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A Community health worker-led positive psychology intervention for African American older adults with chronic pain
Janevic M, Robinson-Lane SG, Courser R, Brines E, Hassett AL
The Gerontologist 2022 Oct;62(9):1369-1380
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND AND OBJECTIVES: Experiencing structural racism over the life course contributes to disproportionate pain-related disability among African American older adults. Positive STEPS, delivered by community health workers, is a culturally congruent chronic pain self-management intervention that incorporates positive psychology principles and gives attention to social determinants of pain and pain management. RESEARCH DESIGN AND METHODS: We conducted a randomized pilot trial among older adults with chronic musculoskeletal pain in an underserved, primarily African American community (Detroit, Michigan). The 7-week intervention included weekly telephone sessions with a community health worker; web-based videos teaching pain self-management skills; positive activities (eg Life Review, Gratitude Jar); and use of wearable activity trackers. Outcomes were measured at baseline and 8-week follow-up. We assessed participant retention, engagement, and satisfaction. RESULTS: Study completers (n = 46; 90% retention) were 93% African American, 89% female, mean 72 years, and completed 5.7 of 7 sessions. Intervention participants versus controls showed greater improvement in PROMIS Pain Interference (4.3-point T -score decrease versus 0.4-point increase; p = 0.01) and the Pain Self-Efficacy Questionnaire (p = 0.007). Furthermore, compared with controls, significantly more intervention participants reported "better" or "much better" global functioning (86% versus 25%; p = 0.000) and pain (67% versus 21%; p = 0.003) since baseline. Improvements in physical functioning, social participation, and resilience were noted, but differences were not significant. Participant feedback on the intervention was overwhelmingly positive. DISCUSSION AND IMPLICATIONS: A community health worker-led chronic pain self-management intervention combining positive activities with self-management skills training demonstrated the potential to enhance pain-related functioning among a vulnerable group of older adults. CLINICAL TRIAL NUMBER: NCT04321239.
Copyright the Gerontological Society of America. Reproduced by permission of the publisher.

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