Does pain self-efficacy predict, moderate or mediate outcomes in people with chronic headache; an exploratory analysis of the CHESS trial.

IF 7.3 1区医学 Q1 CLINICAL NEUROLOGY Journal of Headache and Pain Pub Date : 2024-05-15 DOI:10.1186/s10194-024-01768-5

Siew Wan Hee, Shilpa Patel, Harbinder Sandhu, Manjit S Matharu, Martin Underwood

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Abstract

Background: Chronic headache disorders are disabling. The CHESS trial studied the effects of a short non-pharmacological intervention of education with self-management support for people affected by migraine and/or tension type headache for at least 15 days per month for at least three months. There were no statistically significant effects on the Headache Impact Test-6 (HIT-6) at 12-months. However, we observed improvement in pain self-efficacy questionnaire (PSEQ) and short-term HIT-6. We explored the impact of the CHESS intervention on PSEQ, and subsequently, on the HIT-6 and chronic headache quality of life questionnaire (CH-QLQ) at four, eighth and 12 months.

Methods: We included all 736 participants from the CHESS trial. We used simple linear regression models to explore the change of HIT-6 and CH-QLQ with treatment and PSEQ at baseline (predictor analysis), and the interaction between treatment and baseline PSEQ (moderator analysis). We considered the change of PSEQ from baseline to four months as a mediator in the mediation analysis.

Results: Baseline PSEQ neither predicted nor moderated outcomes. The prediction effect on change of HIT-6 from baseline to 12 months was 0.01 (95% CI, -0.03 to 0.04) and the interaction (moderation) effect was -0.07 (95% CI, -0.15 to 0.002). However, the change of PSEQ from baseline to 4-month mediated the HIT-6 (baseline to 8-, and 12-month) and all components of CH-QLQ (baseline to 8-, and 12-month). The CHESS intervention improved the mediated variable, PSEQ, by 2.34 (95% CI, 0.484 to 4.187) units and this corresponds to an increase of 0.21 (95% CI, 0.03 to 0.45) units in HIT-6 at 12-months. The largest mediated effect was observed on the CH-QLQ Emotional Function, an increase of 1.12 (95% CI, 0.22 to 2.20).

Conclusions: PSEQ was not an effective predictor of outcome. However, change of short-term PSEQ mediated all outcomes, albeit minimally. Future behavioural therapy for chronic headache may need to consider how to achieve larger, and more sustained increases level of self-efficacy than that achieved within the CHESS trial.

Trial registration: ISRCTN79708100.

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疼痛自我效能对慢性头痛患者的疗效是预测、调节还是中介作用；CHESS 试验的探索性分析。

背景：慢性头痛是一种致残性疾病。CHESS试验研究了对偏头痛和/或紧张型头痛患者进行短期非药物干预的效果，即每月至少15天、至少三个月的自我管理支持教育。12个月后，头痛影响测试-6（HIT-6）的统计效果并不明显。不过，我们观察到疼痛自我效能问卷（PSEQ）和短期 HIT-6 均有所改善。我们探讨了CHESS干预对PSEQ的影响，以及随后在4个月、8个月和12个月时对HIT-6和慢性头痛生活质量问卷（CH-QLQ）的影响：我们纳入了 CHESS 试验的全部 736 名参与者。我们使用简单线性回归模型探讨了 HIT-6 和 CH-QLQ 随治疗和基线 PSEQ 的变化（预测分析），以及治疗和基线 PSEQ 之间的交互作用（调节分析）。在中介分析中，我们将 PSEQ 从基线到四个月的变化视为中介因素：结果：基线 PSEQ 既不能预测结果，也不能调节结果。HIT-6从基线到12个月的变化的预测效应为0.01（95% CI，-0.03至0.04），交互（调节）效应为-0.07（95% CI，-0.15至0.002）。然而，PSEQ从基线到4个月的变化对HIT-6（基线到8个月和12个月）和CH-QLQ的所有组成部分（基线到8个月和12个月）都有中介作用。CHESS 干预措施使介导变量 PSEQ 提高了 2.34（95% CI，0.484 至 4.187）个单位，这相当于 12 个月时 HIT-6 提高了 0.21（95% CI，0.03 至 0.45）个单位。CH-QLQ情绪功能的中介效应最大，增加了1.12（95% CI，0.22至2.20）：PSEQ并不能有效预测结果。结论：PSEQ 并不能有效预测疗效，但短期 PSEQ 的变化对所有疗效都有促进作用，尽管作用很小。未来的慢性头痛行为疗法可能需要考虑如何实现比CHESS试验中实现的自我效能水平更大、更持久的提高：ISRCTN79708100。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Headache and Pain 医学-临床神经学

CiteScore

11.80

自引率

13.50%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data. With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.