Skolasky Richard L, Nolan Sarah, Pierre Raven, Vinch Paige, Taylor Janiece L
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University School of Nursing, Baltimore, MD, USA.
BMC Nurs. 2024 Jul 31;23(1):524. doi: 10.1186/s12912-024-02155-w.
Patients with chronic low back (cLBP) pain report reduced physical function and ability to participate in social roles and are more likely to use opioid pain medications. While self-management interventions have been shown to support these patients, their effectiveness has been limited due to poor patient engagement. "Patient activation" encompasses the skills, knowledge, and motivation that a person has to manage their health. Supporting patient activation may improve the effectiveness of self-management for cLBP.
In this single-masked pilot study of adults with cLBP, patients were randomized to receive either no intervention (control) or 6 weekly sessions of an evidence-based web-based self-management program (SMP) with or without health behavior change counseling (HBCC) using motivational interviewing. Participants were assessed at baseline and at 12 and 26 weeks using the Patient Activation Measure, Oswestry Disability Index and PROMIS physical function, social role participation, and pain interference. We assessed acceptability and feasibility based on recruitment, session attendance, and follow-up.
Of 187 individuals screened, 105 were eligible and 34 were randomized to control (n = 12), SMP (n = 4), or SMP + HBCC (n = 18). The population had 19 women, 22 patients married or living with significant other, 13 Black or African American patients, and 4 Hispanic or Latino patients. Participants had a mean (SD) Oswestry Disability Index score of 42 (12), moderate impairments in physical function (40 (6.6)) and social roles (45 (10)), and moderately severe pain interference (61 (6.7)). Of 22 participants receiving SMP sessions, 20 participated in at least 1, 15 participated in at least 3, and 7 participated in all 6 sessions. Loss to follow-up was 6 over the 26-week study. Participants in the SMP and SMP + HBCC groups had at least medium effect size improvements in Patient Activation Measures and small-to-medium effect size improvements in Oswestry Disability Index scores and physical function and large effect size improvement in social roles at 12 weeks. Improvements persisted in the SMP + HBCC group at 26 weeks.
A web-based SMP is acceptable and feasible in this population. Participants who received augmentation with HBCC had persistent improvements in health outcomes at 26 weeks.
ClinicalTrials.gov Identifier NCT06236529 (2/1/2024 - retrospectively registered).
慢性腰痛（cLBP）患者报告其身体功能下降，参与社会角色的能力受限，且更有可能使用阿片类止痛药物。虽然自我管理干预已被证明对这些患者有帮助，但其有效性因患者参与度低而受限。“患者激活”涵盖个人管理自身健康所需的技能、知识和动力。支持患者激活可能会提高cLBP自我管理的有效性。
在这项针对成年cLBP患者的单盲试点研究中，患者被随机分为不接受干预（对照组）或接受为期6周的基于网络的循证自我管理计划（SMP），该计划有或没有使用动机性访谈的健康行为改变咨询（HBCC）。在基线以及第12周和第26周使用患者激活量表、Oswestry功能障碍指数以及患者报告结果测量信息系统（PROMIS）的身体功能、社会角色参与和疼痛干扰情况对参与者进行评估。我们根据招募情况、课程出席率和随访情况评估可接受性和可行性。
在187名 screened 个体中，105名符合条件，34名被随机分配至对照组（n = 12）、SMP组（n = 4）或SMP + HBCC组（n = 18）。该人群中有19名女性，22名患者已婚或与重要他人同住，13名黑人或非裔美国患者，以及4名西班牙裔或拉丁裔患者。参与者的Oswestry功能障碍指数平均（标准差）评分为42（12），身体功能（40（6.6））和社会角色（45（10））有中度损伤，疼痛干扰为中度至重度（61（6.7））。在接受SMP课程的22名参与者中，20名至少参加了1次，15名至少参加了3次，7名参加了全部6次课程。在为期26周的研究中，失访6人。SMP组和SMP + HBCC组的参与者在第12周时，患者激活量表至少有中等效应大小的改善，Oswestry功能障碍指数评分、身体功能有小至中等效应大小的改善，社会角色有大效应大小的改善。SMP + HBCC组在第26周时改善持续存在。
基于网络的SMP在该人群中是可接受且可行的。接受HBCC强化干预的参与者在26周时健康结局持续改善。
ClinicalTrials.gov标识符NCT06236529（2024年1月2日 - 追溯注册）
