Psychosocial interventions for pain management in older adults with dementia: A systematic review of randomized controlled trials. (15th January 2019) - Pu, Lihui
ABSTRACT: Aim: To assess the effectiveness of psychosocial interventions on pain in older adults living with dementia. Design: A systematic review with meta‐analysis of randomized controlled trials. Data sources: Scopus, ProQuest, EBSCO (CINAHL and MEDLINE), PubMed, OVID (PsycINFO), Web of Science, and Cochrane Library were searched from their inception up to 2 May 2018. Review Methods: Risk of bias assessment and meta‐analysis were conducted according to the Cochrane methods using RevMan 5.3 and findings were generated using the GRADE profiler software. Results: Eight studies met the inclusion criteria, but the quality of the current evidence was low to moderate. Results showed that psychosocial interventions significantly reduced the observational pain score and pain medication. Subgroup analyses indicated that sensory stimulation and individual interventions showed a reduction in observational pain in people with dementia. Conclusion: Findings suggest that psychosocial interventions may be potentially effective alternatives for pain management in people with dementia. However, caution is needed in interpreting these results due to limited studies, risk of bias and heterogeneity across studies. Furthermore, well‐designed research is needed on psychosocial interventions to strengthen quality of pain management in people with dementia. Impact: This review synthesized current evidence using psychosocial interventions to manage pain in people with dementia. Findings suggest that psychosocial interventions may lead to a potential reduction in pain and pain medication in people with dementia. Healthcare providers may wish to integrate psychosocial interventions as part of the multimodal approach to the management of pain in people living with dementia. 目的: 评估心理社会干预对老年痴呆患者疼痛的有效性。 设计: 随机对照试验荟萃分析的系统综述。 资料来源: 从其成立到2018年5月2日, 都在Scopus、ProQuest、EBSCO(CINAHL和MEDLINE)、PubMed、OVID(PsycINFO)、科学网和Cochrane图书馆上进行了搜索。 综述方法: 根据Cochrane方法, 使用RevMan 5.3进行偏差性风险评估和荟萃分析, 并使用GRADE profiler软件生成调查结果。 结果: 虽然八项研究符合纳入标准, 但当前证据的质量是从低到中。结果表明, 心理社会干预显著降低了观察性疼痛评分和疼痛药物治疗。亚组分析表明, 感觉刺激和个体干预显示了痴呆患者的观察性疼痛减轻。 结论: 调查结果表明, 心理社会干预可能是痴呆症患者疼痛管理的潜在性有效替代方案。然而, 因为研究有限, 研究之间存在偏差性和异质性的风险, 所以在解释这些结果时需要谨慎。此外, 需要对心理社会干预进行精心设计的研究, 以强化痴呆患者疼痛管理的质量。 影响: 这篇综述综合了目前使用心理社会干预来管理痴呆患者疼痛的证据。调查结果表明, 心理社会干预可能会促进痴呆患者疼痛和疼痛药物治疗的潜在性减少。医疗保健提供者可能希望将心理社会干预作为痴呆症患者疼痛管理多模式方法的一部分。