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Kennedy N, Nelson S, Jerome RN, Edwards TL, Stroud M, Wilkins CH, Harris PA. Recruitment and retention for chronic pain clinical trials: a narrative review. Pain Rep 2022; 7:e1007. [PMID: 38304397 PMCID: PMC10833632 DOI: 10.1097/pr9.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/25/2022] Open
Abstract
Opioid misuse is at a crisis level. In response to this epidemic, the National Institutes of Health has funded $945 million in research through the Helping to End Addiction Long-term (HEAL) Pain Management Initiative, including funding to the Vanderbilt Recruitment Innovation Center (RIC) to strategize methods to catalyze participant recruitment. The RIC, recognizing the challenges presented to clinical researchers in recruiting individuals experiencing pain, conducted a review of evidence in the literature on successful participant recruitment methods for chronic pain trials, in preparation for supporting the HEAL Pain trials. Study design as it affects recruitment was reviewed, with issues such as sufficient sample size, impact of placebo, pain symptom instability, and cohort characterization being identified as problems. Potential solutions found in the literature include targeted electronic health record phenotyping, use of alternative study designs, and greater clinician education and involvement. For retention, the literature reports successful strategies that include maintaining a supportive staff, allowing virtual study visits, and providing treatment flexibility within the trial. Community input on study design to identify potential obstacles to recruitment and retention was found to help investigators avoid pitfalls and enhance trust, especially when recruiting underrepresented minority populations. Our report concludes with a description of generalizable resources the RIC has developed or adapted to enhance recruitment and retention in the HEAL Pain studies. These resources include, among others, a Recruitment and Retention Plan Template, a Competing Trials Tool, and MyCap, a mobile research application that interfaces with Research Electronic Data Capture (REDCap).
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Affiliation(s)
- Nan Kennedy
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Sarah Nelson
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Rebecca N. Jerome
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Terri L. Edwards
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Consuelo H. Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Harris
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Lavender EC, Dusabe-Richards E, Anderson AM, Antcliff D, McGowan L, Conaghan PG, Kingsbury SR, McHugh GA. Exploring the feasibility, acceptability and value of volunteer peer mentors in supporting self-management of osteoarthritis: a qualitative evaluation. Disabil Rehabil 2021; 44:6314-6324. [PMID: 34498993 PMCID: PMC9590401 DOI: 10.1080/09638288.2021.1964625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) affect a large and growing proportion of the population. Treatment options are typically conservative making self-management a priority. Using trained peers to support individuals with OA has potential to improve self-management. PURPOSE To explore the process of engaging and training volunteers to become peer mentors; and to qualitatively evaluate the feasibility, acceptability and value of being a peer mentor to support others' self-management of OA. MATERIALS AND METHODS A qualitative evaluation of a peer mentorship support intervention reporting the processes of recruitment and training; and semi-structured interviews conducted with nine active peer mentors. Transcribed interviews were coded and analysed using framework analysis. RESULTS It was possible to recruit, train and retain volunteers with OA to become peer mentors. The peer mentors benefitted from their training and felt equipped to deliver the intervention. They enjoyed social elements of the mentorship intervention and gained satisfaction through delivering valued support to mentees. Peer mentors perceived the mentorship intervention to have a positive impact on self-management of OA for mentees. CONCLUSION Training volunteers with OA to become peer mentors was feasible and acceptable. Peer mentors perceived their support benefitted others with OA. They positively rated their experience of providing mentorship support.IMPLICATIONS FOR REHABILITATIONThis study demonstrates that it is possible to recruit, train and engage older volunteers to become peer mentors for people with osteoarthritis.Training should highlight the significance of employing key self-management techniques such as goal-setting.Peer mentors acknowledged that they benefitted from training and delivering the mentorship intervention, and this impacted positively on their own osteoarthritis self-management.Careful consideration of matching mentors and mentees appears to enhance the success of mentorship support.Recognising the impact of mentorship support on mentees' self-management is central to peer mentors' sustained engagement with the intervention.
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Affiliation(s)
| | | | - Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury & Rochdale Care Organisation, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Collard VEJ, Gillett JL, Themelis K, Tang NKY. An exploratory investigation into the effects of mental defeat on pain threshold, pain rating, pain anticipation, and mood. Curr Psychol 2021. [DOI: 10.1007/s12144-021-01548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractIn chronic pain, mental defeat is considered as a disabling type of self-evaluation triggered by repeated episodes of debilitating pain. This exploratory study experimentally tested the effect of an activated sense of defeat, as well as its interaction with pain catastrophizing, on pain and mood. Participants (N = 71) were allocated to either high or low pain catastrophizing groups and then randomly assigned to receive either defeat or neutral manipulations. A cold pressor task administered before and after the thought manipulation measured pain threshold, alongside visual analogue scales for mental defeat, attention, pain intensity, pain anticipation as well as mood. Thought manipulation checks supported successful defeat activation. Defeat activation was associated with increased negative mood and attentional disengagement from the nociceptive stimuli, irrespective of pain catastrophizing tendency. There were no changes in pain threshold, pain or pain anticipation ratings. The results suggest that mental defeat can be experimentally activated using an autobiographical memory task and that an activated sense of defeat appears to operate independently from pain catastrophizing in influencing mood and attentional disengagement from the nociceptive stimuli. Future research can utilize our experimental approach to evaluate the effect of an activated sense of mental defeat in people with chronic pain, for whom the magnitude of pain, mood and attentional responses may be stronger and broader.
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Abstract
Placing the person at the centre of their health and care has been a key part of health and care policy for nearly 2 decades. Fundamental to this approach is the role self-management support plays in increasing the confidence, skills and knowledge of a person in manging their health and wellbeing. This practical review article sets out to explore the historical context of self-management in England, its current status and the challenges faced in delivering self-management programmes. The demand on the health and care system continues to grow and so the need to move to a more holistic system of care with the person at its centre is greater than it has ever been before. With an increasingly fiscally restricted environment with which to operate, how can commissioners, health specialists and service providers work together to develop integrated pathways of care that provide the right care, at the right time and in the right place.
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Ashaye T, Hounsome N, Carnes D, Taylor SJC, Homer K, Eldridge S, Spencer A, Rahman A, Foell J, Underwood MR. Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial. BMJ Open 2018; 8:e019491. [PMID: 29880563 PMCID: PMC6009475 DOI: 10.1136/bmjopen-2017-019491] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs. DESIGN Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731). SETTING 25 general practices and two community musculoskeletal services in the UK (London and Midlands). PARTICIPANTS 703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial. MAIN OUTCOME MEASURES Anonymised prescribing data over 12 months extracted from GP electronic records. RESULTS Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). The mean number of opioid prescriptions per patient prescribed any opioid was 8.0 (SD=7.9). A third of patients on opioids were prescribed more than one type of opioid; the most frequent combinations were: codeine plus tramadol and codeine plus morphine. The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 (SD=29) for patients prescribed weak opioids and £174 (SD=421) for patients prescribed strong opioids. Approximately 40% of patients received >3 prescriptions of strong opioids per year, with an annual cost of £236 per person. CONCLUSIONS Long-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines. TRIAL REGISTRATION NUMBER ISRCTN24426731; Post-results.
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Affiliation(s)
- Tomi Ashaye
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Hernon MJ, Hall AM, O'Mahony JF, Normand C, Hurley DA. Systematic Review of Costs and Effects of Self-Management Interventions for Chronic Musculoskeletal Pain: Spotlight on Analytic Perspective and Outcomes Assessment. Phys Ther 2017; 97:998-1019. [PMID: 29029553 DOI: 10.1093/ptj/pzx073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 07/17/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Evidence for the cost-effectiveness of self-management interventions for chronic musculoskeletal pain (CMP) lacks consensus, which may be due to variability in the costing methods employed. PURPOSE The purposes of the study were to identify how costs and effects have been assessed in economic analysis of self-management interventions for CMP and to identify the effect of the chosen analytical perspective on cost-effectiveness conclusions. DATA SOURCES Five databases were searched for all study designs using relevant terms. STUDY SELECTION Two independent researchers reviewed all titles for predefined inclusion criteria: adults (≥18 years of age) with CMP, interventions with a primary aim of promoting self-management, and conducted a cost analysis. DATA EXTRACTION Descriptive data including population, self-management intervention, analytical perspective, and costs and effects measured were collected by one reviewer and checked for accuracy by a second reviewer. DATA SYNTHESIS Fifty-seven studies were identified: 65% (n = 37) chose the societal perspective, of which 89% (n = 33) captured health care utilization, 92% (n = 34) reported labor productivity, 65% (n = 24) included intervention delivery, and 59% (n = 22) captured patient/family costs. Types of costs varied in all studies. Eight studies conducted analyses from both health service and societal perspectives; cost-effectiveness estimates varied with perspective chosen, but in no case was the difference sufficient to change overall policy recommendations. LIMITATIONS Chronic musculoskeletal pain conditions where self-management is recommended, but not as a primary treatment, were excluded. Gray literature was excluded. CONCLUSION Substantial heterogeneity in the cost components captured in the assessment of self-management for CMP was found; this was independent of the analytic perspective used. Greater efforts to ensure complete and consistent costings are required if reliable cost-effectiveness evidence of self-management interventions is to be generated and to inform the most appropriate perspective for economic analyses in this field.
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Affiliation(s)
- Marian J Hernon
- School of Public Health, Physiotherapy, and Sports Science, A101 Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Amanda M Hall
- Faculty of Medicine, Memorial University of Newfoundland
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Deirdre A Hurley
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin
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Forbes G, Loudon K, Treweek S, Taylor SJC, Eldridge S. Understanding the applicability of results from primary care trials: lessons learned from applying PRECIS-2. J Clin Epidemiol 2017. [PMID: 28629699 DOI: 10.1016/j.jclinepi.2017.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare two approaches for trial teams to apply PRECIS-2 to pragmatic trials: independent scoring and scoring following a group discussion. STUDY DESIGN AND SETTING We recruited multidisciplinary teams who were conducting or had conducted trials in primary care in collaboration with the Pragmatic Clinical Trials Unit, Queen Mary University of London. Each team carried out two rounds of scoring on the nine PRECIS-2 domains: first independently using an online version of PRECIS-2 and second following a discussion. RESULTS Seven teams took part in the study. Before the discussion, within-team agreement in scores was generally poor and not all raters were able to score all domains; agreement improved after the discussion. The PRECIS-2 wheels suggested that the trials were pragmatic, although some domains were more pragmatic than others. CONCLUSION PRECIS-2 can facilitate information exchange within trial teams. To apply PRECIS-2 successfully, we recommend a discussion between those with detailed understanding of what usual care is for the intervention, the trial's design including operational and technical aspects, and the PRECIS-2 domains. For some cluster-randomized trials, greater insight may be gained by plotting two PRECIS-2 wheels, one at the individual participant level and another at the cluster level.
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Affiliation(s)
- Gordon Forbes
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK.
| | - Kirsty Loudon
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA, UK
| | - Shaun Treweek
- Health Services Research Unit University of Aberdeen Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
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Nøst TH, Steinsbekk A, Bratås O, Grønning K. Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study. Trials 2016; 17:325. [PMID: 27430319 PMCID: PMC4950079 DOI: 10.1186/s13063-016-1462-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND People struggling with chronic pain may benefit from different types of non-pharmacological interventions such as self-management courses. Self-management courses aim to increase participants' skills and knowledge in managing chronic conditions. Community health-care services in Norway have increasingly established Healthy Life Centres (HLCs) to offer easily accessible interventions to people in need of support to better handle a life with chronic illness. The aim of this trial is to investigate the expectations, effect and experience of an easily accessible, group-based self-management course delivered at a HLC for people with chronic pain. METHODS/DESIGN This is an open pragmatic two-armed randomised controlled trial with an embedded qualitative study. The intervention is a self-management course comprising education, discussions, exchange of experiences between the participants, and physical movement exercises. The control group is offered a drop-in outdoor physical activity. The intervention period is 6 weeks. The primary outcome is patient activation measured by the patient activation measure (PAM). The secondary outcomes include measures of self-efficacy, pain and quality of life. Data will be collected at baseline, and after 3, 6 and 12 months. Using a mixed linear model, the number needed in each arm to achieve a power of 80 % becomes 55. To allow for dropout, the aim is to include 120 participants. Analysis will be done using mixed linear models. In the embedded qualitative study, we will perform semi-structured face-to-face interviews with a sample from both trial arms before randomisation and after 3 and 12 months. The topics elaborated will be motivation for participation and experiences with the activity related to possible changes in managing and coping with chronic pain. DISCUSSION There is need for more knowledge on interventions delivering self-care support in an easily accessible way that aim to reach those in need of this kind of health service. This trial will produce important knowledge on the effect and the experiences of participants in such an easily accessible self-management course delivered in Norwegian public primary care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02531282 . Registered on 21 August 2015.
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Affiliation(s)
- Torunn Hatlen Nøst
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Aslak Steinsbekk
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Ola Bratås
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kjersti Grønning
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Taylor SJC, Carnes D, Homer K, Kahan BC, Hounsome N, Eldridge S, Spencer A, Pincus T, Rahman A, Underwood M. Novel Three-Day, Community-Based, Nonpharmacological Group Intervention for Chronic Musculoskeletal Pain (COPERS): A Randomised Clinical Trial. PLoS Med 2016; 13:e1002040. [PMID: 27299859 PMCID: PMC4907437 DOI: 10.1371/journal.pmed.1002040] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is the leading cause of disability worldwide. The effectiveness of pharmacological treatments for chronic pain is often limited, and there is growing concern about the adverse effects of these treatments, including opioid dependence. Nonpharmacological approaches to chronic pain may be an attractive alternative or adjunctive treatment. We describe the effectiveness of a novel, theoretically based group pain management support intervention for chronic musculoskeletal pain. METHODS AND FINDINGS We conducted a multi-centre, pragmatic, randomised, controlled effectiveness and cost-effectiveness (cost-utility) trial across 27 general practices and community musculoskeletal services in the UK. We recruited 703 adults with musculoskeletal pain of at least 3 mo duration between August 1, 2011, and July 31, 2012, and randomised participants 1.33:1 to intervention (403) or control (300). Intervention participants were offered a participative group intervention (COPERS) delivered over three alternate days with a follow-up session at 2 wk. The intervention introduced cognitive behavioural approaches and was designed to promote self-efficacy to manage chronic pain. Controls received usual care and a relaxation CD. The primary outcome was pain-related disability at 12 mo (Chronic Pain Grade [CPG] disability subscale); secondary outcomes included the CPG disability subscale at 6 mo and the following measured at 6 and 12 mo: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain acceptance (Chronic Pain Acceptance Questionnaire), social integration (Health Education Impact Questionnaire social integration and support subscale), pain-related self-efficacy (Pain Self-Efficacy Questionnaire), pain intensity (CPG pain intensity subscale), the census global health question (2011 census for England and Wales), health utility (EQ-5D-3L), and health care resource use. Analyses followed the intention-to-treat principle, accounted for clustering by course in the intervention arm, and used multiple imputation for missing or incomplete primary outcome data. The mean age of participants was 59.9 y, with 81% white, 67% female, 23% employed, 85% with pain for at least 3 y, and 23% on strong opioids. Symptoms of depression and anxiety were common (baseline mean HADS scores 7.4 [standard deviation 4.1] and 9.2 [4.6], respectively). Overall, 282 (70%) intervention participants met the predefined intervention adherence criterion. Primary outcome data were obtained from 88% of participants. There was no significant difference between groups in pain-related disability at 6 or 12 mo (12 mo: difference -1.0, intervention versus control, 95% CI -4.9 to 3.0), pain intensity, or the census global health question. Anxiety, depression, pain-related self-efficacy, pain acceptance, and social integration were better in the intervention group at 6 mo; at 12 mo, these differences remained statistically significant only for depression (-0.7, 95% CI -1.2 to -0.2) and social integration (0.8, 95% CI 0.4 to 1.2). Intervention participants received more analgesics than the controls across the 12 mo. The total cost of the course per person was £145 (US$214). The cost-utility analysis showed there to be a small benefit in terms of quality-adjusted life years (QALYs) (0.0325, 95% CI -0.0074 to 0.0724), and on the cost side the intervention was a little more expensive than usual care (i.e., £188 [US$277], 95% CI -£125 [-US$184] to £501 [US$738]), resulting in an incremental cost-effectiveness ratio of £5,786 (US$8,521) per QALY. Limitations include the fact that the intervention was relatively brief and did not include any physical activity components. CONCLUSIONS While the COPERS intervention was brief, safe, and inexpensive, with a low attrition rate, it was not effective for reducing pain-related disability over 12 mo (primary outcome). For secondary outcomes, we found sustained benefits on depression and social integration at 6 and 12 mo, but there was no effect on anxiety, pain-related self-efficacy, pain acceptance, pain intensity, or the census global health question at 12 mo. There was some evidence that the intervention may be cost-effective based on a modest difference in QALYs between groups. TRIAL REGISTRATION ISRCTN Registry 24426731.
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Affiliation(s)
- Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
- * E-mail:
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Kate Homer
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Brennan C. Kahan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Anne Spencer
- Health Economics Group, Institute of Health Research, University of Exeter, Devon, United Kingdom
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, United Kingdom
| | - Anisur Rahman
- Department of Rheumatology, University College London, London, United Kingdom
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom
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Kahan BC, Diaz-Ordaz K, Homer K, Carnes D, Underwood M, Taylor SJ, Bremner SA, Eldridge S. Coping with persistent pain, effectiveness research into self-management (COPERS): statistical analysis plan for a randomised controlled trial. Trials 2014; 15:59. [PMID: 24528484 PMCID: PMC3930300 DOI: 10.1186/1745-6215-15-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Coping with Persistent Pain, Effectiveness Research into Self-management (COPERS) trial assessed whether a group-based self-management course is effective in reducing pain-related disability in participants with chronic musculoskeletal pain. This article describes the statistical analysis plan for the COPERS trial. METHODS AND DESIGN COPERS was a pragmatic, multicentre, unmasked, parallel group, randomised controlled trial. This article describes (a) the overall analysis principles (including which participants will be included in each analysis, how results will be presented, which covariates will be adjusted for, and how we will account for clustering in the intervention group); (b) the primary and secondary outcomes, and how each outcome will be analysed; (c) sensitivity analyses; (d) subgroup analyses; and (e) adherence-adjusted analyses. TRIAL REGISTRATION ISRCTN24426731.
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Affiliation(s)
- Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, London E1 2AB, UK.
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Abstract
BACKGROUND Sensitivity analyses are an important tool for understanding the extent to which the results of randomised trials depend upon the assumptions of the analysis. There is currently no guidance governing the choice of sensitivity analyses. DISCUSSION We provide a principled approach to choosing sensitivity analyses through the consideration of the following questions: 1) Does the proposed sensitivity analysis address the same question as the primary analysis? 2) Is it possible for the proposed sensitivity analysis to return a different result to the primary analysis? 3) If the results do differ, is there any uncertainty as to which will be believed? Answering all of these questions in the affirmative will help researchers to identify relevant sensitivity analyses. Treating analyses as sensitivity analyses when one or more of the answers are negative can be misleading and confuse the interpretation of studies. The value of these questions is illustrated with several examples. SUMMARY By removing unreasonable analyses that might have been performed, these questions will lead to relevant sensitivity analyses, which help to assess the robustness of trial results.
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Affiliation(s)
- Tim P Morris
- Hub for Trials Methodology Research, MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner Street, London E1 2AB, UK
| | - Ian R White
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
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Carnes D, Homer K, Underwood M, Pincus T, Rahman A, Taylor SJC. Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course. BMJ Open 2013; 3:e003534. [PMID: 24231458 PMCID: PMC3831098 DOI: 10.1136/bmjopen-2013-003534] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. DESIGN We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. SETTING Primary care in the inner city of London, UK. PARTICIPANTS Adults (18 years or older) with chronic musculoskeletal pain. OUTCOMES Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. RESULTS The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. CONCLUSIONS The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received.
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Affiliation(s)
- Dawn Carnes
- Centre for Primary Care and Public Health, Barts and The School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Barts and The School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Jones T, Lookatch S, Moore T. Effects of a single session group intervention for pain management in chronic pain patients: a pilot study. Pain Ther 2013; 2:57-64. [PMID: 25135037 DOI: 10.1007/s40122-013-0012-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Behavioral and psychological interventions are key components of treating chronic pain. However, there are logistical barriers to providing such treatments, including a lack of psychological staff to provide such interventions and limited ability of patients with chronic pain to attend multiple sessions. As other areas of mental health have shown promise in providing single session interventions for various conditions, this pilot study hypothesized that a single group session for chronic pain patients could be helpful in decreasing patient pain catastrophizing. The five content areas addressed in the group were termed understanding, accepting, calming, balancing, and coping. Methods A pilot study was undertaken. Chronic pain patients were given a pre-group assessment, including the Pain Catastrophizing Scale with a follow-up assessment administered 3 months later. Results Fifty-three patients were studied. Results showed a significant decrease in overall pain catastrophizing scores at follow-up. A clear majority of patients also reported that the group was helpful and should be offered to other pain patients. Conclusion This study suggests that a single session group can be a helpful intervention for patients with chronic pain.
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