Développement et évaluation d'une intervention infirmière virtuelle sur mesure visant à faciliter l'autogestion de la douleur après une chirurgie cardiaque

Plusieurs études ont démontré que prés de deux tiers des patients subissant une chirurgie cardiaque souffrent de douleur d’intensité modérée à sévère. Ces niveaux de douleur semblent être partiellement expliqués par la présence de barrières individuelles face au soulagement de la douleur. Le savoir acquis sur les cognitions associées à la douleur ne semble pas avoir été traduit dans de nouvelles approches éducatives face à la douleur aiguë. Le but du projet doctoral était 1) de développer une intervention visant à faciliter l’autogestion de la douleur postopératoire après une chirurgie cardiaque et, 2) d’en évaluer l’acceptabilité et la faisabilité, ainsi que le potentiel d’efficacité sur le soulagement de la douleur de patients subissant une chirurgie cardiaque. Le développement de l’iintervention SOULAGE-TAVIE a inclus quatre étapes fondées sur les savoirs clinique, empirique et théorique et inspirées de plusieurs écrits méthodologiques. SOULAGE-TAVIE consiste en une session préopératoire éducative sur la gestion de la douleur post-chirurgie cardiaque d’approximativement 30 minutes sur un ordinateur, dispensée sur mesure en fonction d’un algorithme. Deux renforcements cliniques en personne sont aussi offerts en phase postopératoire. L’évaluation de l’intervention consistait en un essai clinique pilote à répartition aléatoire incluant 60 participants répartis entre le groupe expérimental (GE : SOULAGE-TAVIE) et le groupe contrôle (GC : soins usuels incluant un feuillet d’information). Les données étaient recueillies au moment de l’admission et dans les sept jours postopératoires. SOULAGE-TAVIE a été jugée comme acceptable et faisable. De plus, les participants du GE n’ont pas expérimenté une douleur de plus faible intensité mais ils ont rapporté significativement moins d’interférence de la douleur avec la toux et la respiration profonde, ont démontré moins de barrières face à la gestion de la douleur et ont consommé plus d’opiacés. Cette étude pilote procure des résultats prometteurs sur les bénéfices potentiels de cette nouvelle approche sur mesure utilisant les technologies de l’information et de la communication (TIC). L’autonomisation des personnes est cruciale et complémentaire pour soutenir le soulagement de la douleur dans le contexte actuel de soins.Several studies have shown that many patients undergoing a cardiac surgery suffer from moderate to severe pain. These levels of pain may be explained by individual barriers toward pain relief. Knowledge acquired on pain-related cognitions has not been translated into new approaches. The aim of the doctoral project was 1) to develop an intervention to facilitate the self-management of postoperative pain after cardiac surgery and, 2) to assess its the acceptability and feasibility and to investigate its efficacy potential on pain relief in patients undergoing cardiac surgery. The development of SOULAGE-TAVIE included four steps based on clinical, empirical and theoretical knowledge and inspired by diverse methodological considerations. SOULAGE-TAVIE consists in a 30-minute computer-tailored preoperative educational session about postoperative pain management, tailored according to an algorithm. Two short reinforcements are provided in person. The evaluation of SOULAGE-TAVIE consisted in a pilot randomized controlled trial including 60 participants assigned to the experimental group (EG: SOULAGE-TAVIE) and the control group (CG: usual care including educational pamphlet). Data were collected at the time of admission and across Day 1 to 7 after surgery. The results provide preliminary support for the acceptability and feasibility of a tailored and virtual intervention. The results revealed that patients of the EG did not experience less intense pain but they reported significantly less pain interference when breathing/coughing, exhibited fewer pain-related barriers, and consumed more opioid medication. This pilot study provides promising results to support the potential benefits of this new web-tailored approach. Patient empowerment is complementary yet crucial in the current context of care and may contribute to improve pain relief

The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol

Abstract Background Numerous psychological risk and protective factors have been identified as contributing to or preventing the development of the prevalent issue of chronic pain. Systematic reviews of studies on psychological interventions that tackle these factors have shown limited effects on chronic pain. Therefore, implementing psychological interventions before pain becomes chronic has been put forward. However, the efficacy of such interventions in preventing the transition from acute to chronic pain has not yet been systematically assessed. Methods The aims of this systematic review are to assess the effects of psychological interventions applied in the acute pain phase on pain severity as well as on physical, psychological, and social functions at 3 months and beyond. Randomized controlled trials including psychological intervention as a treatment of primary interest and participants with pain of less than 3 months duration will be considered. The following comparisons will be undertaken: psychological interventions with (1) standard treatment, (2) information, (3) waiting-list, and (4) active treatment. The primary outcome will be pain severity using indicators such the presence or absence of pain and self-report measures such as the numeric pain intensity rating scale. Secondary outcomes will include pain-related disability, mood, coping with pain, quality of life, health care utilization, and work capability. A systematic review of English and French articles in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials will be conducted without date restriction. Extracted data will include demographics and clinical characteristics, sample size, intervention and control group types, assessment tools used, time interval of measurement, fidelity of the intervention, and attrition rate. Standardized mean differences (SMD) and risk ratios with 95% confidence intervals (CI) will be used to assess treatment effects. Discussion This systematic review is the first in examining the effects of psychological interventions implemented in the acute pain phase with the objective of preventing chronic pain. Results of this systematic review could provide information on psychological intervention characteristics that are most helpful for individuals with pain and guidance as to when such interventions should be applied in the continuum of care. Systematic review registration PROSPERO CRD4201604931

Additional file 1: of The effect of tailored Web-based interventions on pain in adults: a systematic review protocol

PRISMA-P 2015 checklist. The PRISMA framework will be used to ensure the transparent reporting of this systematic review including the flow diagram. (DOCX 35.5 kb

My pain coach ::a mobile system with tangible interface for pain assessment

Pain assessment is an essential first step in planning for and providing pain management. Access to effective pain management programs is often limited, due to scarcity of services. Other barriers to treatment include physical symptoms that limit mobility, distance from a clinic, transportation requirements and cost constraints. In response to these barriers to service delivery, the demand for online health resources is growing. However, current solutions present a number of shortcomings, in particular when referring to usability and accessibility. This paper presents the vision of the My Pain Coach system and the first prototype generated as the result of the first iteration of the development process. This prototype is based on a smartphone app and presents two different interfaces: a force-sensitive touchscreen, and a tangible interface based on a textile mat. A preliminary usability evaluation has been conducted and the results show that these interfaces are perceived as excellent from a usability point of view. Nevertheless, further development and testing are still required for the tangible interface

Additional file 2: of The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol

This file describes the search strategy to identify relevant studies. (DOCX 102 kb

Additional file 1: of The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol

This file describes where to find essential items of a systematic review. (DOCX 35 kb