Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
J Neurotrauma. 2023 Dec;40(23-24):2667-2679. doi: 10.1089/neu.2023.0200. Epub 2023 Sep 22.
Our goal was to test the effectiveness of collaborative care (CC) versus usual care (UC) to improve treatment of pain, depression, physical inactivity, and quality of life in outpatients with spinal cord injury (SCI). We conducted a single blind parallel group randomized controlled trial. The setting was two outpatient SCI rehabilitation clinics within a large academic medical center. Participants were 174 outpatients who were on average 47.7 years old, 76% male, 76% white, 8% Hispanic, 47% tetraplegic, 95% more than 1 year post-SCI, and 45% on Medicare. The intervention consisted of a mental health-trained collaborative care manager (CM) integrated into two SCI rehabilitation medicine clinics and supervised by content experts in pain and mental health treatment. The CM provided assessment, medical care coordination, adherence support, outcome monitoring, and decision support along with brief psychological interventions to the patients via up to 12 in-person or telephone sessions. Among all participants, 61% chose to focus on pain; 31% on physical activity and 8% on depression. The primary outcome was quality of life as measured by the World Health Organization Quality of Life-BREF at the end of treatment (4 months). Secondary outcomes were quality of life at 8 months and pain intensity and interference, depression severity, and minutes per week of moderate to vigorous physical activity at 4 and 8 months. A total of 174 participants were randomized 1:1 to CC ( = 89) versus UC ( = 85). The primary analysis, a mixed-effects linear regression adjusting for time since injury and sex, revealed a non-significant trend for greater improvement in quality of life in CC versus UC at 4 months ( = 0.083). Secondary analyses showed that those receiving CC reported significantly greater improvement in pain interference at 4- and 8-months and in depression at 4-months, but no significant effect on physical activity. We conclude that in an outpatient SCI care setting, CC is a promising model for delivering integrated medical and psychological care and improving management of common, chronic, disabling conditions such and pain and depression.
我们的目标是测试协作式护理（CC）与常规护理（UC）的有效性，以改善脊髓损伤（SCI）门诊患者的疼痛、抑郁、身体活动不足和生活质量的治疗效果。我们进行了一项单盲平行组随机对照试验。该试验地点为一家大型学术医疗中心的两个门诊 SCI 康复诊所。参与者为 174 名平均年龄为 47.7 岁的门诊患者，其中 76%为男性，76%为白人，8%为西班牙裔，47%为四肢瘫痪，95%以上为 SCI 后 1 年以上，45%为医疗保险患者。干预措施包括一位接受过心理健康培训的协作式护理经理（CM），该经理整合到两个 SCI 康复医学诊所中，并由疼痛和心理健康治疗方面的专家进行监督。CM 通过最多 12 次面对面或电话会议，为患者提供评估、医疗协调、遵医嘱支持、结果监测和决策支持，以及简短的心理干预。在所有参与者中，61%选择专注于疼痛；31%选择身体活动，8%选择抑郁。主要结局是治疗结束时（4 个月）用世界卫生组织生活质量简表（BREF）测量的生活质量。次要结局是 8 个月时的生活质量以及 4 个月和 8 个月时的疼痛强度和干扰、抑郁严重程度以及每周中等至剧烈身体活动的分钟数。共有 174 名参与者以 1:1 的比例随机分为 CC 组（ = 89）和 UC 组（ = 85）。主要分析采用混合效应线性回归，调整损伤后时间和性别，结果显示 4 个月时 CC 组的生活质量较 UC 组有显著改善的趋势（ = 0.083）。次要分析显示，接受 CC 治疗的患者在 4 个月和 8 个月时的疼痛干扰以及 4 个月时的抑郁症状均有显著改善，但对身体活动没有显著影响。我们得出结论，在门诊 SCI 护理环境中，CC 是提供综合医疗和心理护理的有前途的模式，可以改善疼痛和抑郁等常见、慢性、致残性疾病的管理。
