Von Korff M, Moore J E, Lorig K, Cherkin D C, Saunders K, González V M, Laurent D, Rutter C, Comite F
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA.
Spine (Phila Pa 1976). 1998 Dec 1;23(23):2608-15. doi: 10.1097/00007632-199812010-00016.
Randomized, controlled trial.
To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations.
Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated.
Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care.
Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls.
Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.
随机对照试验。
评估由受过培训的背痛外行人主导的、针对初级保健中疼痛患者的为期四节的自我管理小组干预措施。该干预旨在减少患者的担忧，鼓励自我护理，并减少活动受限情况。
教育干预的随机试验表明，激活干预可能改善背痛结局。专家意见越来越认为有效的背痛自我管理对取得良好结局很重要。在本研究中，对一项旨在激活患者并支持有效自我管理的教育干预进行了评估。
在因背痛进行初级保健就诊6至8周后，邀请患者参加一个改善背痛自我管理的教育项目。那些通过返回一份简短问卷表示感兴趣的患者有资格参与研究。参与者（n = 255）被随机分配到自我管理小组干预组或常规护理对照组。在随机分组后3、6和12个月评估干预相对于常规护理的效果，并对基线值进行控制。干预包括一个为期四节的小组，运用解决问题的技巧进行背痛自我管理，并辅以支持积极管理背痛的教育材料（书籍和视频）。这些小组由经过培训以实施完全结构化小组方案的外行人领导。对照组接受常规护理，并辅以一本关于背痛护理的书籍。
随机分配到自我管理小组的参与者报告称对背痛的担忧明显减少，对自我护理更有信心。在6个月时，自我管理小组参与者的罗兰残疾问卷得分相对于常规护理对照组显著更低（P = 0.007），且在12个月时，这种差异在临界显著水平上持续存在（P = 0.09）。在自我管理小组参与者中，48%在6个月时罗兰残疾问卷得分降低了50%或更多，而常规护理对照组中这一比例为33%。
由经过培训的外行人按照结构化方案领导的自我管理小组，在减少担忧、产生对自我护理的积极态度以及减少初级保健中背痛患者的活动受限方面比常规护理更有效。
