Dindo Lilian, Chaison Angelic, Rodrigues Merlyn, Woods Ken, Mark Alicia, Boykin Derrecka
VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Contemp Clin Trials Commun. 2023 Jun 20;34:101178. doi: 10.1016/j.conctc.2023.101178. eCollection 2023 Aug.
This single-arm, open pilot study examined the feasibility and initial efficacy of a 1-day virtual Acceptance and Commitment Therapy (ACT) group workshop for distressed veterans.
We collaborated with veteran-serving community-based organizations to enhance outreach to veterans, especially those in rural areas. Veterans completed a baseline assessment and two follow-up assessments (1 month, 3 months) after workshop participation. Feasibility outcomes included reach (workshop recruitment and completion rates; veteran characteristics) and acceptability (open-ended survey question about satisfaction). Clinical outcomes included psychological distress (Outcome Questionnaire-45), stressor-related distress (PTSD Checklist-5), community reintegration (Military to Civilian Questionnaire), and meaning and purpose (PROMIS Short Form). Psychological flexibility (Action and Acceptance Questionnaire-II) - the proposed change mechanism underlying ACT - was also measured.
Sixty-four veterans (50% rural, 39% self-identified as female) participated in a virtual workshop (97.1% completion rate). Overall, veterans liked the format and interactive nature of workshops. Convenience was noted as a benefit, while connectivity issues were highlighted as a drawback. Veterans showed improvements in psychological distress (F(2,109) = 3.30; p = 0.041), stressor-related distress (F(2,110) = 9.50; p = 0.0002), community reintegration (F(2,108) = 4.34; p = 0.015), and meaning and purpose (F(2,100) = 4.06; p = 0.020) over time. No between-group differences were detected, based on rurality or gender.
Pilot findings were promising and warrant a larger randomized trial to assess the efficacy of the 1-day virtual ACT workshop. Integrating community-engaged and participatory-research designs can enhance the external validity of these future studies and promote greater health equity.
这项单臂开放性试点研究考察了为期1天的虚拟接纳与承诺疗法（ACT）小组工作坊对痛苦退伍军人的可行性和初步疗效。
我们与为退伍军人服务的社区组织合作，以加强对退伍军人的宣传，特别是农村地区的退伍军人。退伍军人在参加工作坊后完成了基线评估和两次随访评估（1个月、3个月）。可行性结果包括覆盖范围（工作坊招募和完成率；退伍军人特征）和可接受性（关于满意度的开放式调查问题）。临床结果包括心理困扰（结果问卷-45）、与应激源相关的困扰（创伤后应激障碍检查表-5）、社区重新融入（从军人到平民问卷）以及意义和目的（患者报告结果测量信息系统简表）。还测量了心理灵活性（行动与接纳问卷-II）——ACT潜在的拟议改变机制。
64名退伍军人（50%为农村地区，39%自我认定为女性）参加了虚拟工作坊（完成率97.1%）。总体而言，退伍军人喜欢工作坊的形式和互动性。便利性被认为是一个优点，而网络连接问题被突出为一个缺点。随着时间的推移，退伍军人在心理困扰（F(2,109) = 3.30；p = 0.041）、与应激源相关的困扰（F(2,110) = 9.50；p = 0.0002）、社区重新融入（F(2,108) = 4.34；p = 0.015）以及意义和目的（F(2,100) = 4.06；p = 0.020）方面均有改善。基于农村地区或性别，未检测到组间差异。
试点结果很有前景，值得进行更大规模的随机试验来评估为期1天的虚拟ACT工作坊的疗效。整合社区参与和参与性研究设计可以提高这些未来研究的外部效度，并促进更大的健康公平。
