Coping skills training for arthritis: An effectiveness trial

描述（由申请人提供）：在美国，导致残疾的主要原因是关节炎，影响了大约60%的65岁以上的人。生物医学治疗在抑制骨关节炎（OA）疾病进展和消除疼痛和功能损害方面的能力有限。与健康相关的生活质量测量一致地记录了关节炎患者的显著损害。疗效试验证明，疼痛应对技能训练（CST）可以减轻关节炎的疼痛，改善身体和社会功能，提高自我效能，减少心理困扰。尽管如此，绝大多数OA患者无法使用CST。增加患者获得CST的机会需要创新的医疗保健模式。理想情况下，CST应纳入患者的社区医疗环境。在这些环境中的提供者中，护士从业人员（NP）在患者教育方面受过培训，似乎非常适合提供CST。这一应用是第一次有效性试验——将社区卫生服务从学术机构引入社区初级保健办公室，在那里，国家卫生服务人员将接受培训，提供手动的、10期的社区卫生服务。提出了一项针对OA慢性疼痛患者的随机、对照（治疗与常规护理）多中心试验（N=272）。意向治疗分析将评估这种治疗交付模式与常规护理对照组相比是否产生显著的益处。在治疗前、治疗后以及6个月、1年、2年随访时，对疼痛、身心残疾、自我效能、疼痛应对技能和生活质量进行评估。将进行成本效益分析。本研究通过对有效性研究成果的综合评价，将对有效性研究科学做出重要贡献。分析将检查目标人群的覆盖率、NPs对治疗保真度的评估、患者对治疗的接受程度、消费者满意度以及药物和其他关节炎治疗的使用情况。如果这一试验取得成功，它将为随后的研究奠定基础，以调查创新战略，以加强维持CST的效果，将CST的电话和电脑传送结合起来，并进行卫生经济分析。这项研究将测试一种创新的医疗服务模式，旨在使关节炎患者更广泛地获得疼痛应对技能培训（CST）。CST已被证明可以改善患者的功能和生活质量，而不是药物和其他医疗治疗所能提供的。本R01再申请旨在检验初级保健执业护士对骨关节炎患者进行心理干预——疼痛应对技能训练（CST）的有效性。测量患者的疼痛、心理残疾、自我效能、疼痛应对技能、生活质量以及成本效益。

DESCRIPTION (provided by applicant): The leading cause of disability in the U.S. is arthritis, affecting approximately 60 percent of those over 65 years of age. Biomedical treatments are limited in their ability to curb osteoarthritis (OA) disease progression and to eliminate pain and functional impairment. Health-related quality of life measures consistently document significant impairment in persons with arthritis. Efficacy trials have documented that Pain Coping Skills Training (CST) for arthritis reduces pain, improves physical and social functioning, increases self-efficacy, and reduces psychological distress. Despite this, CST is unavailable to the vast majority of OA patients. Increasing patient access to CST will require an innovative healthcare model. Ideally, CST should be integrated into patients' community medical settings. Among providers in these settings, nurse practitioners (NP) with their training in patient education, seem well-suited to deliver CST. This application is the first effectiveness trial -bringing CST from academic settings into community primary care offices where NPs will be trained to deliver manualized, 10-session CST. A randomized, controlled (treatment vs. usual care) multi- site trial (N=272) for OA patients with chronic pain is proposed. Intent-to-treat analyses will evaluate whether this treatment delivery model yields significant benefits compared with a usual-care control group. Assessments of pain, physical and psychological disability, self-efficacy, pain coping skills, and quality of life will be conducted pre-treatment, post-treatment, and at 6-month, 1-, 2-year follow-ups. Cost-effectiveness analyses will be conducted. This study will make important contributions to the science of effectiveness research through comprehensive assessment of outcomes specific to effectiveness research. Analyses will examine reach into the target population, assessment of treatment fidelity by NPs, patient uptake of treatment, consumer satisfaction, and utilization of medication and other arthritis treatments. If this trial is successful, it will set the stage for subsequent studies to investigate innovative strategies to enhance maintenance of CST effects, to incorporate telephone and computer delivery of CST, and to conduct health economic analyses. This research will test an innovative health care delivery model designed to make pain coping skills training (CST) more widely available to patients with arthritis. CST has been shown to improve patients' functioning and quality of life beyond what medications and other medical treatment offer. This R01 reapplication proposes to examine the effectiveness of having nurse practitioners in primary care practices deliver a psychological intervention--Pain Coping Skill Training (CST) -- to osteoarthritis patients. Patients' pain, psychological disability, self-efficacy, pain coping skills, and quality of life as well as cost effectiveness will be measured.