Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial
Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial
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DOI：
10.1016/j.pain.2014.05.024
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发表时间：
2014-09-01
期刊：
影响因子：
7.4
通讯作者：
Gould, Elaine
中科院分区：
文献类型：
--
作者：
Broderick, Joan E.;Keefe, Francis J.;Gould, Elaine
对伴有膝关节或髋关节慢性疼痛的骨关节炎患者进行了一项多地点、随机、对照临床疗效试验。成人保健护士在患者的医生办公室提供10次干预，疼痛应对技能培训（PCST） （N = 129例患者）；对照组接受常规护理（N = 127例）。在基线、治疗后、6个月随访和12个月随访时评估的主要结果是：疼痛强度、身体功能、心理困扰、自我效能、灾难化、应对策略的使用和生活质量。次要测量包括疲劳、社会功能、健康满意度和止痛药的使用。方法偏向外部效度，符合实用、有效性研究。进行了主要的ITT和次要的协议分析。减减率在预期范围内：治疗后为11%，随访12个月为29%；两组之间的比率没有差异。所有评估点的综合ITT分析表明，与对照组相比，PCST组在疼痛强度、身体功能、心理困扰、疼痛应对策略的使用、自我效能、疲劳、健康满意度和止痛药使用减少等方面均有显著改善。治疗效果对协变量（人口统计学和临床地点）是稳健的。审查了各评估结果的趋势。除自我效能外，所有结果在12个月的随访中都保持不变；自我效能的效果随着时间的推移而降低。按方案分析没有产生更大的效应量。对治疗依从性高与治疗依从性低的PCST患者的比较表明，高依从性患者的治疗效果更好。结果支持执业护士提供PCST治疗慢性骨关节炎疼痛的有效性。(C) 2014国际疼痛研究协会。Elsevier B.V.版权所有。
A multisite, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners provided a 10-session intervention, pain coping skills training (PCST), in patients' doctors' offices (N = 129 patients); the control group received usual care (N = 127 patients). Primary outcomes assessed at baseline, posttreatment, 6-month follow-up, and 12-month follow-up were: pain intensity, physical functioning, psychological distress, self-efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary ITT and secondary per-protocol analyses were conducted. Attrition was within the expected range: 11% at posttreatment and 29% at 12-month follow-up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared with the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self-efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self-efficacy, were maintained through the 12-month follow-up; effects for self-efficacy degraded over time. Per-protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more vs less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of nurse practitioner delivery of PCST for chronic osteoarthritis pain. (C) 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.