Hybrid effectiveness-implementation trial of guided relaxation and acupuncture for chronic sickle cell disease pain (GRACE): A protocol

Background

People with sickle cell disease frequently use complementary and integrative therapies to cope with their pain, yet few studies have evaluated their effectiveness. The 3-arm, 3-site pragmatic Hybrid Effectiveness-implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE) has 3 priorities: (1) evaluate guided relaxation and acupuncture to improve pain control; (2) determine the most appropriate and effective treatment sequence for any given patient based on their unique characteristics; and (3) describe the processes and structures required to implement guided relaxation and acupuncture within health care systems.

Methods

Participants (N = 366) are being recruited and randomized 1:1:1 to one of 2 intervention groups or usual care. The acupuncture intervention group receives 10 sessions over approximately 5 weeks. The guided relaxation intervention group receives access to video sessions ranging from 2 to 20 min each viewed daily over 5 weeks. The usual care group receives the standard of clinical care for sickle cell disease. Participants are re-randomized at 6 weeks depending on their pain impact score. Assessments occur at 6 weeks, 12 weeks, and 24 weeks. The primary outcome is the change in pain impact score and secondary measures include opioid use, anxiety, depression, sleep, pain catastrophizing, substance use, global impression of change, constipation, and hospitalizations. The GRACE study uses the Consolidated Framework for Implementation Research to plan, execute, and evaluate the associated implementation processes.

Conclusion

The results from GRACE will represent a critical step toward improving management of pain affecting patients with sickle cell disease.ClinicalTrials.gov Identifier: NCT04906447.

Pragmatic clinical trials: Increasing the rate of translating nursing research into practice†

AIM

Nursing research worldwide is committed to rigorous scientific inquiry that provides a significant body of knowledge to advance nursing practice. One way to advance nursing practice is to increase the rate at which nursing research findings are translated into clinical practice, and one way to do that is to use pragmatic clinical trial research designs. This article aims to describe and advocate for the increased use of pragmatic clinical trials in nursing research and to provide a summary of one nursing pragmatic clinical trial.

METHODS

A review and discussion of the features of pragmatic clinical trials.

RESULTS

This article describes the principles and benefits of pragmatic clinical trials. Nurse researchers who use these principles will generate results that are more actionable, patient-centered, and relevant in clinical practice. Focusing on research that provides practical evidence that can be translated into evidence-based practice is an important way to improve the environment for nursing research that leads more rapidly to improved nursing practice.

CONCLUSIONS

Embracing and increasing our use of pragmatic clinical trial design concepts in nursing research can enhance the significance of our findings and facilitate the translation of our research into practice.