Coping skills training for arthritis: An effectiveness trial

描述（由申请人提供）：在美国残疾的主要原因是关节炎，影响大约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障碍方面的能力有限。与健康相关的生活质量的措施，一贯记录显着损害的人与关节炎。疗效试验证明，关节炎疼痛应对技能训练（CST）可减轻疼痛，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，CST对绝大多数OA患者不可用。增加患者获得CST的机会将需要创新的医疗保健模式。理想的情况是，CST应融入患者的社区医疗环境。在这些环境中的供应商，执业护士（NP）与他们的培训，病人教育，似乎非常适合提供CST。该应用程序是第一个有效性试验-将CST从学术环境带入社区初级保健办公室，在那里NP将接受培训，以提供手动的10节CST。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与常规护理对照组相比，这种治疗模式是否产生显著的益处。将在治疗前、治疗后以及6个月、1年和2年随访时评估疼痛、身体和心理残疾、自我效能、疼痛应对技能和生活质量。将进行成本效益分析。本研究将通过对有效性研究成果的全面评估，为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范围，NP对治疗保真度的评估，患者对治疗的接受，消费者满意度以及药物和其他关节炎治疗的利用。如果这项试验是成功的，它将为以后的研究奠定基础，探讨创新的战略，以加强维持CST的影响，将电话和计算机交付CST，并进行卫生经济分析。这项研究将测试一种创新的医疗保健提供模式，旨在使疼痛应对技能培训（CST）更广泛地提供给关节炎患者。CST已被证明可以改善患者的功能和生活质量，超出药物和其他医疗提供的范围。这R 01重新申请建议检查的有效性，有执业护士在初级保健的做法提供心理干预-疼痛应对技能培训（CST）-骨关节炎患者。将测量患者的疼痛、心理残疾、自我效能、疼痛应对技能和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.