Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.
Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.
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DOI：
10.2196/medinform.7117
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发表时间：
2017-10-17
影响因子：
3.2
通讯作者：
Kerns RD
中科院分区：
文献类型：
--
作者：
Johnson SS;Levesque DA;Broderick LE;Bailey DG;Kerns RD
慢性疼痛是一个重大的公共卫生负担，影响更多的美国人比心血管疾病，糖尿病和癌症的总和。退伍军人不成比例地受到慢性疼痛的影响。在以前部署的士兵和退伍军人中，慢性疼痛的患病率估计在44%至60%之间。本研究的目的是开发和试点测试健康eRide：你的疼痛管理之旅，一个移动的疼痛自我管理计划，为退伍军人慢性肌肉骨骼疼痛。基于行为改变的跨理论模型，该干预措施是针对退伍军人采用健康的疼痛自我管理策略及其首选策略的改变阶段而量身定制的。它还涉及压力管理和健康的睡眠，这是有希望的综合治疗退伍军人疼痛和并发症的两个组成部分，包括创伤后应激障碍（PTSD）和创伤性脑损伤。此外，Health eRide利用游戏原理、短信（短消息服务，SMS）和社交网络来提高参与度和保留率。试点测试参与者是69名退伍军人，他们是在退伍军人健康管理局机构通过面对面和邮寄、社区外展和基于网络的调查公司招募的。参与者完成了移动交付的基线评估和健康eRide干预会话。在接下来的30天里，他们可以访问个人活动中心，提供额外的阶段匹配活动和信息，并可以选择接收量身定制的短信。在基线和30天随访时进行的前后评估包括疼痛、疼痛影响、疼痛自我管理策略的使用、PTSD以及在行动或维持阶段采用疼痛自我管理、管理压力和养成健康睡眠习惯的百分比。还在随访时评估了变更的总体印象以及程序可接受性和可用性。在完成30天后评估的44名退伍军人中，疼痛（P<0.001）和疼痛影响（P<0.001）在统计学上显著减少; PTSD症状有所减轻（P= 0.05）。在采取疼痛自我管理（P= 0.01）和管理压力（P<0.001）的行动或维持阶段，参与者的百分比有显著的前后增加，但没有练习健康的睡眠习惯（P= 0.11）。全球变化印象衡量标准显示，大多数国家都有一定程度的改善。用户对可接受性的评价相当高;可用性的评价略低于数字节目的平均水平。初步数据表明，健康eRide计划对退伍军人慢性肌肉骨骼疼痛的潜在影响。结果强调，同时解决其他行为可能是一种有前途的方法来管理疼痛和共病状况。需要进行额外的形成性研究，以完成Health eRide计划的开发，并解决需要改进的可用性领域。需要进行一项随机试验，并进行更长时间的随访，以证明该计划对疼痛和疼痛自我管理的长期影响。
Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management.