采取行动减轻疼痛：一项针对慢性肌肉骨骼疼痛的黑人群体的以步行为重点、主动式辅导干预的随机临床试验。
Taking ACTION to Reduce Pain: a Randomized Clinical Trial of a Walking-Focused, Proactive Coaching Intervention for Black Patients with Chronic Musculoskeletal Pain.
机构信息
Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN, 55417, USA.
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Gen Intern Med. 2022 Nov;37(14):3585-3593. doi: 10.1007/s11606-021-07376-2. Epub 2022 Feb 7.
BACKGROUND
Black patients in the USA are disproportionately affected by chronic pain, yet there are few interventions that address these disparities.
OBJECTIVE
To determine whether a walking-focused, proactive coaching intervention aimed at addressing contributors to racial disparities in pain would improve chronic pain outcomes among Black patients compared to usual care.
DESIGN
Randomized controlled trial with masked outcome assessment ( Clinicaltrials.gov : NCT01983228).
PARTICIPANTS
Three hundred eighty Black patients at the Atlanta VA Health Care System with moderate to severe chronic back, hip, or knee pain.
INTERVENTION
Six telephone coaching sessions over 8-14 weeks, proactively delivered, using action planning and motivational interviewing to increase walking, or usual care.
MAIN MEASURES
Primary outcome was a 30% improvement in pain-related physical functioning (Roland Morris Disability Questionnaire [RMDQ]) over 6 months among Black patients, using intention-to-treat. Secondary outcomes were improvements in pain intensity and interference, depression, anxiety, global impression of change in pain, and average daily steps.
KEY RESULTS
The intervention did not produce statistically significant effects on the primary outcome (at 6 months, 32.4% of intervention participants had 30% improvement on the RMDQ vs. 24.7% of patients in usual care; aOR=1.61, 95% CI, 0.94 to 2.77), nor on other secondary outcomes assessed at 6 months, with the exception that intervention participants reported more favorable changes in pain relative to usual care (mean difference=-0.54, 95% CI, -0.85 to -0.23). Intervention participants also experienced a significant reduction in pain intensity and pain interference over 3 months (mean difference=-0.55, 95% CI, -0.88 to -0.22).
CONCLUSIONS
A novel intervention to improve chronic pain among Black patients did not produce statistically significant improvements on the primary outcome relative to usual care. More intensive efforts are likely required among this population, many of whom were economically disadvantaged and had mental health comorbidities and physical limitations.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT01983228.
背景
美国的黑人患者受到慢性疼痛的影响不成比例，但解决这些差异的干预措施很少。
目的
确定一项以步行为重点、主动提供的教练干预措施，旨在解决导致疼痛方面种族差异的因素，是否会改善与黑人患者相比，常规护理的慢性疼痛结局。
设计
随机对照试验，结果评估设盲（Clinicaltrials.gov：NCT01983228）。
参与者
亚特兰大退伍军人医疗保健系统的 380 名黑人患者，患有中度至重度慢性背痛、髋部或膝部疼痛。
干预
8-14 周内进行 6 次电话教练，主动提供，使用行动计划和动机访谈来增加步行，或常规护理。
主要测量指标
黑人患者的疼痛相关身体功能（罗伦·莫里斯残疾问卷[RMDQ]）在 6 个月内改善 30%是主要结局，采用意向治疗。次要结局包括疼痛强度和干扰、抑郁、焦虑、疼痛变化的总体印象以及平均每日步数的改善。
主要结果
干预措施对主要结局没有产生统计学上的显著影响（在 6 个月时，干预组中有 32.4%的患者在 RMDQ 上有 30%的改善，而常规护理组中有 24.7%的患者；比值比[OR]=1.61，95%置信区间[CI]，0.94 至 2.77），也没有对 6 个月时评估的其他次要结局产生影响，除了干预组患者报告疼痛相对于常规护理有更有利的变化（平均差异=-0.54，95%置信区间，-0.85 至-0.23）。干预组患者在 3 个月内的疼痛强度和疼痛干扰也显著降低（平均差异=-0.55，95%置信区间，-0.88 至-0.22）。
结论
一项改善黑人患者慢性疼痛的新干预措施相对于常规护理，在主要结局上没有产生统计学上的显著改善。在这个人群中，可能需要更密集的努力，其中许多人经济拮据，并有心理健康合并症和身体限制。
试验注册
Clinicaltrials.gov 标识符：NCT01983228。
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