Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

Autor:	Kerns RD; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System., Burns JW; Department of Behavioral Sciences, Rush University Medical Center., Shulman M; Psychology Service, Northport VA Medical Center., Jensen MP; Department of Rehabilitation Medicine, University of Washington., Nielson WR; Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care London., Czlapinski R; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System., Dallas MI; Physical Medicine and Rehabilitation Service, VA Connecticut Healthcare System., Chatkoff D; Department of Psychology, University of Michigan-Dearborn., Sellinger J; Psychology Service, VA Connecticut Healthcare System., Heapy A; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System., Rosenberger P; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System.
Jazyk:	angličtina
Zdroj:	Health psychology : official journal of the Division of Health Psychology, American Psychological Association [Health Psychol] 2014 Sep; Vol. 33 (9), pp. 938-47. Date of Electronic Publication: 2013 Dec 02.
DOI:	10.1037/a0034406
Abstrakt:	Objective: This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors. Method: One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment. Results: No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition. Conclusions: Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes. ((PsycINFO Database Record (c) 2014 APA, all rights reserved).)
Databáze:	MEDLINE
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