Telehealth Therapy Effects of Nurses and Mental Health Professionals From 2 Randomized Controlled Trials for Chronic Back Pain
Telehealth Therapy Effects of Nurses and Mental Health Professionals From 2 Randomized Controlled Trials for Chronic Back Pain
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DOI：
10.1097/ajp.0000000000000678
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发表时间：
2019-04-01
影响因子：
2.9
通讯作者：
Rutledge, Thomas
中科院分区：
文献类型：
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作者：
Gannon, Jamie;Atkinson, Joseph H.;Rutledge, Thomas
目的：比较心理健康专业人员与初级保健护士提供的远程保健认知行为疗法（CBT）和支持性护理（SC）治疗慢性腰痛的疗效，使用来自2项单独随机对照试验的数据。两项试验均在同一家医院完成，使用相同的研究设计、研究团队和结局指标。材料与方法：研究1（心理健康专业研究）（N=66; 2007年至2011年）和研究2（护理研究）（N=61; 2012年至2016年）的参与者是慢性腰痛（>= 4/10强度）患者，随机接受8周CBT或SC远程医疗条件，以匹配接触频率，格式和时间。参与者完成了对背痛残疾（罗兰莫里斯残疾问卷[RMDQ]）、疼痛强度（数字评定量表[NRS]）、抑郁症状（贝克抑郁量表2 [BDI-2]）、疼痛灾难化（疼痛灾难化量表[PCS]）和总体改善（全球临床抑郁量表[GCI]）的有效测量。结果如下：治疗后的意向治疗分析显示，两项研究和两种治疗从治疗前到治疗后，RMDQ（Cohen d=0.33至0.55）、NRS（d=0.45至0.90）、PCS（d=0.21至0.41）和GCI（18.5%至39.1%）评分均显著改善。BDI评分的变化不一致（d=-0.06至0.51）。分析显示，在RMDQ、NRS、PCS或GCI测量中，经过培训的护士与精神卫生专业人员之间的治疗效果无显著差异（P>0.20）。讨论内容：这些临床试验的结果表明，当由初级保健护士或心理健康专业人员提供时，基于家庭的远程医疗CBT和SC治疗慢性背痛的益处是相当的。
Objective: To compare the efficacy of mental health professional versus primary care nurse-delivered telehealth cognitive-behavioral therapy (CBT) and supportive care (SC) treatments for chronic low back pain, using data from 2 separate randomized controlled trials. Both trials were completed in the same hospital and used the same study design, research team, and outcome measures. Materials and Methods: Participants from Study 1 (Mental Health Professional Study) (N=66; 2007 to 2011) and Study 2 (Nursing Study) (N=61; 2012 to 2016) were patients with chronic low back pain (>= 4/10 intensity) randomized to either an 8-week CBT or an SC telehealth condition matched for contact frequency, format, and time. Participants completed validated measures of improvement in back pain disability (Roland Morris Disability Questionnaire [RMDQ]), pain intensity (Numeric Rating Scale [NRS]), depressive symptoms (Beck Depression Inventory 2 [BDI-2]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), and overall improvement (Global Clinical Impressions [GCI]). Results: Intent-to-treat analyses at posttreatment showed that scores on the RMDQ (Cohen d=0.33 to 0.55), NRS (d=0.45 to 0.90), PCS (d=0.21 to 0.41), and GCI (18.5% to 39.1%) improved significantly in both studies and in both treatments from pretreatment to posttreatment. Changes in BDI scores were inconsistent (d=-0.06 to 0.51). The analyses revealed no significant differences in treatment efficacy between the trained nurse versus the mental health professionals on the RMDQ, NRS, PCS, or GCI measures (P>0.20). Discussion: Results from these clinical trials suggest that the benefits of home-based, telehealth-delivered CBT and SC treatments for chronic back pain were comparable when delivered by a primary care nurse or mental health professional.