Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans—Rationale, Methods, and Implementation

Seal, Karen H.; Becker, William C.; Murphy, Jennifer L.; Purcell, Natalie; Denneson, Lauren M.; Morasco, Benjamin J.; Martin, Aaron M.; Reddy, Kavitha P.; Iseghem, Theresa van; Krebs, Erin E.; Painter, Jacob; Hagedorn, Hildi; Pyne, Jeffrey M.; Hixon, John; Maguen, Shira; Neylan, Thomas C.; Borsari, Brian; DeRonne, Beth; Gibson, Carolyn J.; Matthias, Marianne S.; Frank, Janet C.; Krishnaswamy, Akshaya; Li, Yongmei; Bertenthal, Daniel; Chan, Allan; Núñez, Alejandro; McCamish, Nicole

doi:10.1093/pm/pnaa366

Cited by 16 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of a study by Blau et al showed mental health of veterans with university degrees being significantly different from that of other veterans [ 25 ]. In this respect, a previous study dealing with veterans’ quality of life reported that higher level of education affects their quality of life, which is in turn affected by their mental health [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Sense of loneliness of veterans in Southern Iran: a cross-sectional study

et al. 2023

View full text Add to dashboard Cite

Aims More than three decades have passed since the end of the Iraq-Iran war, and this period has been concurrent with a rapid growth of the older community in Iran which includes the community of veterans who often suffer from serious psychological and behavioral problems. The study aimed to investigate the prevalence and determinants of loneliness in middle and older veterans in southern Iran. Materials & methods A cross-sectional study conducted among 583 middle and older male veterans (50 years <) who were selected by the census method in 2021. Data collection was done using UCLA Loneliness Scales. The collected data were entered into SPSS version-26 and Amos-24 and analyzed by multivariate ANOVA, multivariate regression, and structural equation at a threshold significance level of 0.05. Findings The mean score of feeling lonely in the veterans was 51.08 ± 4.74. The study found a significant relationship between the participants’ education and their feeling of loneliness (P-value = 0.01, effect size = -0.31). Multivariate regression demonstrated that demographic variables (i.e., age, employment status, level of education, type of living) and the severity and type of injury predict 31% of the variance in the middle and older veterans’ feeling of loneliness. Conclusion The mental, psychological and physical effects of war disability were associated with the social functions of veterans in the family and community. Strategies such as increasing social support and psychological counseling for veterans along with improving their pension and income can be effective in promoting public health, especially the mental health of this group.

show abstract

Section: Discussionmentioning

confidence: 99%

Sense of loneliness of veterans in Southern Iran: a cross-sectional study

et al. 2023

View full text Add to dashboard Cite

show abstract

“…WH coaches are employees of the VHA, and a subset of these employees are Veterans. Qualifications for WH coaches typically include a bachelor’s or higher degree in a behavioral or social science, and specialized experience in helping clients reach wellness goals utilizing motivational interviewing and shared decision-making health coaching techniques [ 37 ]. In addition, a growing number of health coaches obtain a National Board Certification of a Health and Wellness Coach (NBC-HWC) [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches’ Expanded Services and Support during COVID-19

Hale–Gallardo

Kreider

Castañeda

et al. 2022

IJERPH

View full text Add to dashboard Cite

The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role, during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed.

show abstract

“…Figure 1 presents the wHOPE study design; full details have been published elsewhere. 5 Briefly, participants are randomized to three arms, two active treatments (Whole Health Team and Primary Care Group Intervention), 13 and Usual Primary Care in an approximately 11:11:2 ratio, stratified by site. The primary outcome is change in pain interference score using the Brief Pain Inventory 14 from baseline to the final study outcome assessment at 12 months.…”

Section: Methodsmentioning

confidence: 99%

“…The primary aim is to reduce pain interference; the secondary aim is to improve functioning and quality of life among Veterans with moderate to severe chronic pain. 5 Individuals randomized to the Whole Health Team arm attend one initial and four follow-up visits with an interdisciplinary co-located team consisting of a medical provider and at least one complementary integrative health provider (e.g. acupuncturist, Tai Chi instructor) to develop a personalized health plan to manage chronic pain using non-pharmacological strategies.…”

Section: Background/aimsmentioning

confidence: 99%

Impact of complex, partially nested clustering in a three-arm individually randomized group treatment trial: A case study with the wHOPE trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background/Aims When participants in individually randomized group treatment trials are treated by multiple clinicians or in multiple group treatment sessions throughout the trial, this induces partially nested clusters which can affect the power of a trial. We investigate this issue in the Whole Health Options and Pain Education trial, a three-arm pragmatic, individually randomized clinical trial. We evaluate whether partial clusters due to multiple visits delivered by different clinicians in the Whole Health Team arm and dynamic participant groups due to changing group leaders and/or participants across treatment sessions during treatment delivery in the Primary Care Group Education arm may impact the power of the trial. We also present a Bayesian approach to estimate the intraclass correlation coefficients. Methods We present statistical models for each treatment arm of Whole Health Options and Pain Education trial in which power is estimated under different intraclass correlation coefficients and mapping matrices between participants and clinicians or treatment sessions. Power calculations are based on pairwise comparisons. In practice, sample size calculations depend on estimates of the intraclass correlation coefficients at the treatment sessions and clinician levels. To accommodate such complexities, we present a Bayesian framework for the estimation of intraclass correlation coefficients under different participant-to-session and participant-to-clinician mapping scenarios. We simulated continuous outcome data based on various clinical scenarios in Whole Health Options and Pain Education trial using a range of intraclass correlation coefficients and mapping matrices and used Gibbs samplers with conjugate priors to obtain posteriors of the intraclass correlation coefficients under those different scenarios. Posterior means and medians and their biases are calculated for the intraclass correlation coefficients to evaluate the operating characteristics of the Bayesian intraclass correlation coefficient estimators. Results Power for Whole Health Team versus Primary Care Group Education is sensitive to the intraclass correlation coefficient in the Whole Health Team arm. In these two arms, an increased number of clinicians, more evenly distributed workload of clinicians, or more homogeneous treatment group sizes leads to increased power. Our simulation study for the intraclass correlation coefficient estimation indicates that the posterior mean intraclass correlation coefficient estimator has less bias when the true intraclass correlation coefficients are large (i.e. 0.10), but when the intraclass correlation coefficient is small (i.e. 0.01), the posterior median intraclass correlation coefficient estimator is less biased. Conclusion Knowledge of intraclass correlation coefficients and the structure of clustering are critical to the design of individually randomized group treatment trials with partially nested clusters. We demonstrate that the intraclass correlation coefficient of the Whole Health Team arm can affect power in the Whole Health Options and Pain Education trial. A Bayesian approach provides a flexible procedure for estimating the intraclass correlation coefficients under complex scenarios. More work is needed to educate the research community about the individually randomized group treatment design and encourage publication of intraclass correlation coefficients to help inform future trial designs.

show abstract

Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans—Rationale, Methods, and Implementation

Cited by 16 publications

References 18 publications

Sense of loneliness of veterans in Southern Iran: a cross-sectional study

Sense of loneliness of veterans in Southern Iran: a cross-sectional study

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches’ Expanded Services and Support during COVID-19

Impact of complex, partially nested clustering in a three-arm individually randomized group treatment trial: A case study with the wHOPE trial

Contact Info

Product

Resources

About