自我效能感和灾难化在解释接受物理治疗的慢性广泛性疼痛患者的残疾、疼痛和疲劳改善中的作用：探索性分析。
The role of self-efficacy and catastrophizing in explaining improvements in disability, pain and fatigue among patients with chronic widespread pain treated with physiotherapy: an exploratory analysis.
机构信息
Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Group, 69 Church Street West, Radcliffe, Manchester M26 2SP, UK; School of Health Sciences, University of Salford, Allerton Building, University of Salford, Salford, Manchester M6 6PU, UK; Department of Sport & Exercise Sciences, Faculty of Science & Engineering Manchester Metropolitan University, All Saints Building, Manchester M15 6BH, UK.
Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Group, 69 Church Street West, Radcliffe, Manchester M26 2SP, UK; School of Healthcare, Faculty of Medicine and Health, Baines Wing, University of Leeds, Leeds LS2 9JT, UK.
出版信息
Physiotherapy. 2022 Mar;114:96-102. doi: 10.1016/j.physio.2021.03.009. Epub 2021 Mar 24.
OBJECTIVES
Most research exploring the relationship between cognitive factors (catastrophizing and self-efficacy beliefs) and levels of pain, disability and fatigue in patients with chronic widespread pain has been performed in multidisciplinary environments. It is less clear whether these associations are valid in other clinical environments. This study therefore aimed to establish whether changes in cognitive factors were related to changes in pain, disability and fatigue among patients treated in a physiotherapy-led symptom management programme.
DESIGN
A longitudinal pre-post treatment study. Regression analyses were performed with change in pain, disability, physical and mental fatigue as the dependent measures. Demographics, change in pain and fatigue (when not dependent variables) and cognitive factors were entered as independent variables. β values were calculated for the final model.
SETTING
Two out-patient physiotherapy departments in Manchester, UK.
PARTICIPANTS
Fifty patients with persistent widespread pain.
INTERVENTION
A physiotherapist-led symptom management programme.
MAIN OUTCOME MEASURES
Disability (Fibromyalgia Impact Questionnaire), Pain (Numeric Pain Rating Scale and Fatigue (Chalder Fatigue Scale) RESULTS: Significant changes in disability, fatigue and cognitive factors were observed after treatment. Changes in self-efficacy beliefs (β=-0.38, P<0.05) and catastrophizing (β=0.41, P<0.05) were significantly related to reductions in disability. There was no significant relationship between change in the cognitive variables and change in pain or fatigue.
CONCLUSIONS
Self-efficacy beliefs and catastrophizing were important determinants of change in disability, but not pain or fatigue among patients with chronic widespread pain attending physiotherapy. Cognitively-informed physiotherapy appeared to be effective in reducing disability and fatigue and modifying cognitive factors. Such interventions may offer an effective treatment option for patients with chronic widespread pain and future randomised controlled trials are required to fully assess this.
目的
大多数探索认知因素（灾难化和自我效能信念）与慢性广泛性疼痛患者疼痛、残疾和疲劳水平之间关系的研究都是在多学科环境中进行的。在其他临床环境中，这些关联是否成立尚不清楚。因此，本研究旨在确定在理疗主导的症状管理计划中治疗的患者中，认知因素的变化是否与疼痛、残疾和疲劳的变化相关。
设计
一项纵向治疗前后研究。使用疼痛、残疾、身体和精神疲劳的变化作为因变量进行回归分析。将人口统计学、疼痛和疲劳的变化（当不作为因变量时）以及认知因素作为自变量。计算最终模型的β值。
设置
英国曼彻斯特的两个门诊理疗部门。
参与者
50 名持续性广泛疼痛患者。
干预
理疗师主导的症状管理计划。
主要观察指标
残疾（纤维肌痛影响问卷）、疼痛（数字疼痛评分量表）和疲劳（查尔德疲劳量表）。
结果
治疗后观察到残疾、疲劳和认知因素的显著变化。自我效能信念（β=-0.38，P<0.05）和灾难化（β=0.41，P<0.05）的变化与残疾的减少显著相关。认知变量的变化与疼痛或疲劳的变化之间没有显著关系。
结论
自我效能信念和灾难化是慢性广泛性疼痛患者接受理疗后残疾变化的重要决定因素，但不是疼痛或疲劳的决定因素。认知启发式理疗似乎能有效降低残疾和疲劳，并改变认知因素。这种干预可能为慢性广泛性疼痛患者提供一种有效的治疗选择，需要进一步的随机对照试验来全面评估。
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