Coping Skills Training for Arthritis: An Effectiveness Trial

关节炎应对技能训练：有效性试验

基本信息

批准号：
8117248
负责人：
Joan E Broderick
金额：
$ 48.76万
依托单位：
STATE UNIVERSITY NEW YORK STONY BROOK
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-15 至 2014-01-15
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8117248
关键词：
Adherence Adopted Adoption Adult Adult Health Nursing Affect Aftercare Age-Years Arthritis Behavior Therapy Behavioral Behavioral Medicine Caring Centers for Disease Control and Prevention (U.S.)Characteristics Chronic Cities Clinical Cognitive Therapy Communities Community Practice Complex Computers Consumer Satisfaction Control Groups Coping Skills Counseling Cultural Diversity Data Degenerative polyarthritis Diagnosis Discipline of Nursing Disease Progression Dose Educational Intervention Educational process of instructing Effectiveness Evaluation Foundations Goals Guidelines Health Personnel Health Policy Healthcare Healthy People 2010 Impairment Intervention Laboratories Maintenance Measures Medical Medicine Mental Health Modeling Nurse Practitioners Nurses Office Nursing Outcome Assessment Outcome Measure Pain Pain Measurement Patient Care Patient Education Patient Self-Report Patients Persons Pharmaceutical Preparations Physical Function Physicians Policy Maker Primary Care Physician Primary Health Care Protocols documentation Provider Psychologist Public Health Quality of life Randomized Reapplication Relative (related person)Research Research Personnel Sampling Science Self Efficacy Site Social Functioning Staging Target Populations Techniques Telephone Testing Therapeutic Time Training Translating Translational Research Treatment Protocols Treatment outcome United States National Institutes of Health Virginia arthritis education base chronic pain coping cost effectiveness design disability disorder prevention effectiveness research effectiveness trial efficacy trial follow-up functional disability health care delivery health economics health related quality of life improved improved functioning innovation model design multi-site trial patient population programs psychologic psychological distress psychosocial research to practice satisfaction skills skills training statistics suburb theories therapy design treatment as usual treatment effect trial comparing uptake

项目摘要

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.

描述（由申请人提供）：美国残疾的主要原因是关节炎，影响65岁以上的人中约有60％。生物医学治疗的抑制骨关节炎（OA）疾病进展并消除疼痛和功能障碍的能力受到限制。与健康相关的生活质量措施一致地记录了关节炎患者的重大损害。功效试验证明，用于关节炎的疼痛应对技巧训练（CST）减轻疼痛，改善身体和社会功能，提高自我效能感并减少心理困扰。尽管如此，绝大多数OA患者都无法获得CST。增加患者进入CST将需要创新的医疗保健模型。理想情况下，CST应集成到患者的社区医疗环境中。在这些环境中的提供者中，护士从业人员（NP）接受了患者教育的培训，似乎非常适合提供CST。该申请是从学术环境到社区初级保健办公室的第一个有效性试验，将培训NP，以提供手动的10条经营CST。提出了针对OA慢性疼痛患者的随机控制（治疗与常规护理）多部位试验（n = 272）。意图对治疗分析将评估与通常的护理对照组相比，该治疗输送模型是否会产生显着的好处。评估疼痛，身体和心理残疾，自我效能感，疼痛应对能力和生活质量将进行治疗，治疗后，并在6个月，1-1-1岁的2年随访中进行。将进行成本效益分析。这项研究将通过对特定于有效性研究的结果进行全面评估，对有效性研究科学做出重要贡献。分析将检查到目标人群中的范围，评估NP的治疗保真度，患者的治疗，消费者满意度以及药物和其他关节炎治疗的利用。如果该试验成功，它将为随后的研究奠定阶段，以调查增强CST效果的创新策略，以纳入CST的电话和计算机交付以及进行健康经济分析。这项研究将测试一种创新的医疗保健分娩模型，旨在使关节炎患者更广泛地使用疼痛应对技能培训（CST）。已显示CST可以改善患者的功能和生活质量，超出药物和其他医疗服务。该R01重新申请提议研究让护士从业人员在初级保健实践中提供心理干预的有效性 - 对骨关节炎患者的应对技巧培训（CST）。将测量患者的疼痛，心理残疾，自我效能感，疼痛应对能力，生活质量以及成本效益。