Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial.
Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial.
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DOI：
10.1097/j.pain.0000000000002436
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发表时间：
2022-05-01
期刊：
影响因子：
7.4
通讯作者：
Fritz JM
中科院分区：
文献类型：
--
作者：
Lane E;Magel JS;Thackeray A;Greene T;Fino NF;Puentedura EJ;Louw A;Maddox D;Fritz JM
慢性脊柱疼痛给世界各地的医疗保健带来了复杂的挑战，需要有效的干预措施。疼痛神经科学教育（PNE）是一种很有前途的干预措施，通过改变个人对疼痛的信念，感知和期望来改善疼痛和残疾。疼痛神经科学教育在严格控制的情况下实施时，在小型对照试验中显示出希望。通过更务实的方法探索有希望的干预措施是改善常规临床护理结果的关键一步，但尚未得到充分研究。本研究的目的是探讨实用的PNE训练对慢性脊柱疼痛患者临床结局的影响。这项随机分组的临床试验在45家门诊物理治疗师（PT）诊所进行。参与者包括108名物理治疗师（45个诊所和16个集群）和319名患者。PT诊所的集群被随机分配到接受PNE培训或不进行干预，并继续进行常规护理（UC）。我们发现两组在12周时的主要结局无显著差异，患者报告结局测量信息系统身体功能计算机自适应测试{平均差异= 1.05（95%置信区间[CI]：-0.73至2.83），P = 0.25}。PNE组在第12周和第2周的疼痛自我效能显著高于未干预组（平均差异分别为3.65 [95%CI：0.00-7.29]，P = 0.049和3.08 [95%CI：0.07至-6.09]，P = 0.045）。然而，对照组（41.1%）和治疗组（44.4%）中相似百分比的参与者报告在2周时接受了忠诚度问题（对疼痛是或否作为感知威胁进行讨论）的治疗。实用的PT PNE训练和交付未能产生显着的功能变化，慢性脊柱疼痛患者，但疼痛自我效能显着改善UC PT。
Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals’ beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: −0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to −6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
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影响因子：
7.2
作者：
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通讯作者：
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影响因子：
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作者：
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影响因子：
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DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R