The effectiveness of peer support interventions for community-dwelling adults with chronic non-cancer pain: a systematic review protocol

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Abstract

Review question/objective

The objective is to identify the effectiveness of peer support interventions in community-dwelling adults with chronic non-cancer pain. More specifically, the objectives are to identify:

Review question/objective

The effectiveness of peer support interventions in function, pain, quality of life, self-efficacy and health service utilization for adults with chronic non-cancer pain dwelling in the community, compared to those receiving usual care or other self-management interventions.

Review question/objective

The specific review question is therefore:

Background

Peer support is increasingly being investigated as a strategy to support the self-management of chronic conditions such as diabetes,1 heart disease,2 brain injury,3 cancer4 and venous leg ulcers.5 This is due in part to the beneficial effect that social support is known to have on health,1 and is in response to the growing need for services that support chronic condition self-management.6,7

Background

Peer support as its simplest can be defined as “the giving of assistance and encouragement by an individual considered equal”.8 However, peer support is complex and takes many varied forms; therefore a more comprehensive definition is “the provision of emotional, appraisal and informational assistance by a created social network member who possesses experiential knowledge…”.8 Peer support interventions are delivered in many forms, including phone calls, email support, home visits and group meetings. Moreover, peer support can be a lone intervention or, more commonly, it can form part of a complex intervention, components of which may be delivered by a healthcare professional.9

Background

Peers are lay people who receive a moderate amount of training in order to deliver an intervention to people with whom they have shared experiences.2 It is suggested that this shared knowledge that health professionals do not possess is key to creating the assistance that people need to manage their condition.1 The amount of training peers have differentiates them from “paraprofessionals” who have received a substantial amount of training and have less mutual identification with the people they are supporting.8

Background

Chronic pain is defined as “continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery”.1 Chronic pain is a major public health problem which affects physical and psychological health as well as social and economic well-being. It is estimated to affect approximately half the UK population.11-12 Due to the multidimensional nature of chronic pain, in which several aspects of health can be affected, multiple outcomes are measured in clinical trials, with current recommendations being the measurement of pain, global improvement, physical functioning and emotional functioning.13 There are many management options for people with chronic pain;14 however due to the chronic nature of the problem self-management is an inevitable part of living with chronic pain.

Background

Self-management interventions do exist for people with chronic pain15 and are aimed at enhancing an individual's ability to live with their chronic condition. In addition to the chronic pain outcomes described above, self-management studies commonly measure health-related quality of life, self-efficacy, self-management knowledge and skills, and health behaviours including physician visits.16-17

Background

Several barriers to continued self-management have been reported, including lack of support from family and friends,18 time constraints, fear of pain, and lack of a self-management plan to follow.19-20 Failure to adequately self-manage chronic pain can adversely affect a person's quality of life, and lead to increased physical discomfort and psychosocial problems, and consequently increased health service utilization. Therefore, any intervention that can help a person to self-manage their chronic condition is important to explore.

Background

Peer support may help to overcome some of the common barriers to the self-management of chronic pain and has been the topic of research in recent years.20-22 Several systematic reviews on peer support have been published in relation to breastfeeding, diabetes, mental health conditions, cancer and HIV. On the topic of chronic non-cancer pain, only two systematic reviews were identified from a detailed search. Parry and Watt-Watson2 reviewed six studies on peer support for people with heart disease, where chronic pain can be an issue. They reported some positive effects on outcomes, including improved self-efficacy and activity levels, and reduced pain and emergency room visits. Bender at al23 reviewed 17 studies on internet-based pain management; this included two studies that evaluated online peer support programs. They reported similar findings to Parry and Watt-Watson2 with improvements in self-efficacy, activity levels and health distress, and reductions in pain intensity. These systematic reviews provide initial evidence of positive effects of peer support in chronic pain. However, chronic pain is prevalent in many other conditions in addition to heart disease, and peer support is delivered in several formats in addition to the internet. To date there has been no systematic review conducted on peer support for community-dwelling adults with chronic non-cancer pain. This review will therefore add to the literature on peer support by assessing the effectiveness of peer support interventions in adults with chronic non-cancer pain.

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