Article Figures & Data
Figures
- Figure 1
CONSORT diagram.
CONSORT = consolidated standards of reporting trials.
- Figure 2
Change from baseline to follow-up in the number of participants who did not have pain that prevented them from walking, had pain but did other forms of exercise, and had pain but did not do other exercise.
Tables
- Table 1
Baseline Characteristics of the 195 Participants Who Completed the Living Healthy Trial
All N = 195 Control n = 99 Intervention n = 96 P Valuea Mean age ± SD 58.9 ± 10.4 57.9 ± 10.8 60.0 ± 9.9 .15 Female, No. (%) 155 (80) 74 (75) 81 (84) .10 African American, No. (%) 188 (96) 94 (95) 94 (98) .27 Education, No. (%) <High school 55 (28) 32 (32) 23 (24) .38 12th grade, GED, high school diploma 70 (36) 32 (32) 38 (40) >High school education 70 (36) 35 (35) 35 (37) Annual household income, No. (%) <$20,000 132 (74) 62 (68) 70 (80) .08 >=$20,000 47 (26) 29 (32) 18 (20) Mean WOMAC total score ± SDb 41 ± 20 42 ± 20 40 ± 20 .61 Mean functional status subscale score ± SD 40 ± 22 41 ± 22 39 ± 22 .56 Mean stiffness subscale score ± SD 49 ± 26 49 ± 25 49 ± 27 .92 Mean pain subscale score ± SD 42 ± 22 43 ± 23 42 ± 21 .70 Health related quality of lifec Mean MCS ± SD 39 ± 7 39 ± 7 39 ± 6 .39 Mean PCS ± SD 39 ± 9 38 ± 9 39 ± 9 .31 Mean hemoglobin A1c, % ± SD 8.3 ± 2.1 8.4 ± 2.2 8.2 ± 2.1 .40 Mean systolic blood pressure, mm Hg ± SD 133 ± 21 133 ± 21 133 ± 20 .94 Mean body mass index, kg/m2 ± SD 37.5 ± 8.0 37 ± 7.0 38 ± 9 .15 Body mass index >30 kg/m2, No. (%) 167 (87) 85 (86) 82 (87) .78 Taking Insulin, No. (%) 89 (46) 48 (49) 41 (43) .42 Explanatory variables Means days per week engaged in intense PA ± SDd 2.5 ± 2.0 2.2 ± 1.9 2.9 ± 2.1 .03 Mean days per week walked for exercise ± SDe 0.6 ± 2.4 0.6 ± 2.3 0.7 ± 2.6 .88 PA despite pain, No. (%)f .69 Did not have pain 71 (37) 33 (34) 38 (40) Unable to walk, did other exercise 53 (27) 28 (29) 25 (26) Unable to walk, no exercise 70 (36) 37 (38) 33 (34) PA levels compared with others, No. (%)g .42 Less active 78 (40) 44 (44) 34 (35) Same as other my age 58 (30) 28 (28) 30 (31) More active 59 (30) 27 (27) 32 (33) GED = general equivalency diploma; MCS = mental health component score; PA = physical activity; PCS = physical component score; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
↵a t-test or χ2 testing between group differences.
↵b Range 0-100; higher score indicates more pain, stiffness, and functional limitation.
↵c Short Form 12; range 0-100; higher score indicates greater quality of life.
↵d “How many times per week do you engage in intense physical activity, enough to work up a sweat?”
↵e “Over the past 7 days, how many days did you walk for exercise?”
↵f “On days you were unable to walk for exercise due to pain, did you do other forms of exercise?”
↵g “How would you compare your activity level to others your age?”
- Table 2
Mean Unadjusted Change in Primary Outcome Measures From Baseline to 3-Month Follow-Up in the Living Healthy Trial
Outcome Baseline Follow-Up Raw Change in Score ± SD P Valuea WOMAC Total Score, mean ± SDb .002 Con 42 ± 20 37 ± 19 -5 ± 18 Int 40 ± 20 30 ± 19 -10 ± 13 Functional status subscale score, mean + SD .01 Con 41 ± 22 36 ± 20 -5 ± 20 Int 39 ± 22 30 ± 20 -9 ± 13 Stiffness subscale score, mean + SD .001 Con 49 ± 25 43 ± 28 -6 ± 25 Int 49 ± 27 34 ± 26 -15 ± 26 Pain subscale score, mean + SD .01 Con 43 ± 23 37.9 ± 19 -4.8 ± 21 Int 42 ± 21 31 ± 21 -10.5 ± 19 Quality of life, SF12c MCS scores, mean ± SD .001 Con 38.6 ± 6.9 42.5 ± 7.0 3.8 ± 8.8 Int 39.4 ± 6.3 44.2 ± 6.8 4.8 ± 8.8 PCS scores, mean + SD .11 Con 38.1 ± 8.7 39.5 ± 8.4 1.4 ± 8.8 Int 39.4 ± 8.9 40.4 ± 8.9 1.0 ± 9.6 Hemoglobin A,c level, %, mean ± SD .85 Con 8.4 ± 2.2 8.4 ± 1.9 0.00 ± 1.3 Int 8.2 ± 2.1 8.3 ± 2.0 0.13 ± 1.2 Systolic blood pressure, mmHg, mean + SD .26 Con 133 ± 21 129 ± 20 -4.5 ± 17.6 Int 133 ± 20 132 ± 22 -1.0 ± 20.0 Body mass index, kg/m2, mean ± SD .99 Con 36.7 ± 7.1 36.8 ± 7.1 0.03 ± 1.3 Int 38.3 ± 8.8 38.2 ± 8.7 -0.07 ± 1.5 Con = control group; GEE = general estimating equation; Int = intervention group; MCS = Mental Health Component Score; PCS = Physical Component Score; SF-12 = Standard Form 12; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
↵a GEE models testing the difference in the change from baseline to follow-up between groups, adjusting for clustering and baseline values.
↵b Range 0-100; higher score indicates more pain, stiffness, and functional limitation.
↵c Range 0-100; higher score indicates greater quality of life.
- Table 3
Mean Change in Physical Activity Measures From Baseline to 3-Month Follow-Up in the Living Healthy Trial
Baseline Follow-Up Raw Change in Score ± SD P Valuea Mean days per week engaged in intense physical activity ± SDb .23 Con 2.2 ± 1.9 2.8 ± 2.0 0.6 ± 2.3 Int 2.8 ± 2.0 3.5 ± 2.2 0.7 ± 2.6 Mean days per week walked for exercise ± SDc <.001 Con 0.8 ± 0.4 0.7 ± 0.5 –0.1 ± 0.4 Int 0.7 ± 0.4 0.9 ± 0.3 0.2 ± 0.5 <.001 Physical activity levels compared with others your age, No. (%)d Less active Con 44 (44) 31 (31) –13 (7) Int 34 (35) 20 (21) –14 (7) Same as others my age Con 28 (28) 42 (42) +14 (7) Int 30 (31) 29 (31) –1 (1) More active Con 27 (27) 26 (26) –1 (1) Int 32 (33) 45 (48) +13 (7) Con = control group; GEE = general estimating equation; Int = intervention group.
↵a GEE models testing the difference in the change from baseline to follow-up between groups, adjusting for clustering and baseline values.
↵b “How many times per week do you engage in intense physical activity, enough to work up a sweat?”
↵c “Over the past 7 days, how many days did you walk for exercise?”
↵d “How would you compare your activity level to others your age?”
Supplemental Appendix & Table
Supplemental Appendix & Table
Files in this Data Supplement:
- Supplemental data: Appendix & Table - PDF file
The Article in Brief
Peer-Delivered Cognitive Behavioral Training to Improve Functioning in Patients With Diabetes: A Cluster-Randomized Trial
Monika M. Safford , and colleagues
Background Rural communities in the Southeastern United States have the highest prevalence of diabetes in the nation. They face considerable barriers to successful diabetes self-management, and up to 75% of adults with diabetes report chronic pain, and may also have depression, anxiety, and physical or emotional disabilities. Cognitive behavioral therapy (CBT) is an effective nonpharmacologic intervention for chronic pain, but it hasn't been well studied in diabetes and chronic pain. Evidence for the effectiveness of peer coach-delivered CBT-based programs for diabetes and chronic pain is also limited.
What This Study Found Trained community members in rural Alabama delivered a diabetes self-management program that incorporated cognitive behavioral approaches to overcoming pain as a barrier to physical activity. Peer trainers were African American women who had personal experiences with diabetes and were lifelong community members. Similarly, participants were mostly low-income African American women recruited through community connections and assigned to the intervention by town block randomization. Adults who completed the 10-week program showed significant improvements in functional status, pain, and quality of life, when compared to a peer-led general health advice control group. At the end of the program, adults in the cognitive behavioral therapy�based program were more likely to report having no pain or finding alternative exercises when pain prevented them from walking.
Implications
- These results demonstrate that peers trained to deliver CBT-based interventions can improve health outcomes in areas where access is limited.
- A peer-delivered program for managing diabetes and chronic pain was shown to be beneficial for rural adults in communities that might otherwise lack access to physician-led services.
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