An intervention to promote quality of life in older adults experiencing chronic nonmalignant pain
Chronic nonmalignant pain (CNP) is a major problem among older adults, emphasizing the need for nurses and other health care professionals to work together in helping the individual to manage it. The major purpose of this study was to develop and test a nurse-guided pain management (NGPM) program that combines the practice of tai chi chuan with cognitive-behavioral therapy, presenting one possible solution to the management of CNP in older adults. A one-group, pretest-posttest repeated measures design was used with participants serving as their own controls to pilot testing the intervention and determine the effects on five specific outcomes (i.e., physical health, mental health, chronic pain intensity, chronic pain experience, and chronic pain self-efficacy) of older adults with CNP. Specific study aims were to determine (a) the observed rate of change (slope) from initiation of the NGPM program to three months post-completion for each participant's outcomes, (b) the predictors of the change slopes, and (c) whether the NGPM program reduces the average level of pain perceived by the individual, improves chronic pain self-efficacy, improves the experience of living with CNP, and improves the overall quality of life (QOL). Measures were obtained pre-intervention, immediate post-intervention and 3 months post-intervention. Twenty-five older adults, who met the inclusion criteria, were recruited form a local senior center and an independent living retirement community; 16 completed the study. Individuals' change slopes indicated that individual variability existed among participants' responses to the intervention, with change trajectories demonstrating nonlinear trends. The results of backward-deletion regression analyses revealed 1-, 2-, and 3-predictor models that significantly predicted change slopes of mental health, chronic pain intensity, and chronic pain experience, respectively. Both MANOVA and MANCOVA analyses suggested that older adults with chronic musculoskeletal pain who participated in the NGPM program showed significant improvements. Use of the Friedman's test showed similar results. The study findings provide preliminary evidence suggesting the benefits of a 12-week NGPM Program for older adults who experience chronic pain. Clinicians should attend to the individuals' differing responses while providing self-management group interventions for chronic pain is clear.