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Mindfulness based stress reduction improves psychological well-being and restores immune function in women with breast cancer, from diagnosis through 6-months post-cancer treatment
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- 자료유형학술지논문
- 저자명Janusek, L. W.,Tell, D.,Mathews, H. L.
- 학회/출판사/기관명Elsevier Science B.V., Amsterdam
- 출판년도2015
- 언어영어
- 학술지명/학위논문주기Brain, behavior, and immunity
- 발행사항Vol.49//SUPNo.-[2015]_x000D_
- ISBN/ISSN0889-1591
- 소개/요약Background: Chronic musculoskeletal pain is a common public health threat across populations with point prevalence reported from 20% to 37%. It is well recognised that chronic pain is a complex biological, psychological, social and existential phenomenon which requires a multidimensional treatment approach. Recent studies have shown multidisciplinary bio-psycho-social rehabilitation for people with various chronic pain conditions to be efficacious, particularly when offered as a group therapy. Purpose: The purpose of this study was to address the effectiveness, in terms of pain intensity and health related quality of life (HRQL), of two inpatient multidisciplinary interventions for women with chronic musculoskeletal pain; traditional pain management program (TMP) versus a similar program also including neuroscience patient education and mindfulness-based cognitive therapy (NEM). Methods: This observational longitudinal cohort study conducted at a rehabilitation centre in Iceland included 122 women receiving TMP intervention (2001–2005), 90 receiving NEM intervention (2006–2008) and 57 waiting list controls (2008). Both programs emphasized 4-weeks multidisciplinary rehabilitation, each counting approximately 100 hours of activities. Both intervention groups participated in body awareness sessions, aqua gymnastics and walking. Physical training in the TMP group emphasized traditional endurance, strength and flexibility training, while in the NEM group the emphasis was on motor control in conjunction with neuroscience patient education and mindfulness-based cognitive therapy. Pain intensity was measured on a visual analogue scale and HRQL was measured on the Icelandic Quality of Life questionnaire, before and after intervention. Analysis of variance was used to assess differences between study groups, as well as subgroup comparisons. Alpha-level was set at 0.05. Results: Compared with waiting list controls we observed statistically significant changes in pain intensity (p < 0.001) and all domains of HRQL (p < 0.001) (except finances) among women receiving both TMP and NEM interventions. There were no differences between treatment groups except that NEM participants reported a significant improvement in their sleep (change score 8.0 vs. 4.4; p = 0.008). Women with low HRQL at baseline improved more than those with higher HRQL (mean TMP = 13.4; NEM = 12.9 if HRQL < 35 vs. mean TMP = 6.6 and NEM = 7.8 if HQRL > 35). Conclusion(s): Our non-randomized study suggests that a 4-week multidisciplinary program reduces pain and improves quality of life among women with chronic pain. Those who report lower levels of quality of life at the beginning, gain most. Longer-term follow-ups are needed to address whether these quality of life improvements sustain. The later development of changing the group discussions to Mindfulness based cognitive therapy led by psychologists and to include neuroscience patient education led by physical therapists improved participants’ sleep. A randomized controlled trial is needed to determine if either one of the two elements alone or this combination can be held responsible for the improvements in sleep superior to the TMP approach. Implications: Physical therapists are generally a prominent profession in multidisciplinary teams offering treatment for people with chronic pain conditions. Based on our results it is important to integrate body-mind interaction in program development and to include neuroscience patient education as an addition to more traditional programs.
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