University of Texas Health Science Center (UTHealth), Cizik School of Nursing, Houston, Texas.
University of Nevada, Las Vegas, School of Nursing, Los Vegas, Nevada.
Pain Manag Nurs. 2022 Jun;23(3):301-310. doi: 10.1016/j.pmn.2021.11.007. Epub 2021 Dec 25.
Chronic low back pain, one of the most common reasons for seeking healthcare services, causes significant negative impacts on individuals and society. Nonpharmacologic therapies and self-management are included in practice guidelines, but their implementation is challenging.
To assess the feasibility of using an auricular point acupressure (APA) mobile app as a self-guided tool to learn and self-administer APA to manage chronic low back pain (cLBP) and to compare cLBP outcomes between 2 groups (app vs app + telehealth).
A 2-phase study design was used. In phase 1, participants (app group, n = 18) had in-person study visits and installed the app to learn and self-administer APA to manage cLBP. In phase 2, all research activities occurred remotely due to the COVID-19 pandemic, so a second group was recruited (app + telehealth, n = 19). The app + telehealth group underwent a virtual session, installed the app, and were provided the opportunity for questions and verification on the accuracy of the self-administered APA.
The participants were recruited by distributing study flyers at outpatient clinics and referrals.
Participants with chronic low back pain were eliglbe for the study.
Using a quasi-experimental design with a mixed methods approach, all participants were instructed to download the APA app, provided an APA kit (includes seeds embedded within pre-cut squares of adhesive tape), and advised to self-administer APA with guidance from the app for 4 weeks to manage their cLBP. Study outcomes were collected at the preintervention time point as well as postintervention and 1-month follow-up. Interviews were also conducted at the postintervention time point.
Of the 37 participants enrolled, six dropped out, and the attrition rate was 16%. Adherence to APA practice was high (85%-94%). After 4 weeks of APA treatment, participants in the app + telehealth group experienced a 29% decrease in pain intensity during the postintervention time point and a 35% reduction during the 1-month follow-up. Similar improvements were noted in pain interference (28%) and physical function (39%) for participants in the app + telehealth group at the 1-month follow-up. These changes are slightly higher compared with those in the app group (21% pain intensity reduction, 23% improved pain interferences, and 26% improved physical function) during the 1-month follow-up. Overall, APA was found to be feasible using the app and the qualitative findings showed acceptability of the intervention in both groups.
It is feasible to learn and self-administer APA with an app, supplemented with either in-person or telehealth sessions, presenting a promising intervention toward cLBP self-management. Telehealth was found to boost this intervention effectively.
慢性下背痛是寻求医疗服务的最常见原因之一，它会对个人和社会造成重大的负面影响。非药物治疗和自我管理已被纳入实践指南，但实施起来具有挑战性。
评估使用耳穴按压（APA）移动应用程序作为自我指导工具来学习和自我管理慢性下背痛（cLBP）的可行性，并比较两组（应用程序组和应用程序+远程医疗组）之间 cLBP 结果的差异。
采用两阶段研究设计。在第 1 阶段，参与者（应用程序组，n=18）进行了面对面的研究访问，并安装了应用程序来学习和自我管理 cLBP 的 APA。在第 2 阶段，由于 COVID-19 大流行，所有研究活动均远程进行，因此招募了第二组（应用程序+远程医疗组，n=19）。应用程序+远程医疗组参加了一个虚拟会议，安装了应用程序，并提供了机会对自我管理的 APA 的准确性进行提问和验证。
参与者通过在门诊和转诊处分发研究传单招募。
患有慢性下背痛的患者符合研究条件。
使用准实验设计和混合方法，所有参与者均被指示下载 APA 应用程序，提供 APA 套件（包括嵌入在预切胶粘方块中的种子），并在应用程序的指导下自行进行 APA 治疗 4 周，以管理他们的 cLBP。在干预前、干预后和 1 个月随访时收集研究结果。在干预后还进行了访谈。
37 名入组的参与者中，有 6 名退出，失访率为 16%。APA 实践的依从性很高（85%-94%）。在 4 周的 APA 治疗后，应用程序+远程医疗组的参与者在干预后时间点的疼痛强度降低了 29%，在 1 个月随访时降低了 35%。应用程序+远程医疗组的参与者在 1 个月随访时，疼痛干扰（28%）和身体功能（39%）也有类似的改善。与应用程序组相比（1 个月随访时疼痛强度降低 21%，疼痛干扰改善 23%，身体功能改善 26%），这些变化略高。总体而言，使用应用程序学习和自我管理 APA 是可行的，并且定性研究结果表明两组对干预的接受度都很高。
使用应用程序结合面对面或远程医疗会议学习和自我管理 APA 是可行的，为慢性下背痛的自我管理提供了一种很有前途的干预措施。远程医疗被发现可以有效地增强这种干预措施。
