医学report代写 The main goal of this research was to compare the effectiveness of an ACT procedure developed for outpatient primary care with CBT..
Part 1: Critical Review医学report代写
The main goal of this research was to compare the effectiveness of an ACT procedure developed for outpatient primary care with CBT in people with a variety of chronic illnesses. Methods
The researchers enlisted a total of 114 people between the ages of 18 and 89 years. All described unspecified chronic benign pain lasting over 24 weeks and causing at least a 5/10 on a rating scale in terms of severity and interference (Wetherell et al., 2011). Various methods were used to recruit the participants, including data from primary care clinics, advertisements, pain support groups, and many more.
Participants were ruled out if they had a psychological disorder, manic episode, or drug use problem within the previous 24 weeks; were actively undergoing pain psychotherapy; or had specific medical conditions that may prevent them from participating (Wetherell et al., 2011).
Participants were also expected to be stable on all mood or pain therapies for at least eight weeks before participating in the research,and to stay steady on those therapies during the study unless clinically appropriate, to eliminate reasons for fluctuations in pain or mood that were not related to the research interventions (Wetherell et al., 2011).
The researchers followed ethical guidelines. For example, they acquired the approval of relevant authorities, including the University of California, the San Diego Institutional Review Board, and the VA San Diego Healthcare System Research and Development Committee (Wetherell et al., 2011). Additionally, all respondents were asked to review and fill consent forms before participating in the study (Wetherell et al., 2011).
Emotional distress, pain interference, pain intensity, physical activity, life quality, and therapy satisfaction were assessed. The outcome measures were selected based on VA guidelines (Wetherell et al., 2011) and the Initiative on Methods, Measurement,
and Pain Assessment in Clinical Trials (IMMPACT) recommendations (Wetherell et al., 2011). Measures of agony management and agony tolerance were used as mediator variables to explore both therapies' mechanisms.医学report代写
According to the researchers, one drawback of the analysis is that all indicators were self-reported. The authors argue that tangible results, like reducing job and decreased illness periods, definitely have a significant public wellbeing effect and could be additionally relevant than self-rated discomfort intrusion with everyday life (Wetherell et al., 2011).
They also state that some performance-based indicators, like sit-to-stand duration, can also be more robust performance measures. Still, these results are less expected to improve in an unconnected pain category than in a multidisciplinary recovery program that comprises physical therapy (Wetherell et al., 2011). Additionally,
the researchers suggest that medication in this research was administered in a group setting instead of an individual setting. According to them, group therapy is more widely used in many primary care settings than personal counselling; although, personal counselling may have achieved better outcomes (Wetherell et al., 2011).
ACT and CBT were beneficial therapies for chronic pain, positively influencing pain and mood interference. On the other hand, ACT could be more advantageous because patients valued it higher than CBT in terms of satisfaction. (Wetherell et al., 2011).
Advantages and Implications
The researchers claim that several methodological features of their study are noteworthy. Principally, they believe that it addresses shortcomings of past ACT treatment studies, including tiny sample sizes, inadequate medical and clinical assessment tests, non-manualised care elements, and no monitoring for therapist impacts. As a result,
they claim that their study aimed to improve past works by integrating a clinical test and SCID interview as a research recruitment component, attracting a broad and diversified chronic agony sample, using handbook interventions administered by a few carefully monitored personnel with experience in ACT and CBT. Also,
this included using thorough controls like an extroversion test.医学report代写
The authors conclude that the current findings represent a significant step forward in recognising the advantages of ACT therapies for prolonged pain compared to a "best practice" behavioural management.
Ultimately, according to the authors, the study's primary therapeutic implication is the affirmation that a brief medical procedure can be as effective as clinical pain management in minimising pain intervention. In this context, they suggest such a treatment could be implemented relatively quickly in a basic medical care context, maybe a portion of a phased care approach.
More importantly, the researchers suggest that patients that fail to respond to this form of treatment may require more thorough personalised care (Wetherell et al., 2011).
Part 2: Developments in the Field
At least three seminal systemic analyses have conducted ACT trials for chronic pain patients since 2011. Overall, these studies show that ACT can significantly boost health outcomes. Hann and McCracken (2014) conducted a systematic survey of evaluation methods applied in RCTs of ACT for grownups with chronic pain.
The researchers were interested in knowing the form of primary and secondary outcome dimensions evaluated, the extent to which these dimensions represented IMMPACT guidance versus the conceptual perspective motivating ACT, methods to intervention procedure evaluation in the studies, and ultimately, a narrative analysis of intervention effectiveness.
Two studies were assessed as low risk, four were considered uncertain, and four were deemed to be an increased possibility of partiality. ACT was generally not more successful compared to the "active" settings of correlation (for example, CBT) on most results.
Similarly, Veehof et al. (2016) piloted a meta-analysis of twenty-eight articles to evaluate the efficacy of treatments based on acceptance and mindfulness for prolonged agony patients through RCTs. A maximum of twenty-five articles matched these treatments to a waitlist, standard treatment, or support/learning groups,
自2011年以来，至少有三项系统性分析对慢性疼痛患者进行了ACT试验。总体而言，这些研究表明ACT可以显着改善健康状况。 Hann和McCracken（2014）对患有慢性疼痛的成年人的ACT RCT中应用的评估方法进行了系统的调查。
with five studies including active interventions as endpoints医学report代写
Using passive control criteria as parallels, slight after-treatment implications for pain intensity, disability, depression, and life quality were discovered, while mild implications were found for anxiety and pain intrusion. In terms of follow-up, the pain effect grew but stayed minimal, while the depression effects and life quality grew and became medium.
The impact on pain intrusion grew and became significant. The impacts on disability and anxiety were kept to a minimum. ACT had statistically significantly higher mean implications for anxiety and depression than MBIs, which is intriguing. The variations between acceptance-based approaches and MBIs and conventional CBT were not statistically relevant.医学report代写
Hughes et al.
(2017) recently published an upgrade on ACT justification when used to treat chronic pain patients. In their analysis, they looked at eleven RCTs. The researchers noted that ACT outperformed passive control settings (standard care, waitlist) in terms of improving pain tolerance (average–significant impact size) and performing (low impact outcome size) as the main result.
Only psychological versatility had a modest-significant impact size among the secondary outcomes. When compared to active therapies, ACT outperformed active relaxation and creative composition in some primary and secondary outcomes. In comparison to ACT, minor differences in aggregate SMDs on life quality, depression, and pain severity were observed in CBT's support.
Certain methodological flaws医学report代写
like the everyday use of limited data, ambiguous compliance with regulatory manuals, study loyalty, and the inability to blind subjects to treatment assignments should balance the above positive results.Some critics of ACT argue that its growth hasn't been followed by enhanced methodological quality (Öst, 2014). In comparison to the APA Unit 12 group,
which suggests "solid research backing" for acute and recurrent pain in practice, Öst (2014) claimed that when procedural issues are considered, ACT can be deemed "possibly effective" for chronic diseases. Overall, a group of experts recently challenged this meta-analysis's empirical rationality due to interpretation bias (Atkins et al., 2014). Nonetheless,
it is beneficial to address a few of the procedural flaws of prior ACT experiments outlined by Öst to unequivocally convince legislators that ACT is an efficient psychiatric medication for chronic pain control.
Dropouts from RCTs of psychiatric therapies have piqued researchers' interest in recent years
It is regarded as a serious concern thanks to the absence of explanatory accuracy in science and the inability to fulfil the clients' health needs. In RCTs of ACT, a 15.8% dropout rate was recently recorded (12.1% in fibromyalgia and chronic pain) (Ong et al., 2018), which is marginally better than the 25.3 per cent reported by CBT in the same meta-analysis.
Overall, the current scientific evidence suggests that conventional CBT is comparable to or slightly more effective than the ACT, but at the cost of a higher patient loss rate during treatment. An ongoing issue in the ACT is whether dropout rates differ due to specific parameters like counselling style, counsellor expertise, or chronic pain site or nature when it is directly administered to chronic pain patients.
These analyses are currently impossible due to a lack of data.
Emerging Research on ACT's Economic Efficiency for Chronic Pain医学report代写
In a market-based world, both policymakers and medical practitioners are currently facing financial stress. Practitioners require cost-effective interventions, mainly where the public and limited resources partially finance hospital services. The economic efficiency theory is founded on the premise that healthcare policies must be centred on treatment costs for patients' health benefits (Haycox & Noble, 2009).
Therapies based on attention and acceptance are consistently growing and being used in various settings (hospitals, institutions, and businesses) globally. Additionally, more studies in healthcare economics, broadly focusing on psychotherapy and particularly on third-wave CBT, have been called.
Though research has begun in this field, recent data from economic assessments of such treatments show that ACT is possible to treat chronic pain in a cost-effective way (Feliu-Soler et al., 2018).医学report代写
With pain disability as the main result, Kemani et al
(2015) standardised adults from Sweden with undefined chronic pain to ACT or applied relaxation, both active therapies given over 12 weeks. The following care and three months check, ongoing economic ratios showed that ACT was highly economical than applied relaxation, but these results were no longer relevant at six months check. Luciano et al.
(2017) recently tried the usefulness costs of group ACT and observed that 2.5-hour cycles (8 in total) were economical in primary-care for Spanish patients enrolled for fibromyalgia relative to prescribed treatment options. As a result, ACT has positive economical outcomes in individuals with prolonged pain compared to active psychiatric therapies and prescribed drugs.
（2015）来自瑞典的标准化成人，对ACT或施加放松没有明确的慢性疼痛，均在12周内接受了有效的治疗。 经过护理和三个月的检查，持续的经济比率表明，ACT比放松治疗更为经济，但是在六个月的检查中，这些结果不再相关。 Luciano等。
There is an increasing interest in ACT economic assessments. Currently
two future economic reviews tend to strengthen the evidence available on ACT for chronic pain (Hayes et al., 2014). Factors such as the absence, accessibility constraints, longer waiting lists, and more available healthcare professionals, and the goal of lowering the cost of treatment make it increasingly common for internet psychologic treatment,医学report代写
with ACT included. In comparison with the waitlist in Ireland analysis, Hayes et al. (2014) evaluate the costs-utilities of an eight-week internet ACT initiative for 152 chronically ill patients. Contrary to earlier research, the investigators are utilising the comparatively modern form of EuroQoL (EQ-5D-5L) instead of the classical one, which is anticipated to shift more susceptibly.
The possible cost/effectiveness of a directed (educated eCoaches) versus a freehand ACT (ActonPain) program is being examined in chronic pain adults in a related study conducted in Germany (Lin et al., 2015). Unlike the Irish research, this is the broad RCT (100 patients for every research branch), with prolonged close (6 months),
but these cost-efficacy findings were not yet reported. Further well-structured ACT economic assessments for chronic pain, comprising economical tests incorporated into RCTs, are required.
Reflection and Implications of Wetherell et al. (2011)医学report代写
Overall, substantial progress in the status of evidence on ACT for chronic pain management has been made since Wetherell et al. (2011) was written. Nonetheless, there is still room for future research. Questions that direct future research in this regard are consistent with those that exist for other psychotherapy in agony management,
and thus the general profession. The question 'which intervention is suited for whom' is probably nuanced, or treatment moderators. Due to difficulties in understanding sociodemographic variables as moderators, a potential theory-motivated approach may be helpful.
Future studies may study whether psychological versatility baseline levels have a moderate impact on intervention in this context. In this manner, when moderators are marked, it could be possible to pick treatment participants based on critical process measures scores. This expansion examines whether such delivery formats are more suitable for patients with various degrees of psychological versatility.
For instance, remote delivery may be best suited to people with slightly enhanced cognitive flexibility. In contrast, more thorough direct and nursing home medications may be needed for individuals with little cognitive flexibility.
The application of psychological models医学report代写
such as act to particular chronic pain disorders, like those arising in light of other clinical manifestations, is one area of increasing concern. While it is commonly believed that ACT (and other therapeutic models) work for all forms of pain, analysis is required. Given that only two RCTs of psychiatric therapies have been performed in this demographic,
neuropathic pain provides a specifically promising field (Eccleston et al., 2015). Furthermore, the utilisation of repeated sampling of cognitive flexibility processes, such as observational evaluation, maybe a significant advancement in behavioural flexibility science.
With the growing demands on healthcare systems globally, there is a decisive necessity for open and cost-effective ACT provision approaches. Training outpatient rehabilitation practitioners, like physiotherapists, to perform short modes of ACT with limited training,
can be an effective technique to improve access in the future for face-to-face methods (Godfrey et al., 2016). This strategy could effectively use the holistic approach that is so critical in chronic pain management.
Atkins, P. W., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J., Rovner, G., ... & Hayes, S. C. (2017). Departing from the essential features of a high-quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259-272.
Eccleston, C., Hearn, L., & de C Williams, A. C. (2015). Psychological therapies for the management of chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews, (10).
Feliu-Soler, A., Cebolla, A.,
McCracken, L. M., D’Amico, F., Knapp, M., López-Montoyo, A., ... & Luciano, J. V. (2018). The economic impact of third-wave cognitive-behavioural therapies: a systematic review and quality assessment of economic evaluations in randomised controlled trials. Behaviour therapy, 49(1), 124-147.
Godfrey, E., Holmes, M. G., Wileman, V., McCracken, L., Norton, S., Moss-Morris, R., ... & Critchley, D. (2016). Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain. BMJ Open, 6(6).
Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomised controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of contextual behavioural science, 3(4), 217-227.
Haycox, A., & Noble, E. (2009).
What is health economics? Hayward Medical Communications, a division of Hayward Group Ltd, 3-6.
Hayes, S., Hogan, M., Dowd, H., Doherty, E., O'Higgins, S., Gabhainn, S. N., ... & McGuire, B. E. (2014). Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial. BMJ Open, 4(7).
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain. The Clinical journal of pain, 33(6), 552-568.
Kemani, M. K., Olsson, G. L., Lekander, M., Hesser, H., Andersson, E., & Wicksell, R. K. (2015). Efficacy and cost-effectiveness of acceptance and commitment therapy and applied relaxation for longstanding pain. The Clinical journal of pain, 31(11), 1004-1016.
Lin, J., Lüking, M., Ebert, D. D.
Buhrman, M., Andersson, G., & Baumeister, H. (2015). Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial. Internet Interventions, 2(1), 7-16.
Luciano, J. V., D'Amico, F., Feliu-Soler, A., McCracken, L. M., Aguado, J., Peñarrubia-María, M. T., ... & García-Campayo, J. (2017). Cost-utility of group acceptance and commitment therapy for fibromyalgia versus recommended drugs: an economic analysis alongside a 6-month randomised controlled trial conducted in Spain (EFFIGACT Study). The Journal of Pain, 18(7), 868-880.
Ong, C. W., Lee, E. B., & Twohig, M. P. (2018). A meta-analysis of dropout rates in acceptance and commitment therapy. Behaviour research and therapy, 104, 14-33.
Öst, L. G. (2014).
The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behaviour research and therapy, 61, 105-121.
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance-and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive behaviour therapy, 45(1), 5-31.
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., ... & Atkinson, J. H. (2011). A randomised, controlled trial of acceptance and commitment therapy and cognitive-behavioural therapy for chronic pain. Pain, 152(9), 2098-2107.