Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain
Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain
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DOI：
10.1093/ptj/pzx091
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发表时间：
2017-12-01
期刊：
影响因子：
3.2
通讯作者：
Grotle, Margreth
中科院分区：
文献类型：
--
作者：
Mansell, Gemma;Storheim, Kjersti;Grotle, Margreth
背景存在许多治疗腰痛的干预措施，但这些治疗的机制并不总是清楚的。这种情况尤其适用于包含几个不同组成部分和提供方法的生物心理社会干预措施。本研究的目的是通过疾病认知、背痛神话和疼痛灾难化对残疾结局的间接影响来检查认知患者教育（科普）干预的间接影响。本研究是科普随机对照试验的次要分析。方法.中介分析技术被用来检查COPE干预的间接影响，通过残留的变化（基线治疗后）在3个变量假设为目标的科普干预治疗后残疾的结果。在分析中控制了基线疼痛强度、疼痛持续时间、临床医生类型和治疗-介质相互作用项。初步分析证实，疼痛灾难化和疾病认知（而不是背痛神话）的变化与干预组的分配和治疗后残疾评分有关。通过疾病感知和疼痛灾难化对治疗后残疾评分的变化，治疗产生了统计学显著的间接效应（疾病感知标准化间接效应= 0.09 [95% CI = 0.03 - 0.16];疼痛灾难化标准化间接效应= 0.05 [95% CI = 0.01 - 0.12]）。然而，包含交互作用项导致间接效应显著降低，效应不再具有统计学显著性。局限性。这项研究提出了一个二次分析的变量没有被确定为潜在的重要治疗目标的先验;其他，未测量的因素也可能是重要的，在解释治疗效果。科普干预通过改变疾病认知和疼痛灾难化对治疗后残疾的间接影响可以估计，这一发现表明这些变量可能是生物心理社会干预的可行治疗目标;然而，这一发现必须根据调整后的分析来看待，调整后的分析表明，通过纳入治疗-介质相互作用项，间接影响显着减少。
Background. Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery.Objective. The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome.Design. This study was a secondary analysis of the COPE randomized controlled trial. Methods. Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline-posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis.Results. Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. Limitations. This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects.Conclusions. The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term.