Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: how does change in pain and function relate?
Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: how does change in pain and function relate?
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DOI：
10.1097/01.j.pain.0000460355.17246.6c
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发表时间：
2015-04-01
期刊：
影响因子：
7.4
通讯作者：
Tai, Gabrielle
中科院分区：
文献类型：
--
作者：
Palermo, Tonya M.;Law, Emily F.;Tai, Gabrielle
虽然接受认知行为治疗慢性疼痛的青少年在治疗后立即改善疼痛和功能，但有限的数据可用于了解青少年在心理治疗期间所做的变化。我们试图描述疼痛和功能变化的不同轨迹模式，以了解互联网提供的认知行为治疗（CBT）期间这些变化的时间关联。在8周的治疗期间，对135名11至17岁的慢性疼痛青少年进行每周重复的疼痛和功能评估，这些青少年被随机分配到正在进行的互联网提供CBT（基于网络的青少年疼痛管理：Web-MAP 2）试验的认知行为干预组。使用随机效应增长混合模型，我们的特点是疼痛和功能障碍的轨迹，发现不同的轨迹组，表明模式的线性和二次效应。变化轨迹显示，一些患者的疼痛和功能障碍正在改善，另一些则恶化或变化极小。配对t检验比较了疼痛和功能的受试者内相对变化率，证明治疗期间疼痛和功能的变化范围相似。没有证据支持疼痛或功能的改善先于其他领域的变化。研究结果可能有助于为未来儿科慢性疼痛的心理社会治疗研究提供信息，以考虑如何针对不同的患者反应特征制定治疗策略。这可能会导致干预策略的发展，既可以更有效地针对儿童的疼痛和功能在治疗过程中，并导致治疗后的持续变化。
Although pain and function improve at immediate posttreatment for youth receiving cognitive behavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function to understand the temporal association of these changes during internet-delivered cognitive behavioral therapy (CBT). Weekly repeated assessments of pain and function were conducted during 8 weeks of treatment among 135 adolescents, aged 11 to 17 years, with chronic pain who were randomized to the cognitive behavioral intervention arm of an ongoing trial of internet-delivered CBT (Web-based-management of adolescent pain: Web-MAP2). Using random-effects growth mixture models, we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear, and quadratic effects. Trajectories of change showed that some patients' pain and functional disability were improving, others worsened or changed minimally. Paired t tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children's pain and function during treatment and lead to sustained changes after treatment.