BACKGROUND: According to the World Health Organization, long-term illness will account for almost three-quarters of global deaths by 2020. Evidence supports the use of both self-management and mindfulness-based interventions (MBIs) for those who live with long-term illness. While this research is promising, a major barrier with traditional MBIs is the amount of time they require (eight weeks) and the necessity of a trained specialist. OBJECTIVE: The aim of this thesis is to develop and evaluate a brief MBI for those with long-term illness, through a literature review, a qualitative study and a pilot study. METHODS: A systematic review of studies using brief MBIs for health-related outcomes was the initial stage. This provided a basis for a qualitative study, which was conducted to assess views of long-term illness patients (i.e., persistent pain, chronic obstructive pulmonary disease, cardiovascular disease) on the acceptability of a brief (10 minute) MBI, to define population suitability and to refine delivery and assessment. A pilot randomised controlled trial (RCT), informed by results from the first study, was then conducted with persistent pain patients. A brief mindfulness body scan audio was compared to an active control and immediate effects of the intervention were assessed with brief measures for perceived pain severity, distress and distraction. Feasibility of a definitive RCT was assessed in relation to recruitment and retention rates. At baseline, one week and one month, assessments included: mindfulness, anxiety, depression, health-related quality of life, pain catastrophizing, pain self-efficacy, activities of daily living limitations, and ratings o f‘usefulness’ and ‘likelihood to recommend’ the intervention. RESULTS: The review identified 71 eligible studies of brief MBIs, including 70 RCTs. Sixty-seven studies observed a positive effect on at least one health related outcome. There was high heterogeneity for both types of MBI and health-related outcomes and low use of clinical populations. Results from the qualitative study, with 14 patients, suggested that a brief MBI audio was acceptable and was most suited to a persistent pain population. Patients tended to prefer an MBI of 15 minutes rather than 10 minutes. In the pilot study of a 15 minute MBI audio, of 220 patients referred, 147 were randomised and 71 completed all assessments. There were no significant immediate effects of the MBI, although there was a tendency for a marked improvement in both groups. Significant effects were found for ‘usefulness’ at one week and self-efficacy at one month in the MBI group compared with the control. Levels of recruitment were acceptable and attrition rates were high. CONCLUSIONS: The findings of the systematic review demonstrate that brief MBIs can have a positive impact on a range of health-related outcomes and that further studies are required, especially with clinical populations. Qualitative findings confirm the acceptability of a brief MBI, particularly for a persistent pain population. In the pilot study, lack of immediate effects could be due to the potency of the control and a less engaging control needs to be considered. A definitive trial is required in which retention of patients is optimized, for example, by delivering the MBI alongside existing rehabilitative programmes.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:754062 |
| Date | January 2018 |
| Creators | Howarth, Anastassia |
| Publisher | St George's, University of London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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