A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial

Does, Monique B.; Adams, Sara R.; Kline-Simon, Andrea H.; Marino, Catherine; Charvat-Aguilar, Nancy; Weisner, Constance M.; Rubinstein, Andrea L.; Ghadiali, Murtuza; Cowan, Penney; Young-Wolff, Kelly C.; Campbell, Cynthia I.

doi:10.1186/s12913-024-10558-3

Table 3 Outcomes at baseline and 12 months and between-group differences at 12 months

From: A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial

Outcome measure modeled as:	Inter-vention^a	Usual care^b	Between-group differences for intervention vs usual care at 12 months
Outcome measure modeled as:	Inter-vention^a	Usual care^b	Observed		Estimated^c
Continuous outcomes	Mean (SD)	Mean (SD)	Differences in Means (95% CI)	P ^d	Differences in Means (95% CI)	P
PAM-13 score
Baseline	65.8 (15.0)	65.2 (15.9)
12 months	67.7 (14.8)	66.6 (14.0)	1.07 (-2.01 to 4.14)	.49	-0.10 (-2.97 to 2.78)	.95
*PROMIS—Quality of Life*^e
Global Physical Health
Baseline	38.3 (6.3)	38.2 (6.1)
12 months	40.9 (7.6)	39.0 (6.3)	1.97 (0.49 to 3.45)	.01	1.63 (0.27 to 2.98)	.02
Global Mental Health
Baseline	45.8 (9.4)	45.1 (8.3)
12 months	47.8 (8.0)	46.9 (8.3)	1.61 (-0.08 to 3.30)	.06	1.33 (-0.37 to 3.03)	.12
Pain intensity (scale 1–10)
Baseline	6.7 (1.4)	6.7 (1.6)
12 months	5.8 (2.1)	6.1 (1.7)	-0.28 (-0.69 to 0.12)	.22	-0.28 (-0.63 to 0.07)	.12
Prescription opioid use, MME/day
Baseline	35.8 (68.9)	32.1 (43.8)
12 months	28.0 (70.7)	25.3 (32.9)	2.73 (-8.79 to 14.23)	.64	4.08 (-6.97 to 15.13)	.47
Binary outcomes	N (%)	N (%)	Differences in Proportion (95% CI)	P ^f	Odds Ratio (95% CI)	P
Moderate to severe depression^g
Baseline	49 (25.9)	46 (24.7)
12 months	25 (15.1)	45 (25.6)	-0.11 (-0.19 to -0.02)	.02	0.40 (0.18 to 0.87)	.02
*Use of Patient Portal*
Used health and wellness resources
Baseline	47 (25.0)	42 (22.6)
12 months	76 (45.8)	50 (28.4)	0.17 (0.07 to 0.27)	< .001	2.50 (1.42 to 4.40)	.002
Checked labs or immunization history^h
Baseline	160 (85.1)	157 (84.4)
12 months	133 (80.1)	118 (67.0)	0.13 (0.04 to 0.22)	.006	2.70 (1.29 to 5.65)ⁱ	.008ⁱ
*Pain Management Strategies*
Meditation, relaxation, or mindfulness
Baseline	64 (33.9)	50 (26.7)
12 months	61 (36.7)	34 (19.3)	0.17 (0.08 to 0.27)	< .001	2.72 (1.61 to 4.58)	< .001
Exercise, stretching or physical therapy
Baseline	108 (57.1)	95 (50.8)
12 months	127 (76.5)	100 (56.8)	0.20 (0.10 to 0.29)	< .001	2.24 (1.29 to 3.88)	.004
Ordinal outcomes (scale 1–5)	Mean (SD)	Mean (SD)	Differences in Means (95% CI)	P ^d	Odds Ratio (95% CI)	P
Overall health
Baseline	2.7 (0.9)	2.6 (0.9)
12 months	2.7 (0.9)	2.4 (0.9)	0.29 (0.09 to 0.49)	.004	3.14 (1.64 to 6.01)	< .001
*Function*
Social activity and roles
Baseline	3.3 (1.1)	3.1 (1.1)
12 months	3.3 (1.0)	3.1 (0.9)	0.24 (0.04 to 0.44)	.02	1.51 (0.91 to 2.51)	.11
Everyday physical activities
Baseline	3.4 (1.0)	3.3 (1.0)
12 months	3.6 (1.1)	3.3 (1.1)	0.28 (0.04 to 0.51)	.02	1.54 (0.89 to 2.68)	.13

Abbreviations: SD standard deviation. CI confidence interval. PAM-13 Patient Activation Measure-13, PROMIS Patient-Reported Outcomes Measurement Information System, MME morphine milligram equivalents
^aN = 189 at Baseline; N = 166 at 12 months
^bN = 187 at Baseline; N = 176 at 12 months
^cModeled with generalized estimating equation (GEE); Outcomes were modeled separately; The independent variables in the models of study outcomes were time, intervention, the interaction of time intervention, baseline Chronic Pain Coping Inventory-42 (CPCI-42) relaxation, and baseline CPCI-42 exercise (CPCI relaxation and exercise were statistically different in the study arms at baseline)
^dT-test
^ePROMIS Global Health raw scores are converted to T-scores, with a mean of 50 and a standard deviation of 10
^fChi-square
^gModerate to severe depression as measured by a Patient Health Questionnaire-9 score ≥ 10
^hFor this self-reported measure at baseline, patients were asked if they ever used the service. At the 12-month follow-up survey, patients were asked about their use in the previous 6 months. Since the ‘ever used’ proportion was higher than the 12-month proportion, baseline values were excluded from the model and only the 6th and 12th month values were used

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