支持患者坚持疼痛自我管理:如何进行?——编辑

IF 1.5 Q3 REHABILITATION European Journal of Physiotherapy Pub Date : 2022-03-02 DOI:10.1080/21679169.2022.2044140
A. Söderlund
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引用次数: 0

摘要

坚持治疗疼痛在临床实践和研究中是至关重要的。此外,管理慢性疼痛和其他慢性疾病的一个重要组成部分是支持患者发展和从事新的行为,例如使用需要长期维持的自我管理策略。然而,如何有效地支持和增加对治疗的坚持是一种新的行为尚不清楚。依从性概念被认为是依从性概念的发展。从患者的角度来看,依从性不是一个自主决策的过程。它更多的是遵循物理治疗师或其他卫生保健人员的命令。然而,依从性是一种以患者为中心的建议交流,患者独立决定反对或接受双方的协议和建议。在过去的几十年里,人们很少关注提高依从性以实现持续行为改变的策略。过去的研究主要集中在不坚持的问题上,而不是研究支持坚持的解决方案。我们非常需要进一步了解如何处理坚持治疗的主要障碍,以及如何指导患者或客户在疼痛自我管理中改变坚持治疗的行为。此外,应用程序和基于网络的策略,以促进坚持治疗慢性疼痛和其他慢性疾病确实需要研究。坚持体育活动和锻炼计划的显著水平显示出与疼痛管理的积极结果高度相关。然而,对支持坚持的有效策略的研究是缺乏的。很有可能,患者和客户的信念、认知和情绪在寻找成功和支持性的行为改变策略方面发挥着重要作用。在一项范围审查中,研究表明,为了支持依从性,与能力相关的策略,如对患者的教育、监督、对活动的掌握和分级,以及旨在提高自我效能感的锻炼,都是重要的。此外,增加动机的策略,如确定改变的准备,行为的自我监控和目标设定似乎对坚持有积极的影响。此外,可能与改变机会相关的策略是进行助推器会议,从治疗师或重要的其他人那里获得反馈,以及社会支持,促进了对活动和锻炼的坚持。在研究和临床工作中,理解和应用策略来提高对疼痛自我管理制度的依从性对于改善长期疼痛结果至关重要。是时候在临床实践和研究中解决这些与疼痛自我管理相关的干预行为改变挑战了。
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Supporting patients’ adherence in pain self-management: how to proceed? – Editorial
Adherence in pain treatment in clinical practice and research is critical. Further, an important component in managing chronic pain, but also in other chronic conditions, is supporting patients to develop and engage in new behaviours, e.g. using self-management strategies that need to be sustained over time. However, how to effectively support and increase adherence to treatment representing a new behaviour is not clear. The adherence concept is considered as a development of the compliance concept. Compliance from a patient’s point of view is not an autonomous decision-making process. It is more of following orders from physiotherapist or other health care staff. Adherence however is a patient-centered communication of recommendation where the patient independently decides against or for a mutual agreement and advice. For the past few decades there has been little attention on strategies to increase adherence to achieve sustained behavioural change. The past research has focussed on the problems of non-adherence rather than studying solutions of supporting adherence. There is a great need of advancing in our understanding of how to handle the key barriers to adherence and how to coach changes in patient’s or client’s adherence behaviour in pain self-management. Also, the App and Web-based strategies to promote adherence in treatments for chronic pain and other chronic conditions do need to be studied. Significant levels of adherence to physical activity and exercise programs have shown high correlations with positive outcomes in pain management. However, research on effective strategies for supporting adherence is lacking. Very likely, patients’ and clients’ beliefs, cognitions, and emotions play an important role in finding successful and supportive behaviour change strategies for adherence. In a scoping review, it was shown that for supporting adherence, capability-related strategies such as education of the patient, supervision, mastery of and grading of activities and exercise aiming to increase self-efficacy were important. Further, motivation increasing strategies such as identifying readiness for change, self-monitoring of behaviour and goal setting seem to have positive impact on adherence. Additionally, strategies that could be related to opportunity for change were having booster sessions, getting feedback from therapist or significant others as well as social support facilitated adherence to activities and exercise [1]. Understanding and applying strategies for increasing adherence to the pain self-management regimes in research and clinical work is essential to improve long-term pain outcomes. It is time to address these interventional behaviour change-related challenges in pain self-management within clinical practice and research.
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