Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial.

BACKGROUND: Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8-week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1-year follow-up. METHODS: One hundred and seventy-five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory-Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self-efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1-year follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. RESULTS: Eighty-three participants (47.4%) returned the outcome measures at 1-year follow-up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1-year follow-up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. CONCLUSIONS: The study results showed no significant difference between the two groups for the primary outcome pain interference at 1-year follow-up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. SIGNIFICANCE: Few previous randomized controlled trials investigating ACT for chronic pain have included long-term follow-up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1-year follow-up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain.

Factors affecting QOL of the home-bound elderly disabled.

The purpose of this study was to clarify the factors affecting the quality of life (QOL) of the elderly home-bound patients. Data were collected from 56 chronically disabled elderly persons (mean age of 76.7 years) who needed a long-term home-based care. They were assessed on QOL, range of activity, functional capacity, and capacity of family care functioning as well as socio-economic condition. The QOL was evaluated by using Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The activities of daily living (ADL) and handicaps were evaluated by the Barthel index and the ESCROW profile, respectively. The capacity of family care functioning was also recorded according to the "Family Care Scale" developed by Hamamura. As a result, there was a significant difference between PGC Morale Scale score and Barthel index score (P < 0.05), and we found a negative correlation between PGC Morale Scale score and ESCROW score (P < 0.05). It was also revealed that the factors affecting the QOL of the home-bound elderly disabled were determined by the motivation, functional capacity, and capacity of family care functioning (P < 0.05). These results suggest that in order to improve their QOL, ADL must be improved, therefore, rehabilitation should be continued to maintain their function after discharging from hospitals and that we should take these factors into consideration, such as living environments and social conditions of the family care. The results also indicate how the patient's independence in the daily life influences social and economic status, and consequently it affects the quality of life.