系统性硬化症患者的疼痛和自我效能：硬皮病患者为中心的干预网络队列研究。
Pain and Self-Efficacy Among Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study.
出版信息
Nurs Res. 2021;70(5):334-343. doi: 10.1097/NNR.0000000000000528.
BACKGROUND
Pain is one of the most common symptoms affecting patients with systemic sclerosis; however, little is known about the relationship between self-efficacy and pain and changes in pain over time.
OBJECTIVES
The purpose of this study was to describe the relationships between self-efficacy and pain in patients with systemic sclerosis, as well as determine whether changes in self-efficacy mediate changes in pain.
METHODS
A prospective longitudinal study was conducted using data from the Scleroderma Patient-Centered Intervention Network Cohort. The baseline sample included 1,903 adults, with a trajectory subsample of 427 who completed 3-month assessments across 3 years. Hierarchical (sequential) forward multivariable regression, covarying for participant characteristics, was conducted to determine the association between self-efficacy and patient characteristics on pain outcomes. Trajectory models, covarying for participant characteristics, were used to examine changes in self-efficacy and pain outcomes across time and whether self-efficacy mediated the pain trajectories.
RESULTS
Mean time since diagnosis was 9.5 years, with 39.2% diagnosed with diffuse cutaneous systemic sclerosis. Greater self-efficacy was associated with less pain interference and intensity. Increasing age, female gender, finger ulcers, and small joint contractures were related to greater pain interference and intensity. Esophageal gastrointestinal symptoms were associated with more pain interference. Self-efficacy and pain trajectories remained stable across time, and self-efficacy did not mediate the pain trajectories.
DISCUSSION
This study identified self-efficacy, age, gender, finger ulcers, small joint contractures, and esophageal gastrointestinal symptoms as important correlates associated with pain in patients with systemic sclerosis. In addition, this study found that self-efficacy and pain outcomes remained stable over time, providing important insights into the longitudinal pain experiences of patients with systemic sclerosis.
背景
疼痛是影响系统性硬化症患者的最常见症状之一；然而，人们对自我效能感与疼痛之间的关系以及疼痛随时间的变化知之甚少。
目的
本研究旨在描述系统性硬化症患者自我效能感与疼痛之间的关系，并确定自我效能感的变化是否介导疼痛的变化。
方法
采用 Scleroderma Patient-Centered Intervention Network Cohort 的前瞻性纵向研究数据。基线样本包括 1903 名成年人，其中 427 名参与者完成了 3 年中 3 个月的评估，构成轨迹亚组。采用分层（顺序）向前多变量回归，共变量为参与者特征，以确定自我效能感与疼痛结局的患者特征之间的关联。考虑到参与者特征，使用轨迹模型来检查自我效能感和疼痛结局随时间的变化，以及自我效能感是否介导疼痛轨迹。
结果
平均诊断后时间为 9.5 年，39.2%被诊断为弥漫性皮肤系统性硬化症。自我效能感越高，疼痛干扰和强度越低。年龄越大、女性、手指溃疡和小关节挛缩与疼痛干扰和强度增加有关。食管胃肠道症状与更多的疼痛干扰有关。自我效能感和疼痛轨迹随时间保持稳定，自我效能感并未介导疼痛轨迹。
讨论
本研究确定了自我效能感、年龄、性别、手指溃疡、小关节挛缩和食管胃肠道症状是与系统性硬化症患者疼痛相关的重要相关因素。此外，本研究发现自我效能感和疼痛结局随时间保持稳定，为系统性硬化症患者的纵向疼痛体验提供了重要的见解。
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