者平均完成了 6.6/7 次课程，100%的人同意或强烈同意他们提高了对疼痛管理的理解。社区卫生工作者的平均合规分数为 1.79（0 到 2 分制）。疼痛干扰从基线到方案后（T 分数从 61.6 降至 57.3，P=.000），疼痛强度（0 到 10 分制，从 6.3 降至 5.1，P=.004）也有所下降。大约 90%的参与者报告说，自基线以来，疼痛和功能至少“好一点”。
结合移动健康工具和社区卫生工作者支持的干预措施有望改善服务不足的老年人群体的疼痛结果。
