Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans-Rationale, Methods, and Implementation
Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans-Rationale, Methods, and Implementation
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DOI：
10.1093/pm/pnaa366
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发表时间：
2020-12-01
期刊：
影响因子：
3.1
通讯作者：
McCamish, Nicole
中科院分区：
文献类型：
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作者：
Seal, Karen H.;Becker, William C.;McCamish, Nicole
背景美国退伍军人事务部（VA）的整体健康模式强调整体自我护理和多模式方法，以改善疼痛，功能和生活质量。wHOPE（整体健康选择和疼痛教育）旨在成为第一个多地点的务实试验，以建立慢性疼痛护理VA整体健康模型的证据。设计wHOPE是一项实用的随机对照试验，比较了全健康团队（WHT）方法与初级保健小组教育（PC-GE）;两者都将与家庭VA初级保健（UPC）进行比较。WHT由医疗提供者，补充和综合健康（CIH）提供者和整体健康教练组成，他们与VA患者合作创建个性化健康计划，强调CIH方法来管理慢性疼痛。活性对照药物PC-GE是适应性慢性疼痛的团体认知行为治疗。第一个目的是测试WHT方法是否上级于PC-GE，以及两者在减少750名患有中度至重度慢性疼痛的退伍军人的疼痛干扰方面是否均上级于UPC（主要结局）。次要结局包括疼痛严重程度、生活质量、心理健康症状的变化以及疼痛的非药物和药物治疗的使用。将从VA电子健康记录和患者报告的12个月随访数据中收集结局。目标2包括以执行为重点的过程评价和预算影响分析。摘要这项试验是疼痛管理合作实验室的一部分，该实验室旨在建立国家级的基础设施，以支持退伍军人和军人的循证非药物疼痛管理方法。
Background. The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Design. wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC-GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC-GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome). Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient-reported data over 12 months of follow-up. Aim 2 consists of an implementation-focused process evaluation and budget impact analysis. Summary. This trial is part of the Pain Management Collaboratory, which seeks to create national-level infrastructure to support evidence-based nonpharmacological pain management approaches for veterans and military service personnel.