Evaluation of a Peer Led Chronic Pain Self-Management Program in a Rural Population

Perspectives on Online Resources for People Experiencing Pain: A Qualitative Study

BACKGROUND

Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain.

OBJECTIVES

This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs.

METHODS

Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources.

CONCLUSION

Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

A regional program evaluation of the Stanford Chronic Pain Self-Management Program in Eastern Ontario, Canada

Background

Health care providers often struggle to treat patients with chronic pain. One potential solution is to facilitate access to programs and tools that develop patients' skills and confidence in managing their own care.

Aims

This study aimed to describe the uptake of the Chronic Pain Self-Management Program (CPSMP) in Eastern Ontario and evaluate the effectiveness of the program in the acquisition of knowledge, confidence, and skills required to manage chronic pain, as measured by the Patient Activation Measure (PAM).

Methods

Using data routinely collected through the CPSMP between December 2017 and May 2023, we conducted a descriptive analysis of the number of participants each year, their gender, and their age distributions. We conducted a longitudinal analysis of the change in PAM score between participants' first (baseline) and last (follow-up) day in the program.

Results

Overall, 1023 individuals enrolled in the CPSMP during the study period, with enrollments peaking in 2018 and remaining stable thereafter. There was a higher proportion of females compared to males (69%, n = 709) and 50- to 59-year-olds compared to other ages. Of the 1023 participants enrolled, 151 completed PAM surveys at baseline and follow-up (15%), of which 69% experienced an increase of at least 4 points on the PAM (104/151).

Conclusion

Most participants were female and aged 50 to 59 years old. Among a sample of participants with available longitudinal data, the CPSMP demonstrated promising effectiveness at equipping participants with the knowledge, skills, and confidence to manage their pain. Replication in a larger representative sample is warranted.

Context factors for implementation of clinical recommendations for chronic musculoskeletal pain

BACKGROUND

 Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings.

AIM

 This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP.

SETTING

 The study focused on the primary health care (PHC) sector in Cape Town, South Africa.

METHODS

 A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes.

RESULTS

 The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations.

CONCLUSION

 There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies.Contribution: The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation

BACKGROUND

Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely.

OBJECTIVE

This study evaluated changes in remote EBP participants' health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022.

METHODS

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings.

RESULTS

A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery.

CONCLUSIONS

The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults.

Remote delivery of self-management education workshops for adults with chronic pain, 2020-2021

OBJECTIVES

We intended to assess changes in pain-related outcomes among rural adults who completed 6-week self-management programs offered remotely during the COVID-19 pandemic.

METHODS

We offered the Chronic Pain Self-Management Program and Chronic Disease Self-Management Program between May 2020 and December 2021. Delivery mode options included 2½-hour weekly videoconference, mailed toolkit plus 1-hour weekly conference call, and mailed toolkit alone. We conducted pre- and post-workshop surveys including questions on patient activation, self-efficacy, depression and pain disability. We used paired t-tests to compare pre-post differences in outcomes among participants completing 4 or more sessions.

RESULTS

Among 218 adults reporting chronic pain, mean age was 57; 83.6% were female; and 49.5% participated via videoconference, 23.4% by phone and 27.1% via mailed toolkit alone. Completion rates were higher among phone (88.2%) versus videoconference (60.2%) workshop participants. Among completers, patient activation (mean change  =  3.61, p  =  0.01) and self-efficacy (mean change  =  3.72, p < 0.0001) increased while depression scores (mean change  =  -1.03, p  =  0.01), pain disability (mean change  =  -0.93, p  =  0.003) and pain symptoms (mean change  =  -0.61, p  =  0.001) decreased over the 6-week period.

DISCUSSION

Self-management programs offered remotely during the pandemic were successful in improving patient activation, self-efficacy, depression, pain disability, and pain symptoms among rural adults experiencing chronic pain.

Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review

INTRODUCTION

Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others.

OBJECTIVE

To analyze the self-management strategies currently used by older adults with chronic pain.

METHOD

An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years.

RESULTS AND CONCLUSION

Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.

[Interdisciplinary pain therapy in the elderly]

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

[Interdisciplinary pain therapy in the elderly]

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

Self-management education for children with epilepsy and their caregivers. A scoping review

Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.