Fanning Jason, Brooks Amber K, Ip Edward, Nicklas Barbara J, Rejeski W Jack, Nesbit Beverly, Ford Sherri
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States.
Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Front Digit Health. 2020 Dec;2. doi: 10.3389/fdgth.2020.598456. Epub 2020 Dec 18.
Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies ( = 5 total) or a 12-week pilot RCT delivered largely in the home ( = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, = 0.12), a large difference in body weight (2.90 kg, = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, = 0.07) with a small effect on steps (297.7 steps, = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature.
ClinicalTrials.gov, Identifier: NCT03377634.
慢性多部位疼痛是衰老过程中的常见现象，与一系列负面健康结果相关。它是一种复杂且多方面的状况，体重增加和长期不活动可能会使其加剧。不幸的是，患有慢性疼痛的老年人在获得基于中心的行为改变干预措施方面存在独特障碍。MORPH研究首先对基于证据的小组介导干预措施进行了调整和反复完善，以便通过移动健康工具（智能手机应用程序、电话会议软件、可穿戴活动监测器、智能体重秤）在家中实施。随后进行了一项试点随机对照试验（RCT），旨在评估MORPH干预措施的可行性，并研究其对身体功能、疼痛、体重和久坐行为的初步影响。我们招募了患有多部位疼痛的低活动量和肥胖老年人，让他们参与一系列单病例（N-of-1）优化研究（共5项）或一项主要在家中进行的为期12周的试点RCT（28人被分配到积极干预组或等待名单对照组）。优化阶段确定了在启动RCT阶段之前进行的几个关键技术（例如，选择新的智能体重秤）和用户界面（例如，澄清应用程序内措辞）修改。协方差分析在控制基线值、性别和年龄后表明，在所有感兴趣的领域中，干预措施都有效果：简短身体性能测试电池得分有显著的临床意义差异（0.63分，P = 0.08），患者报告结果测量信息系统（PROMIS）疼痛强度得分有中度至较大差异（5.52分，P = 0.12），体重有较大差异（2.90千克，P = 0.207），对经调整的ActivPAL评估的久坐时间有中度影响（64.90分钟，P = 0.07），对步数有较小影响（297.7步，P = 0.01）。这些结果表明，为患有疼痛的老年人提供的主要在家中进行的运动和减肥计划是可行的，并为今后此类计划提供了建议。
ClinicalTrials.gov，标识符：NCT03377634。
