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Im B, Oh H, Kim S, Jeong H, Seo W. Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases. HEALTH EDUCATION & BEHAVIOR 2024; 51:625-635. [PMID: 37519028 DOI: 10.1177/10901981231188136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.
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Affiliation(s)
- BoAe Im
- Inha University, Incheon, Republic of Korea
| | - HyunSoo Oh
- Inha University, Incheon, Republic of Korea
| | | | - HyeSun Jeong
- Kongju National University, Gongju, Republic of Korea
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Courtney RE, Schadegg MJ, Bolton R, Smith S, Harden SM. Using a Whole Health Approach to Build Biopsychosocial-Spiritual Personal Health Plans for Veterans with Chronic Pain. Pain Manag Nurs 2024; 25:69-74. [PMID: 37839983 DOI: 10.1016/j.pmn.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
Chronic pain affects over 50 million Americans per year and costs society billions of dollars annually. It is widely accepted that the biomedical model is outdated and research on the biopsychosocial model of chronic pain has increased in recent years, concurrent with investigations into self-management of chronic pain. The Veterans Health Administration (VHA) has incorporated both of these approaches into their Whole Health System. This work describes the VHA Whole Health System, reviews the literature on alignment between the Whole Health System's Circle of Health and chronic pain, and explains how the VHA Whole Health model may be used as a method for organizing self-management strategies within a personal health plan in the context of chronic pain. Given the infusion of nurses throughout the healthcare system, nurses are in a unique position to champion this biopsychosocial-spiritual approach to care.
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Affiliation(s)
- Rena E Courtney
- PREVAIL Center for Chronic Pain, Salem, VA Health Care System, Salem, Virginia; Virginia Tech Carilion School of Medicine, Salem, Virginia.
| | - Mary J Schadegg
- NYU Grossman School of Medicine/NYU Langone Health, New York, New York
| | - Rendelle Bolton
- Center for Healthcare Organization and Implementation Research, Bedford VA Health Care System, Bedford, Massachusetts
| | - Stephanie Smith
- PREVAIL Center for Chronic Pain, Salem, VA Health Care System, Salem, Virginia
| | - Samantha M Harden
- Virginia Tech Carilion School of Medicine, Salem, Virginia; Virginia Tech, Blacksburg, Virginia
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Oloruntoba O, Bergeron CD, Zhong L, Merianos AL, Sherman LD, Kew CL, Goidel RK, Smith ML. Pharmacological Prescribing and Satisfaction with Pain Treatment Among Non-Hispanic Black Men with Chronic Pain. Patient Prefer Adherence 2024; 18:187-195. [PMID: 38264322 PMCID: PMC10804868 DOI: 10.2147/ppa.s435652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Pharmacological strategies are often central to chronic pain management; however, pain treatment among non-Hispanic Black men may differ because of their disease profiles and healthcare interactions. However, less is known about pain medication prescribing and patients' satisfaction with pain treatment and management among non-Hispanic Black men with self-reported chronic pain. Purpose This study assessed factors associated with non-Hispanic Black men being prescribed/recommended narcotics/opioids for chronic pain and their satisfaction with pain treatment/management. Methods Data were analyzed from 286 non-Hispanic Black men with chronic pain who completed an internet-delivered questionnaire. Participants were recruited nationwide using a Qualtrics web-based panel. Logistic regression was used to identify factors associated with being prescribed/recommended narcotics/opioids for pain management treatment. Then, ordinary least squares regression was used to identify factors associated with their satisfaction level with the pain treatment/management received. Results On average, participants were 56.2 years old and 48.3% were prescribed/recommended narcotics/opioids for chronic pain. Men with more chronic conditions (Odds Ratio [OR] = 0.57, P = 0.043) and depression/anxiety disorders (OR = 0.53, P = 0.029) were less likely to be prescribed/recommended narcotics/opioids. Men who were more educated (OR = 2.09, P = 0.044), reported more frequent chronic pain (OR = 1.28, P = 0.007), and were allowed to participate more in decisions about their pain treatment/management (OR = 1.11, P = 0.029) were more likely to be prescribed/recommended narcotics/opioids. On average, men with more frequent chronic pain (B = -0.25, P = 0.015) and pain problems (B = -0.16, P = 0.009) were less satisfied with their pain treatment/management. Men who were allowed to participate more in decisions about their pain treatment/management reported higher satisfaction with their pain treatment/management (B = 0.55, P < 0.001). Conclusion Playing an active role in pain management can improve non-Hispanic Black men's satisfaction with pain treatment/management. This study illustrates the importance of patient-centered approaches and inclusive patient-provider interactions to improve chronic pain management.
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Affiliation(s)
- Oluyomi Oloruntoba
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Lixian Zhong
- Department of Pharmaceutical Sciences, Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Ledric D Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, USA
| | - Chung Lin Kew
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - R Kirby Goidel
- Public Policy Research Institute, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, USA
- Center for Community Health and Aging, Texas A&M University, College Station, TX, USA
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Starzec-Proserpio M, Vandyken C. Telerehabilitation for persistent Pelvic Girdle Pain within a biopsychosocial framework - A case report. Physiother Theory Pract 2023; 39:2251-2261. [PMID: 35481796 DOI: 10.1080/09593985.2022.2069618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Persistent pregnancy-related pelvic girdle pain (PGP) and the resulting consequences may considerably influence a woman's quality of life. The complexity of this condition requires a whole-person centered approach. In response to COVID-19 outbreak, telerehabilitation has emerged as a promising alternative to traditional in-person visits. PURPOSE The aim of this report was to present the potential of telerehabilitation for persistent postpartum PGP within the biopsychosocial framework. CASE DESCRIPTION A 26-year-old female presented with persistent pregnancy-related PGP of 8 months duration after her first vaginal delivery. The video-consults were performed using telerehabilitation platform. The patient received six telerehabilitation consults of 45 min duration over five weeks. Assessment of physical and psychosocial factors, cognitively focused strategies including pain neurophysiology education, sensory-motor remapping exercises, and graded increase of activity were administered. Rehabilitation was divided into the following phases: assessment, desensitization, graded exposure, and supported independence. OUTCOMES The Pelvic Girdle Questionnaire (PGQ) score was significantly reduced from 72.2 during the assessment to 15.3 at discharge. This change was significantly more substantial than the minimal clinically important change estimated for the PGQ. CONCLUSION Physiotherapists can utilize telerehabilitation to assist them with enacting appropriate care measures for persistent PGP within a biopsychosocial framework.
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Rosser BA, Fisher E, Janjua S, Eccleston C, Keogh E, Duggan G. Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2023; 8:CD013863. [PMID: 37643992 PMCID: PMC10476013 DOI: 10.1002/14651858.cd013863.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic pain (pain lasting three months or more) is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Common types (excluding headache) include back pain, fibromyalgia, and neuropathic pain. Access to traditional face-to-face therapies can be restricted by healthcare resources, geography, and cost. Remote technology-based delivery of psychological therapies has the potential to overcome treatment barriers. However, their therapeutic effectiveness compared to traditional delivery methods requires further investigation. OBJECTIVES To determine the benefits and harms of remotely-delivered psychological therapies compared to active control, waiting list, or treatment as usual for the management of chronic pain in adults. SEARCH METHODS We searched for randomised controlled trials (RCTs) in CENTRAL, MEDLINE, Embase, and PsycINFO to 29 June 2022. We also searched clinical trials registers and reference lists. We conducted a citation search of included trials to identify any further eligible trials. SELECTION CRITERIA We included RCTs in adults (≥ 18 years old) with chronic pain. Interventions included psychological therapies with recognisable psychotherapeutic content or based on psychological theory. Trials had to have delivered therapy remote from the therapist (e.g. Internet, smartphone application) and involve no more than 30% contact time with a clinician. Comparators included treatment as usual (including waiting-list controls) and active controls (e.g. education). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 32 trials (4924 participants) in the analyses. Twenty-five studies delivered cognitive behavioural therapy (CBT) to participants, and seven delivered acceptance and commitment therapy (ACT). Participants had back pain, musculoskeletal pain, opioid-treated chronic pain, mixed chronic pain, hip or knee osteoarthritis, spinal cord injury, fibromyalgia, provoked vestibulodynia, or rheumatoid arthritis. We assessed 25 studies as having an unclear or high risk of bias for selective reporting. However, across studies overall, risk of bias was generally low. We downgraded evidence certainty for primary outcomes for inconsistency, imprecision, and study limitations. Certainty of evidence ranged from moderate to very low. Adverse events were inadequately reported or recorded across studies. We report results only for studies in CBT here. Cognitive behavioural therapy (CBT) versus treatment as usual (TAU) Pain intensity Immediately after treatment, CBT likely demonstrates a small beneficial effect compared to TAU (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.39 to -0.16; 20 studies, 3206 participants; moderate-certainty evidence). Participants receiving CBT are probably more likely to achieve a 30% improvement in pain intensity compared to TAU (23% versus 11%; risk ratio (RR) 2.15, 95% CI 1.62 to 2.85; 5 studies, 1347 participants; moderate-certainty evidence). They may also be more likely to achieve a 50% improvement in pain intensity (6% versus 2%; RR 2.31, 95% CI 1.14 to 4.66; 4 studies, 1229 participants), but the evidence is of low certainty. At follow-up, there is likely little to no difference in pain intensity between CBT and TAU (SMD -0.04, 95% CI -0.17 to 0.09; 8 studies, 959 participants; moderate-certainty evidence). The evidence comparing CBT to TAU on achieving a 30% improvement in pain is very uncertain (40% versus 24%; RR 1.70, 95% CI 0.82 to 3.53; 1 study, 69 participants). No evidence was available regarding a 50% improvement in pain. Functional disability Immediately after treatment, CBT may demonstrate a small beneficial improvement compared to TAU (SMD -0.38, 95% CI -0.53 to -0.22; 14 studies, 2672 participants; low-certainty evidence). At follow-up, there is likely little to no difference between treatments (SMD -0.05, 95% CI -0.23 to 0.14; 3 studies, 461 participants; moderate-certainty evidence). Quality of life Immediately after treatment, CBT may not have resulted in a beneficial effect on quality of life compared to TAU, but the evidence is very uncertain (SMD -0.16, 95% CI -0.43 to 0.11; 7 studies, 1423 participants). There is likely little to no difference between CBT and TAU on quality of life at follow-up (SMD -0.16, 95% CI -0.37 to 0.05; 3 studies, 352 participants; moderate-certainty evidence). Adverse events Immediately after treatment, evidence about the number of people experiencing adverse events is very uncertain (34% in TAU versus 6% in CBT; RR 6.00, 95% CI 2.2 to 16.40; 1 study, 140 participants). No evidence was available at follow-up. Cognitive behavioural therapy (CBT) versus active control Pain intensity Immediately after treatment, CBT likely demonstrates a small beneficial effect compared to active control (SMD -0.28, 95% CI -0.52 to -0.04; 3 studies, 261 participants; moderate-certainty evidence). The evidence at follow-up is very uncertain (mean difference (MD) 0.50, 95% CI -0.30 to 1.30; 1 study, 127 participants). No evidence was available for a 30% or 50% pain intensity improvement. Functional disability Immediately after treatment, there may be little to no difference between CBT and active control on functional disability (SMD -0.26, 95% CI -0.55 to 0.02; 2 studies, 189 participants; low-certainty evidence). The evidence at follow-up is very uncertain (MD 3.40, 95% CI -1.15 to 7.95; 1 study, 127 participants). Quality of life Immediately after treatment, there is likely little to no difference in CBT and active control (SMD -0.22, 95% CI -1.11 to 0.66; 3 studies, 261 participants; moderate-certainty evidence). The evidence at follow-up is very uncertain (MD 0.00, 95% CI -0.06 to 0.06; 1 study, 127 participants). Adverse events Immediately after treatment, the evidence comparing CBT to active control is very uncertain (2% versus 0%; RR 3.23, 95% CI 0.13 to 77.84; 1 study, 135 participants). No evidence was available at follow-up. AUTHORS' CONCLUSIONS Currently, evidence about remotely-delivered psychological therapies is largely limited to Internet-based delivery of CBT. We found evidence that remotely-delivered CBT has small benefits for pain intensity (moderate certainty) and functional disability (moderate to low certainty) in adults experiencing chronic pain. Benefits were not maintained at follow-up. Our appraisal of quality of life and adverse events outcomes post-treatment were limited by study numbers, evidence certainty, or both. We found limited research (mostly low to very low certainty) exploring other psychological therapies (i.e. ACT). More high-quality studies are needed to assess the broad translatability of psychological therapies to remote delivery, the different delivery technologies, treatment longevity, comparison with active control, and adverse events.
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Affiliation(s)
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
| | - Sadia Janjua
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
| | | | - Edmund Keogh
- Department of Psychology, University of Bath, Bath, UK
| | - Geoffrey Duggan
- Bath Centre for Pain Services, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Sasseville M, LeBlanc A, Tchuente J, Boucher M, Dugas M, Gisèle M, Barony R, Chouinard MC, Beaulieu M, Beaudet N, Skidmore B, Cholette P, Aspiros C, Larouche A, Chabot G, Gagnon MP. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Syst Rev 2023; 12:78. [PMID: 37143171 PMCID: PMC10157597 DOI: 10.1186/s13643-023-02241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support. METHODS This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. RESULTS Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. CONCLUSIONS While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population. TRIAL REGISTRATION The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).
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Affiliation(s)
- Maxime Sasseville
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada.
| | - Annie LeBlanc
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Jack Tchuente
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | | | | | | | - Nicolas Beaudet
- Université de Sherbrooke, Omnimed, Sherbrooke, Quebec, Canada
| | - Becky Skidmore
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Pascale Cholette
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Quebec City, Canada
| | - Christine Aspiros
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Alain Larouche
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Guylaine Chabot
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Marie-Pierre Gagnon
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
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Fleck DE, Wilson M, Lewis D, Welge JA, Arya G, Sathyan A, Cohen K, John Winhusen T. Neurocognitive predictors of adherence to an online pain self-management program adjunct to long-term opioid therapy. J Clin Exp Neuropsychol 2023; 45:242-254. [PMID: 37278690 PMCID: PMC10526690 DOI: 10.1080/13803395.2023.2221396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION While pain self-management programs can significantly improve patient outcomes, poor adherence is common and the need for research on predictors of adherence has been noted. A potential, but commonly overlooked, predictor is cognitive function. Our aim, then, was to examine the relative influence of various cognitive functional domains on engagement with an online pain self-management program. METHOD A secondary analysis of a randomized controlled trial testing the impact of E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program) plus treatment as usual, relative to treatment as usual alone, on pain and opioid dose outcomes in adults receiving long-term opioid therapy of morphine equivalence dose ≥20 mg; 165 E-health participants who completed an on-line neurocognitive battery were included in this sub-analysis. A variety of demographic, clinical, and symptom rating scales were also examined. We hypothesized that better processing speed and executive functions at baseline would predict engagement with the 4-month E-health subscription. RESULTS Ten functional cognitive domains were identified using exploratory factor analysis and the resultant factor scores applied for hypothesis testing. The strongest predictors of E-health engagement were selective attention, and response inhibition and speed domains. An explainable machine learning algorithm improved classification accuracy, sensitivity, and specificity. CONCLUSIONS The results suggest that cognition, especially selective attention, inhibitory control, and processing speed, is predictive of online chronic pain self-management program engagement. Future research to replicate and extend these findings seems warranted. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT03309188.
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Affiliation(s)
- David E. Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marian Wilson
- Washington State University College of Nursing, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Daniel Lewis
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey A. Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grace Arya
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anoop Sathyan
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH, USA
| | - Kelly Cohen
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH, USA
| | - T. John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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9
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Bosma R, Bisson EJ, Cooper LK, Salomons TV, Galica J, Wilson R. Experience-based design: Empowering individuals while they wait for interprofessional chronic pain care. PATIENT EDUCATION AND COUNSELING 2023; 109:107623. [PMID: 36640452 DOI: 10.1016/j.pec.2023.107623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chronic pain is highly prevalent and a leading cause of disability. Long wait times for interprofessional care provide an opportunity to introduce web-based interventions that improve psychosocial function and patients' readiness and ability to manage their condition. Here we describe the process of partnering with people with lived experience (PWLE) to develop an online self-management program enhanced by motivational interviewing. We also report the multiphase usability testing of the program. METHODS PWLE were included in all aspects of this project from program inception to content creation, module development, usability testing, and knowledge dissemination. Phase 1 included the development of the interactive, web-based modules. This process involved weekly meetings and asynchronous content creation with a core team of interprofessional pain experts, researchers, and PWLE. Phase 2 included usability testing by our PWLE and clinical expert advisory. Phase 3 included survey-based usability testing with a sample of 10 PWLE. RESULTS We created a chronic pain & motivational empowerment program includes a series of eight interactive educational web-based modules. Topics included: setting expectations, chronic pain explained, biopsychosocial factors, empowered management, self-awareness & compassion & acceptance, values, goal setting, and communication. The program is accompanied by a reflection journal and can be enhanced by one-on-one coaching sessions using a motivational interviewing approach. Phase two usability testing resulted in numerous content changes and the addition of accessibility features. Phase 3 usability testing with PWLE found the program highly accessible and easy to use. CONCLUSIONS The engagement of our PWLE team member and advisors made the online program more relevant, sensitive and helpful to the needs of people with pain. PRACTICAL VALUE This PWLE-centric project sets the foundation for future work to examine the feasibility and effectiveness of the program for supporting individuals with chronic pain self-manage.
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Affiliation(s)
- Rachael Bosma
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Canada.
| | - Etienne J Bisson
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lynn K Cooper
- Person with Lived Experience, Canadian Injured Workers Alliance, Canada
| | - Tim V Salomons
- Department of Psychology, Queen's University, Kingston, Canada
| | - Jacqueline Galica
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Rosemary Wilson
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada; School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
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10
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Wilson M, Dolor RJ, Lewis D, Regan SL, Vonder Meulen MB, Winhusen TJ. Opioid dose and pain effects of an online pain self-management program to augment usual care in adults with chronic pain: a multisite randomized clinical trial. Pain 2023; 164:877-885. [PMID: 36525381 PMCID: PMC10014474 DOI: 10.1097/j.pain.0000000000002785] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Readily accessible nonpharmacological interventions that can assist in opioid dose reduction while managing pain is a priority for adults receiving long-term opioid therapy (LOT). Few large-scale evaluations of online pain self-management programs exist that capture effects on reducing morphine equivalent dose (MED) simultaneously with pain outcomes. An open-label, intent-to-treat, randomized clinical trial recruited adults (n = 402) with mixed chronic pain conditions from primary care and pain clinics of 2 U.S. academic healthcare systems. All participants received LOT-prescriber-provided treatment of MED ≥ 20 mg while receiving either E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program), or treatment as usual (TAU). Among 402 participants (279 women [69.4%]; mean [SD] age, 56.7 [11.0] years), 200 were randomized to E-health and 202 to TAU. Of 196 E-heath participants, 105 (53.6%) achieved a ≥15% reduction in daily MED compared with 85 (42.3%) of 201 TAU participants (odds ratio, 1.6 [95% CI, 1.1-2.3]; P = 0.02); number-needed-to-treat was 8.9 (95% CI, 4.8, 66.0). Of 166 E-health participants, 24 (14.5%) achieved a ≥2 point decrease in pain intensity vs 13 (6.8%) of 192 TAU participants (odds ratio, 2.4 [95% CI, 1.2-4.9]; P = 0.02). Benefits were also observed in pain knowledge, pain self-efficacy, and pain coping. The findings suggest that for adults on LOT for chronic pain, use of E-health, compared with TAU, significantly increased participants' likelihood of clinically meaningful decreases in MED and pain. This low-burden online intervention could assist adults on LOT in reducing daily opioid use while self-managing pain symptom burdens.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA, United States
| | - Rowena J. Dolor
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Daniel Lewis
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Saundra L. Regan
- Department of Family & Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Mary Beth Vonder Meulen
- Department of Family & Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - T. John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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11
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Lyon RY, Schuster NM. Rate and Predictors of Patients with Chronic Pain Establishing Care with Pain Psychology Following Pain Physician Referral. PAIN MEDICINE 2023; 24:188-196. [PMID: 35861428 DOI: 10.1093/pm/pnac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine, among patients with chronic pain who had received pain physician referral to pain psychology, the rate of establishing care and factors related to establishing care with pain psychology. DESIGN Retrospective study. SETTING Academic tertiary care center. SUBJECTS Patients from the University of California, San Diego (UCSD) Center for Pain Medicine. METHODS This was an institutional review board-approved, retrospective study of 150 consecutive referrals of unique patients from UCSD Pain Medicine to UCSD Pain Psychology. RESULTS Of 150 patients referred to pain psychology, 74 (49.3%) established care with pain psychology. Of 98 patients who had previously seen mental health services, 58 established care with pain psychology (59.2%; 95% confidence interval [CI]: 49% to 69%), whereas of 52 patients who had not previously seen mental health services, 16 established care with pain psychology (30.8%; 95% CI: 18% to 43%) (odds ratio [OR] 3.26; 95% CI: 1.60 to 6.66). In the patient subset with depression and/or anxiety, of 82 patients who had previously seen mental health services, 47 established care with pain psychology (57.3%; 95% CI: 47% to 68%), whereas of 20 patients who had not previously seen mental health services, three established care with pain psychology (15%; 95% CI: -1% to 31%) (OR 7.61; 95% CI: 2.07 to 28.01). Of 96 patients referred for general pain psychology evaluations, 43 established care (45%; 95% CI: 35% to 55%), whereas of 38 patients referred for preprocedural evaluation for an implantable device, 24 established care (63%; 95% CI: 48% to 78%). CONCLUSION Patients are significantly more likely to establish care with pain psychology if they have previously seen a mental health professional. This was even more marked among the patient subset with a history of depression and/or anxiety who had engaged in mental health services than among those with a history of depression and/or anxiety who had not engaged in mental health services. Whether referral was for general psychological evaluation or preprocedural evaluation for an implantable device did not significantly influence whether patients established care. Targeted interventions are needed to improve the likelihood of patients engaging with pain psychology services.
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Affiliation(s)
- Ronit Y Lyon
- Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
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12
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French O, Mattacola E. How has the COVID-19 pandemic affected patients' experience of pain management therapy? Br J Pain 2023; 17:46-57. [PMID: 36820057 PMCID: PMC9703013 DOI: 10.1177/20494637221121703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The current service evaluation aimed to explore the impact of COVID-19 on patients' experiences of pain management therapy. The study examined the barriers and benefits of the move from face-to-face to eHealth methods of delivery. Design A service evaluation was conducted in an outpatient pain clinic in an NHS Trust in the East of England. A qualitative approach was taken using semi-structured interviews. Methods Participants were recruited through a health psychology service operating as part of a multidisciplinary pain management clinic. Six patients, aged 39-67, were interviewed one-to-one using the online platform ZoomTM. During COVID-19, participants had individual or group pain management therapy via telephone or video conferencing. All interviews were transcribed using Otter.aiTM and thematic analysis was performed. The study was approved by internal clinical governance for service evaluations and the authors adhered to the BPS Code of Human Research Ethics. Results Three key themes emerged from the analysis; Benefits Aside From Pain Relief, Limited Their Experience, and COVID- 19: A D ouble-Edged Sword. Conclusion Findings suggested patients were able to benefit from pain management therapy despite the impact of COVID-19 on daily routines and pain experience. Adopting eHealth methods during the pandemic was an effective means of accessing pain management therapy. These methods allowed patients to continue to benefit from peer support and learn about skills and resources regarding self-management, whilst also improving accessibility for those with chronic pain. Yet, these methods are not without their limitations. Technical issues and difficulties creating therapeutic connections with psychologists limited patients' experience of pain management therapy.
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Affiliation(s)
- Olivia French
- School of Psychology, University of Buckingham, Buckingham, UK
- Olivia French, School of Psychology, University of Buckingham, Hunter Street, Buckingham MK18 1EG, UK.
| | - Emily Mattacola
- School of Psychology, University of Buckingham, Buckingham, UK
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13
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Pester BD, Tankha H, Caño A, Tong S, Grekin E, Bruinsma J, Gootee J, Lumley MA. Facing Pain Together: A Randomized Controlled Trial of the Effects of Facebook Support Groups on Adults With Chronic Pain. THE JOURNAL OF PAIN 2022; 23:2121-2134. [PMID: 36096353 DOI: 10.1016/j.jpain.2022.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
Despite the popularity and affordances of social media groups for people with chronic conditions, there have been few controlled tests of the effects of these groups. This randomized controlled superiority trial examined the effects of Facebook groups on pain-related outcomes and tested whether a professional-led group leads to greater effects than a support group alone. We randomly assigned 119 adults with chronic pain to one of two Facebook group conditions: a standard condition (n = 60) in which participants were instructed to offer mutual support, or a professional-led condition (n = 59) in which the investigators disseminated empirically-supported, socially-oriented psychological interventions. Four groups were run (2 standard, 2 professional-led), each lasting 4 weeks and containing approximately 30 participants. Measures were administered at baseline, post-intervention, and 1-month follow-up. Across conditions, participants improved significantly in primary outcomes (pain severity and interference; medium-large effects) and a secondary outcome (depressive symptoms; small-medium effect), and they retained their outcomes 1 month after the groups ended. The 2 conditions did not differ on improvements. Overall, this study supports the use of social media groups as an additional tool to improve chronic pain-related outcomes. Our findings suggest that professional intervention may not have added value in these groups and that peer support alone may be driving improvements. Alternatively, the psychosocial intervention components used in the current study might have been ineffective, or more therapist direction may be warranted. Future research should examine when and how such guidance could enhance outcomes. PERSPECTIVE: Findings from this randomized trial support the use of both standard and professional-led Facebook groups as an accessible tool to enhance the lives of adults with chronic pain. This article provides direction for how to improve social media groups to optimize outcomes and satisfaction for more users.
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Affiliation(s)
- Bethany D Pester
- Department of Psychology, Wayne State University, Detroit, Michigan.
| | - Hallie Tankha
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Annmarie Caño
- College of Arts and Sciences, Gonzaga University, Spokane, Washington
| | - Stephanie Tong
- Department of Communication, Wayne State University, Detroit, Michigan
| | - Emily Grekin
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Julian Bruinsma
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Jordan Gootee
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
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14
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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15
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Valentijn PP, Tymchenko L, Jacobson T, Kromann J, Biermann CW, AlMoslemany MA, Arends RY. Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37869. [PMID: 36066943 PMCID: PMC9490534 DOI: 10.2196/37869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Digital health solutions can provide populations with musculoskeletal pain with high-reach, low-cost, easily accessible, and scalable patient education and self-management interventions that meet the time and resource restrictions. Objective The main objective of this study was to determine the effectiveness of digital health interventions for people with musculoskeletal pain conditions (ie, low back pain, neck pain, shoulder pain, knee pain, elbow pain, ankle pain, and whiplash). Methods A systematic review and meta-analysis was conducted. We searched PubMed and Cochrane Central Register of Controlled Trials (from 1974 to August 2021) and selected randomized controlled trials of digital health interventions in the target population of patients with musculoskeletal pain with a minimum follow-up of 1 month. A total of 2 researchers independently screened and extracted the data. Results A total of 56 eligible studies were included covering 9359 participants, with a mean follow-up of 25 (SD 15.48) weeks. In moderate-quality evidence, digital health interventions had a small effect on pain (standardized mean difference [SMD] 0.19, 95% CI 0.06-0.32), disability (SMD 0.14, 95% CI 0.03-0.25), quality of life (SMD 0.22, 95% CI 0.07-0.36), emotional functioning (SMD 0.24, 95% CI 0.12-0.35), and self-management (SMD 0.14, 95% CI 0.05-0.24). Conclusions Moderate-quality evidence supports the conclusion that digital health interventions are effective in reducing pain and improving functioning and self-management of musculoskeletal pain conditions. Low-quality evidence indicates that digital health interventions can improve the quality of life and global treatment. Little research has been conducted on the influence of digital health on expenses, knowledge, overall improvement, range of motion, muscle strength, and implementation fidelity. Trial Registration PROSPERO CRD42022307504; https://tinyurl.com/2cd25hus
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Affiliation(s)
- Pim Peter Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands
| | | | | | | | | | - Rosa Ymkje Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,University of Applied Sciences Utrecht, Utrecht, Netherlands
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16
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Stoppok P, Teufel M, Jahre L, Rometsch C, Müßgens D, Bingel U, Skoda EM, Bäuerle A. Determining the Influencing Factors on Acceptance of eHealth Pain Management Interventions Among Patients With Chronic Pain Using the Unified Theory of Acceptance and Use of Technology: Cross-sectional Study. JMIR Form Res 2022; 6:e37682. [PMID: 35976199 PMCID: PMC9434396 DOI: 10.2196/37682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Chronic pain is a complex disease with high prevalence rates, and many individuals who are affected do not receive adequate treatment. As a complement to conventional therapies, eHealth interventions could provide many benefits to a multimodal treatment approach for patients with chronic pain, whereby future use is associated with the acceptance of these interventions. Objective This study aims to assess the acceptance of eHealth pain management interventions among patients with chronic pain and identify the influencing factors on acceptance. A further objective of the study is to evaluate the viability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and compare it with its extended version in terms of explained variance of acceptance. Methods We performed a cross-sectional web-based study. In total, 307 participants with chronic pain, as defined according to the International Association for the Study of Pain criteria, were recruited through flyers, posters, and web-based inquiries between December 2020 and July 2021. In addition to sociodemographic and medical data, the assessment included validated psychometric instruments and an extended version of the well-established UTAUT model. For statistical analyses, group comparisons and multiple hierarchical regression analyses were performed. Results The acceptance of eHealth pain management interventions among patients with chronic pain was overall moderate to high (mean 3.67, SD 0.89). There was significant difference in acceptance among age groups (W=9674.0; r=0.156; P=.04). Effort expectancy (β=.37; P<.001), performance expectancy (β=.33; P<.001), and social influence (β=.34; P<.001) proved to be the most important predictors of acceptance. The extended UTAUT (including the original UTAUT factors as well as sociodemographic, medical, and eHealth-related factors) model explained 66.4% of the variance in acceptance, thus supporting the viability of the model. Compared with the original UTAUT model (performance expectancy, effort expectancy, and social influence), the extended model explained significantly more variance (F25,278=1.74; P=.02). Conclusions Given the association between acceptance and future use, the knowledge of the influencing factors on acceptance should be used in the development and promotion of eHealth pain management interventions. Overall, the acceptance of eHealth pain management interventions was moderate to high. In total, 8 predictors proved to be significant predictors of acceptance. The UTAUT model is a valuable instrument for determining acceptance as well as the factors that influence acceptance of eHealth pain management interventions among patients with chronic pain. The extended UTAUT model provided the greatest predictive value for acceptance.
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Affiliation(s)
- Paula Stoppok
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Caroline Rometsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Diana Müßgens
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
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17
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García-Perea E, Pedraz-Marcos A, Martínez-Rodríguez SH, Otones-Reyes P, Palmar-Santos AM. Effectiveness of a Fibromyalgia Online Nursing Consultation in the Quality of Life: A Randomized Controlled Trial. Pain Manag Nurs 2022; 23:478-485. [PMID: 34654636 DOI: 10.1016/j.pmn.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aim: To evaluate the effectiveness of an online nursing consultation through the Internet platform Red Sinapsis (RS) in improving the perceived quality of life of patients with fibromyalgia (FM). METHOD Eighty patients with FM were randomized to an intervention group (n = 40) or control group (n= 40). The intervention group (IG) was monitored by a nursing specialist through the online platform RS while the control group (CG) received standard follow-up at the clinic. The Fibromyalgia Impact Questionnaire (FIQ) and 36-item Short-Form Health Survey (SF-36) were used at baseline, 6-month, and 12-month follow-up. RESULTS The IG showed a 65% improvement in the perception of their general state of health at 12 months into the study, compared with an improvement of 5.6% in the CG (p < .001). The IG also achieved better results for emotional status, with a maintained improvement throughout the study of more than 2 points in the anxiety variable (from 7.64 to 5.36), that remained constant in the CG. The depression variable also showed constant improvement over the 12 months of the study in the IG, rising from an average of 7.72 (standard deviation [SD] = 2.05) to 5.33 (SD = 1.65), while in the CG a slight deterioration was observed. In both cases, the difference in mood evolution was significant (p < .001). CONCLUSIONS Online nursing follow-up for people with fibromyalgia improves patients' perceived quality of life related to their welfare and emotional state. Fibromyalgia (FM) is among the diseases causing the highest rate of occupational disability in Spain. Fibromyalgia (FM) is a complex condition that causes pain, fatigue, non-refreshed sleep, mood disturbance and cognitive impairment.
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Affiliation(s)
- Eva García-Perea
- Department of Nursing, School of Medicine, University Autonoma of Madrid, Spain
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Nielsen SS, Skou ST, Larsen AE, Bricca A, Søndergaard J, Christensen JR. The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis. Occup Ther Int 2022; 2022:7082159. [PMID: 35814357 PMCID: PMC9208937 DOI: 10.1155/2022/7082159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthy lifestyle is important to decrease health risks in individuals living with chronic pain. From an occupational therapy perspective, human health and lifestyle are linked to occupational engagement in meaningful everyday activities. This study is aimed at investigating the effect of including occupational engagement in chronic pain interventions on lifestyle. Methods In this systematic review (PROSPERO reg. CRD42020159279), we included randomized controlled trials (RCTs) on interventions involving occupational engagement (i.e., occupational performance based on involvement, choice, positive meaning, and commitment) and assessing modifiable lifestyle factors: physical activity, body anthropometrics, alcohol consumption, smoking, stress, and sleep. We sought the databases Ovid MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Scopus, Web of Science, OTseeker, ClinicalTrials.gov, OpenGrey, and the web engine Google Scholar and citations and references of relevant publications. We evaluated methodological quality with the Cochrane risk-of-bias tool 2.0, determined the overall evidence certainty using the GRADE methodology, and performed meta-analysis when two or more trials reported on the outcomes. Results Of the 9526 items identified, 286 were full text screened. We included twelve articles with eleven RCTs comprising 995 adults and assessing physical activity, sleep quality, stress, and Body Mass Index. Sufficient data for meta-analysis was only available for physical activity and sleep quality. The meta-analysis suggested a moderate increase in physical activity after behavioral interventions for fibromyalgia and musculoskeletal pain (SMD = 0.69 (0.29; 1.09)) and a small increase in sleep quality up to 6 months after multidisciplinary self-management of fibromyalgia (SMD = 0.35 (95% CI 0.08; 0.61)). The overall certainty of the evidence was deemed low. Conclusion Including occupational engagement in chronic pain interventions may increase short-term physical activity and long-term sleep quality. Due to the few available RCTs including occupational engagement in chronic pain treatment for adults living with chronic pain, further high-quality RCTs are needed and will likely change the conclusion.
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Affiliation(s)
- Svetlana Solgaard Nielsen
- Research Unit for User Perspectives, Department of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Faelledvej 2C, 4200 Slagelse, Denmark
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Faelledvej 2C, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anette Enemark Larsen
- Department of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Faelledvej 2C, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9A, 5000 Odense C, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit for User Perspectives, Department of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9B, 5000 Odense C, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsloews Vej 9A, 5000 Odense C, Denmark
- Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol Suppl 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease‐specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD‐specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3‐item Likert‐scale adapted from a previous disease stress measure and a 10‐item Likert‐scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health‐related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self‐defined vaso‐occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three‐item and 10‐item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6‐month stress for the 10‐item scale. Cronbach's alpha was high for both the 3‐item (0.73) and 10‐item (0.83) SCD stress scales, test–retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary‐measured healthcare utilization over 6 months. The correlations with the 3‐item scale were stronger, but only statistically significant for depression‐anxiety. The correlation between the two stress scales was 0.59. Both the 3‐item and the 10‐item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test–retest reliability. Further scale validation should determine population norms and response to interventions.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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20
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Implementation of Online Behavior Modification Techniques in the Management of Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071806. [PMID: 35407414 PMCID: PMC8999801 DOI: 10.3390/jcm11071806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The main aim of this systematic review and meta-analysis (MA) was to assess the effectiveness of online behavior modification techniques (e-BMT) in the management of chronic musculoskeletal pain. Methods: We conducted a search of Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioral Collections, from inception to the 30 August 2021. The main outcome measures were pain intensity, pain interference, kinesiophobia, pain catastrophizing and self-efficacy. The statistical analysis was conducted using RStudio software. To compare the outcomes reported by the studies, we calculated the standardized mean difference (SMD) over time and the corresponding 95% confidence interval (CI) for the continuous variables. Results: Regarding pain intensity (vs. usual care/waiting list), we found a statistically significant trivial effect size in favor of e-BMT (n = 5337; SMD = −0.17; 95% CI −0.26, −0.09). With regard to pain intensity (vs. in-person BMT) we found a statistically significant small effect size in favor of in-person BMT (n = 486; SMD = 0.21; 95%CI 0.15, 0.27). With respect to pain interference (vs. usual care/waiting list) a statistically significant small effect size of e-BMT was found (n = 1642; SMD = −0.24; 95%CI −0.44, −0.05). Finally, the same results were found in kinesiophobia, catastrophizing, and self-efficacy (vs. usual care/waiting list) where we found a statistically significant small effect size in favor of e-BMT. Conclusions: e-BMT seems to be an effective option for the management of patients with musculoskeletal conditions although it does not appear superior to in-person BMT in terms of improving pain intensity.
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21
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Effectiveness of Telematic Behavioral Techniques to Manage Anxiety, Stress and Depressive Symptoms in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063231. [PMID: 35328917 PMCID: PMC8951553 DOI: 10.3390/ijerph19063231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 01/07/2023]
Abstract
Anxiety, depressive symptoms and stress have a significant influence on chronic musculoskeletal pain. Behavioral modification techniques have proven to be effective to manage these variables; however, the COVID-19 pandemic has highlighted the need for an alternative to face-to-face treatment. We conducted a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioural Collections. The aim was to assess the effectiveness of telematic behavioral modification techniques (e-BMT) on psychological variables in patients with chronic musculoskeletal pain through a systematic review with meta-analysis. We used a conventional pairwise meta-analysis and a random-effects model. We calculated the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Forty-one randomized controlled trials were included, with a total of 5018 participants. We found a statistically significant small effect size in favor of e-BMT in depressive symptoms (n = 3531; SMD = -0.35; 95% CI -0.46, -0.24) and anxiety (n = 2578; SMD = -0.32; 95% CI -0.42, -0.21) with low to moderate strength of evidence. However, there was no statistically significant effect on stress symptoms with moderate strength of evidence. In conclusion, e-BMT is an effective option for the management of anxiety and depressive symptoms in patients with chronic musculoskeletal pain. However, it does not seem effective to improve stress symptoms.
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22
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De Groef A, Hallemans A, Gebruers N, Meirte J, Saeys W, Truijen S, Haenen V, Johnson C, Meert L, Peeters L, Fransen E, Meeus M, Durnez L. The impact of COVID-19 lockdown on the general health status of people with chronic health conditions in Belgium: a cross-sectional survey study. Physiother Theory Pract 2022; 39:1189-1204. [DOI: 10.1080/09593985.2022.2036278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Edema Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Jill Meirte
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
- Oscare, Organisation for Burns, Scar After-care and Research, Merksem Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
- Rehabilitation Hospital Revarte, Edegem Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
| | - Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
| | - Lotte Meert
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (Pim)
| | - Lies Peeters
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (Pim)
| | - Lies Durnez
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Antwerp, Belgium
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23
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Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Pain 2022; 163:e1041-e1053. [PMID: 35121696 DOI: 10.1097/j.pain.0000000000002606] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study examined the efficacy of Internet-delivered cognitive and behavioural interventions for adults with chronic pain, and explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, and CENTRAL and CINAHL were searched to identify randomised controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% CI 0.21, 0.35), depression (g = 0.43; 95% CI 0.33, 0.54), anxiety (g = 0.32; 95% CI 0.24, 0.40), pain intensity (g = 0.27; 95% CI 0.21, 0.33), self-efficacy (g = 0.39; 95% CI 0.27, 0.52) and pain catastrophizing (g = 0.31; 95% CI 0.22, 0.39). Moderator analyses found interventions which involved clinician guidance had significantly greater effect sizes for interference/disability (g = 0.38), anxiety (g = 0.39), and pain intensity (g = 0.33) compared to those without (g = 0.16, g = 0.18; g = 0.20, respectively). Studies using an inactive control had greater effects for depression (g = 0.46) compared to active control trials (g = 0.22). No differences were found between treatments based on traditional Cognitive Behaviour Therapy versus Acceptance and Commitment Therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.Prospectively registered on OSF Registries (citation: osf.io/cvq3j/).
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White V, Linardon J, Stone JE, Holmes-Truscott E, Olive L, Mikocka-Walus A, Hendrieckx C, Evans S, Speight J. Online psychological interventions to reduce symptoms of depression, anxiety, and general distress in those with chronic health conditions: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2022; 52:548-573. [PMID: 32674747 DOI: 10.1017/s0033291720002251] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. METHOD We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. RESULTS In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22-0.39), anxiety g = 0.19 (95% CI 0.12-0.27), and distress g = 0.36 (95% CI 0.23-0.49). CONCLUSION Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
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Affiliation(s)
- V White
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Linardon
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria3168, Australia
| | - E Holmes-Truscott
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - L Olive
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - A Mikocka-Walus
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - C Hendrieckx
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - S Evans
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Speight
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
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25
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Kelly M, Fullen B, Martin D, McMahon S, McVeigh JG. eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther 2022; 102:6506314. [PMID: 35079826 PMCID: PMC8994513 DOI: 10.1093/ptj/pzab307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. METHODS Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer. RESULTS After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%). CONCLUSIONS There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. IMPACT This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland,Department of Physiotherapy, Mercy University Hospital, Cork, Ireland,Address all correspondence to Marie Kelly at:
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom,NIHR Applied Research Collaborative, North East and North Cumbria, United Kingdom
| | - Sinéad McMahon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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26
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O’Reilly PM, Harney OM, Hogan MJ, Mitchell C, McGuire BE, Slattery B. Chronic pain self-management in middle-aged and older adults: A collective intelligence approach to identifying barriers and user needs in eHealth interventions. Digit Health 2022; 8:20552076221105484. [PMID: 35694121 PMCID: PMC9185015 DOI: 10.1177/20552076221105484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives eHealth refers to health services and health information delivered or
enhanced through the internet and related technologies. The number of
eHealth interventions for chronic pain self-management is increasing.
However, little evidence has been found for the overall efficacy of these
interventions for older adults. The aim of the current study was to use a
Collective Intelligence approach to identify the barriers and specific user
needs of middle-aged and older adults using eHealth for chronic pain
self-management. Methods A Collective Intelligence workshop was conducted with middle-aged and older
adults to generate, clarify, select, and structure ideas in relation to
barriers to eHealth use and specific design requirements for the purposes of
chronic pain self-management. Prior to attending the workshop, participants
received a trigger question requesting the identification of five barriers
to eHealth use for chronic pain self-management. These barriers were
categorised and presented to the group along with barrier-related scenarios
and user need prompts, resulting in the generation of a set of ranked
barriers and a set of user needs. Results A total of 78 barriers were identified, from which six categories emerged:
Content, Support, Technological, Personal, Computer Literacy and
Accessibility. Additional idea-writing and group reflection in response to
these barriers revealed 97 user needs. Conclusion This is the first study to use Collective Intelligence methods to investigate
barriers to eHealth technology use and the specific user needs of
middle-aged and older adults in the context of chronic pain self-management.
The results of the current study provide a platform for the design and
development of enhanced eHealth interventions for this population.
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Affiliation(s)
- Paul M O’Reilly
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Owen M Harney
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Michael J Hogan
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Caroline Mitchell
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian Slattery
- School of Psychology, Dublin City University, Dublin, Ireland
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27
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Khalili-Mahani N, Holowka E, Woods S, Khaled R, Roy M, Lashley M, Glatard T, Timm-Bottos J, Dahan A, Niesters M, Hovey RB, Simon B, Kirmayer LJ. Play the Pain: A Digital Strategy for Play-Oriented Research and Action. Front Psychiatry 2021; 12:746477. [PMID: 34975566 PMCID: PMC8714795 DOI: 10.3389/fpsyt.2021.746477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.
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Affiliation(s)
- Najmeh Khalili-Mahani
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Eileen Holowka
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | | | - Rilla Khaled
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Myrna Lashley
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Tristan Glatard
- Department of Computer Science, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Janis Timm-Bottos
- Department of Creative Art Therapies, Concordia University, Montreal, QC, Canada
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | | | - Bart Simon
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
- Department of Sociology, Concordia University, Montreal, QC, Canada
| | - Laurence J. Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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Janevic M, Robinson-Lane SG, Murphy SL, Courser R, Piette JD. A Pilot Study of a Chronic Pain Self-Management Program Delivered by Community Health Workers to Underserved African American Older Adults. PAIN MEDICINE 2021; 23:1965-1978. [PMID: 33779759 PMCID: PMC9714529 DOI: 10.1093/pm/pnaa468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE African American older adults living in disadvantaged communities are disproportionately burdened by disabling pain. To address their needs, we tested the feasibility and potential effects of a cognitive-behavioral chronic pain self-management program delivered by community health workers. DESIGN A single-group, pre-post evaluation of the STEPS-2 (Seniors using Technology to Engage in Pain Self-management) intervention, in which participants learned pain-management skills through web-based videos. They were also given wearable activity trackers to facilitate incremental increases in walking. In weekly telephone calls, community health workers helped participants apply skills and set goals. SUBJECTS/SETTING Thirty-one adults in Detroit, Michigan (97% African American, 97% female, mean 68.7 years), with chronic musculoskeletal pain. METHODS Participants completed telephone surveys at baseline and eight weeks. We measured changes in PROMIS pain interference and pain intensity, as well as Patient Global Impression of Change in pain and functioning. Feasibility indicators included participant engagement and satisfaction, and fidelity to session protocols by community health workers. RESULTS Participants on average completed 6.6/7 sessions, and 100% agreed or strongly agreed that they improved their understanding of pain management. Average community health worker fidelity score was 1.79 (0 to 2 scale). Pain interference decreased from baseline to post-program (T-score 61.6 to 57.3, P=.000), as did pain intensity (0 to 10 scale, 6.3 to 5.1, P=.004). Approximately 90% of participants reported that pain and function were at least "a little better" since baseline. CONCLUSIONS An intervention combining mobile health tools with support from community health workers holds promise for improving pain outcomes among underserved older adults.
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Affiliation(s)
- Mary Janevic
- Correspondence to: Mary Janevic, PhD, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. Tel: 734 647 3194; Fax: 763-7379; E-mail:
| | - Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Susan L Murphy
- Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Courser
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - John D Piette
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA,VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
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Palfai TP, Kratzer MPL, Morone NE, Bernstein JA. Integrating patient perspectives in the development of a mobile health intervention to address chronic pain and heavy drinking in primary care: a qualitative study of patients in an urban, safety-net hospital setting. Addict Sci Clin Pract 2021; 16:20. [PMID: 33757584 PMCID: PMC7988929 DOI: 10.1186/s13722-021-00230-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic pain and heavy drinking are conditions that commonly co-occur among primary care patients. Despite the availability of behavioral interventions that target these conditions individually, engagement and adherence to treatment remain a challenge, and there have been no interventions designed to address both of these conditions together for patients presenting to primary care. This study seeks to incorporate the perspectives of patients regarding symptoms, treatment experiences, views on behavior change, and technology use to develop a tailored, integrated mobile health intervention that addresses both pain and heavy drinking among patients in primary care. Methods Twelve participants with moderate or greater chronic pain intensity and heavy drinking were recruited from primary care clinics in a large urban safety-net hospital. One-on-one interviews were recorded and transcribed. Codes were developed from interview transcripts, followed by thematic analysis in which specific meanings were assigned to codes. Participants also completed a series of Likert-based rating scales to evaluate components of the proposed intervention to supplement qualitative interviews. Results A number of themes were identified that had implications for intervention tailoring including: ambivalence about changing drinking, low expectations about pain treatment success, desire for contact with a designated provider, common use of smartphones but lack of familiarity with functions as a potential barrier to use, and strategies to maintain engagement and adherence. Evaluative ratings indicated that the proposed intervention content was perceived as helpful and the proposed structure, layout and design of the mobile intervention was acceptable to patients. Conclusions Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is an acceptable method of addressing chronic pain and heavy drinking among patients in primary care. The interviews highlight the need to utilize an intervention approach that addresses motivation to change drinking, sets realistic expectations for change, provides careful attention to training/education of the use of technology components, and fosters engagement through the use of reminders, feedback, and personalized activities.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA.
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA
| | - Natalia E Morone
- Department of Medicine, Section of Internal Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Judith A Bernstein
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, 4th Floor, Boston, MA, 02118, USA
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Chen T, Or CK, Chen J. Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc 2021; 28:414-423. [PMID: 33236109 PMCID: PMC7883981 DOI: 10.1093/jamia/ocaa282] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted. RESULTS Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits. CONCLUSIONS Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Winhusen T, Wilson M, Dolor RJ, Theobald J, Lewis D, Regan SL, Vonder Meulen MB. Design considerations for a remote randomized multi-site clinical trial evaluating an e-health self-management program for chronic pain patients receiving opioid therapy. Contemp Clin Trials 2021; 101:106245. [PMID: 33309947 PMCID: PMC7954981 DOI: 10.1016/j.cct.2020.106245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Abstract
Based on the adverse consequences and inadequate evidence of effectiveness for long-term opioid therapy (LOT), the CDC developed recommendations to decrease the use of LOT and morphine equivalent dose (MED) for patients receiving LOT. However, the majority of these patients report that opioid medication is significantly beneficial for pain management and are hesitant to reduce/decrease its use. Compounding the problem is poor access to non-pharmacologic therapies for many patients due to insurance reimbursement structures and limited pain-service availability. EMPOWER is an intent-to-treat, two-arm, open-label, randomized controlled trial evaluating a web-based self-management chronic pain program (E-Health) that has been found to reduce self-reported MED, while also decreasing pain, in two randomized controlled trials. Approximately 400 chronic pain patients receiving LOT at a daily average prescribed MED ≥ 20 mg at one of two U.S. healthcare systems, located in North Carolina and Ohio, will be randomized in a 1:1 ratio to treatment as usual (TAU) or TAU plus E-Health (E-Health+). TAU consists of LOT from a prescribing clinician. E-Health+ participants are provided with a 4-month E-Health subscription (active treatment phase). All participants will complete web-based self-report measures at baseline, the end of the active treatment phase, and 6-months post-active treatment. Opioid prescription information will be collected from the participants' electronic health record (EHR) from baseline through 6 months post-active treatment. This paper describes design considerations for this unique trial which is conducted completely remotely, with no in-person visits, and utilizes the EHR for participant identification and primary outcome collection.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Marian Wilson
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd., Spokane, WA 99202, USA
| | - Rowena J Dolor
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3(rd) floor, Durham, NC 27701, USA
| | - Jeff Theobald
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Daniel Lewis
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Saundra L Regan
- Department of Family & Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Mary Beth Vonder Meulen
- Department of Family & Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
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Design and conduct of confirmatory chronic pain clinical trials. Pain Rep 2020; 6:e845. [PMID: 33511323 PMCID: PMC7837951 DOI: 10.1097/pr9.0000000000000854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022] Open
Abstract
The purpose of this article is to provide readers with a basis for understanding the emerging science of clinical trials and to provide a set of practical, evidence-based suggestions for designing and executing confirmatory clinical trials in a manner that minimizes measurement error. The most important step in creating a mindset of quality clinical research is to abandon the antiquated concept that clinical trials are a method for capturing data from clinical practice and shifting to a concept of the clinical trial as a measurement system, consisting of an interconnected set of processes, each of which must be in calibration for the trial to generate an accurate and reliable estimate of the efficacy (and safety) of a given treatment. The status quo of inaccurate, unreliable, and protracted clinical trials is unacceptable and unsustainable. This article gathers aspects of study design and conduct under a single broad umbrella of techniques available to improve the accuracy and reliability of confirmatory clinical trials across traditional domain boundaries.
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Colorafi K, Thomas A, Wilson M, Corbett CF. Perspectives of Aging Adults Who Frequently Seek Emergency Department Care. Pain Manag Nurs 2020; 22:184-190. [PMID: 33317936 DOI: 10.1016/j.pmn.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/14/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of people managing chronic conditions is growing with the rapidly aging population. Visits to the emergency department are steadily rising, but little is known about the rationale of those seeking emergent care. AIMS The goal of this study was to better understand, from the patients' perspective, the reasons for seeking care in an emergency department setting. DESIGN A qualitative descriptive design was used to interview aging adults with at least two chronic conditions who made three or more visits to the emergency department within a year. PARTICIPANTS/SUBJECTS The eight-person sample was 88% female and 75% white, with an average age of 54 years. METHODS Participant interviews were conducted with a semistructured interview guide. Conventional content analysis was used to examine words and phrases in professionally transcribed documents. Qualitative methods for testing and confirming conclusions were performed. RESULTS We discovered that aging adults visit the emergency department to seek relief from unrelenting pain and to overcome barriers to receiving treatment for pain in ambulatory settings. Participants reported feeling judged when seeking emergency department care for pain management. CONCLUSIONS Participants described emergency department care as the only option in response to several barriers to healthcare access. Most commonly, emergency department care was sought when relief from persistent or acute pain was required. One way to reduce strain on EDs from pain-related visits is to manage patients with persistent pain more proactively in their community environment.
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Affiliation(s)
- Karen Colorafi
- School of Nursing and Human Physiology, Gonzaga University, Spokane, Washington; College of Nursing, Washington State University, Spokane, Washington.
| | - Amy Thomas
- College of Nursing, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington
| | - Cynthia F Corbett
- College of Nursing, Washington State University, Spokane, Washington; College of Nursing, University of South Carolina, Columbia, South Carolina
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Perlini C, Donisi V, Del Piccolo L. From research to clinical practice: a systematic review of the implementation of psychological interventions for chronic headache in adults. BMC Health Serv Res 2020; 20:459. [PMID: 32450871 PMCID: PMC7247180 DOI: 10.1186/s12913-020-05172-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychological interventions have been proved to be effective in chronic headache (CH) in adults. Nevertheless, no data exist about their actual implementation into standard clinical settings. We aimed at critically depicting the current application of psychological interventions for CH into standard care exploring barriers and facilitators to their implementation. Secondarily, main outcomes of the most recent psychological interventions for CH in adults have been summarized. METHODS We conducted a systematic review through PubMed and PsycINFO in the time range 2008-2018. A quality analysis according to the QATSDD tool and a narrative synthesis were performed. We integrated results by: contacting the corresponding author of each paper; exploring the website of the clinical centers cited in the papers. RESULTS Of the 938 identified studies, 28 papers were selected, whose quality largely varied with an average %QATSDD quality score of 64.88%. Interventions included CBT (42.85%), multi-disciplinary treatments (22.43%), relaxation training (17.86%), biofeedback (7.14%), or other interventions (10.72%). Treatments duration (1 day-9 months) and intensity varied, with a prevalence of individual-basis implementation. The majority of the studies focused on all primary headaches; 4 studies focused on medication-overuse headache. Most of the studies suggest interventions as effective, with the reduction in frequency of attacks as the most reported outcome (46.43%). Studies were distributed in different countries, with a prevalent and balanced distribution in USA and Europe. Ten researches (35.71%) were performed in academic contexts, 11 (39.28%) in clinical settings, 7 (25%) in pain/headache centres. Interventions providers were professionals with certified experience. Most of the studies were funded with private or public funding. Two contacted authors answered to our e-mail survey, with only one intervention implemented in the routine clinical practice. Only in three out of the 16 available websites a reference to the implementation into the clinical setting was reported. CONCLUSION Analysis of contextual barriers/facilitators and cost-effectiveness should be included in future studies, and contents regarding dissemination/implementation of interventions should be incorporated in the professional training of clinical scientists. This can help in filling the gap between the existing published research and treatments actually offered to people with CH.
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Affiliation(s)
- Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness of an electronic pain management programme for the working population with chronic pain: study protocol for a randomized controlled trial. Trials 2020; 21:421. [PMID: 32448387 PMCID: PMC7245757 DOI: 10.1186/s13063-020-04348-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background Chronic pain is highly prevalent in the working population. People tend to attempt self-initiated treatments to manage their pain. The self-efficacy of behavioural change is a suitable model for guiding the development of an electronic pain management programme (ePain). The aim in this study is to develop ePain and to evaluate its effectiveness at improving pain self-efficacy, reducing pain intensity and negative emotions, and increasing quality of life. Methods This study will be a randomized controlled trial. ePain will take the form of a 6-week online pain management programme. Participants will be aged 15 years or above, have chronic pain, and be employed. They must complete the baseline questionnaire and will be randomized into intervention and control groups. They will receive notifications to encourage their participation in ePain and complete the evaluation questionnaires. They will complete the process evaluation at week 3, the post assessment at week 6, and the follow-up assessment at week 12. The study will focus on pain self-efficacy; pain situations; negative emotions including levels of depression, anxiety, and stress; and quality of life. The participants’ opinions of ePain will be collected as feedback. Data will be analysed on an intention-to-treat basis and generalized estimating equations will be used to investigate the time-averaged difference and differences at each follow-up time. Discussion The study will provide information about the pain situations of online users in the working population. The participants will benefit from improvements in pain self-efficacy, pain situations, emotional status, and quality of life. The study will illustrate whether online learning is an effective intervention for improving the pain self-efficacy of the working population. Trial registration ClinicalTrials.gov, NCT03718702. Registered on 23 October 2018.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, BN1 9PH, UK
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Tankha H, Caño A, Corley A, Dillaway H, Lumley MA, Clark S. A Novel Couple-Based Intervention for Chronic Pain and Relationship Distress: A Pilot Study. COUPLE & FAMILY PSYCHOLOGY 2020; 9:13-32. [PMID: 34017649 PMCID: PMC8132556 DOI: 10.1037/cfp0000131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic pain contributes to psychological and relationship distress in individuals with pain as well as their partners. Prior pain interventions have addressed this important social context by engaging partners in treatment; however, partners have not been considered co-participants who can benefit directly from therapy, but rather incorporated as pain management coaches or guides. This manuscript assesses the feasibility, acceptability, and preliminary outcomes of a novel intervention which targets both partners and focuses on improving well-being in couples in which one or both partners experiences chronic pain and relationship distress. Fifteen couples participated in Mindful Living and Relating, a 6-session in-person intervention, and completed baseline and post-treatment outcome measures. Both quantitative and qualitative methods were used to evaluate participants' engagement in and experiences of the intervention, as well as preliminary outcomes. Results suggest that couples were engaged in, and reported satisfaction with, the treatment. Participants who completed the therapy (N = 28; 14 couples) reported reductions in depressive symptoms and improvements in relationship satisfaction and partner responsiveness, and individuals with pain reported reductions in pain interference. In post-treatment interviews, couples reported their preference for couple therapy over individual therapy for pain and relationship distress. Although the conduct of the therapy was feasible for couples who enrolled in the trial, initial recruitment difficulties suggested feasibility challenges. Recommendations are made for researchers who are interested in designing psychological interventions to improve quality of life in the context of chronic illness.
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Affiliation(s)
- Hallie Tankha
- Wayne State University, Department of Psychology 5057 Woodward Avenue, Detroit, Michigan, 48202, USA
| | - Annmarie Caño
- Wayne State University, Department of Psychology and Office of the Provost, 656 W. Kirby, 4228 FAB, Detroit, Michigan, 48202, USA
| | - Angelia Corley
- Wayne State University, Department of Psychology 5057 Woodward Avenue, Detroit, Michigan, 48202, USA
| | - Heather Dillaway
- Wayne State University, Department of Sociology, 2237 Faculty Administration Building, Detroit, Michigan, 48202, USA
| | - Mark A. Lumley
- Wayne State University, Department of Psychology 5057 Woodward Avenue, Detroit, Michigan, 48202, USA
| | - Shannon Clark
- Wayne State University, Department of Psychology 5057 Woodward Avenue, Detroit, Michigan, 48202, USA
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Li Y, Tse MYM. An Online Pain Education Program for Working Adults: Pilot Randomized Controlled Trial. J Med Internet Res 2020; 22:e15071. [PMID: 31934865 PMCID: PMC6996734 DOI: 10.2196/15071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/01/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pain is a common public health concern, and the pain situation among the general population is serious in mainland China. Working adults commonly experience pain because of long sitting times, a lack of free time, and exercise. A lack of pain-related knowledge is also a significant factor. Educational and therapeutic programs delivered online were used more often in Western countries, and accessible programs in China are limited, especially for pain management. Therefore, we carried out an online pain education program for working adults to self-manage pain. The program was delivered through WeChat, a popular and secure social media with a large population base in China. Objective This study aimed to (1) provide pain-related knowledge and self-relief strategies, (2) help participants reduce pain and improve pain-related emotional well-being, and (3) explore participants’ learning performance and the acceptability of the online pain education program. Methods This was a randomized controlled trial. Chinese adults aged between 16 and 60 years with full-time employment, with pain in the past 6 months, and without any mental illness were recruited using snowball sampling through the internet and were randomly allocated to an experimental group and a control group in 1:1 ratio after the baseline assessment. The 4-week educational program that included basic knowledge of pain, pharmacological and nonpharmacological treatments, and related resources was provided only to the experimental group. Outcomes of pain, depression, anxiety, stress, and pain self-efficacy were measured at baseline (T0), posttreatment (T1), and 1-month follow-up (T2). Participants’ acceptability and satisfaction were explored after completing the educational program. Results In total, 95 eligible participants joined in the program: 47 in the experimental group and 48 in the control group. Neck and shoulder, head, and back were most commonly reported pain sites with high pain scores. Pain intensity and interference of the experimental group were significantly reduced after the educational program. Depression, anxiety, and stress clinically improved and pain self-efficacy improved after the educational program. The difference in depression, anxiety, stress, and pain self-efficacy within a group or between groups was not statistically significant; however, clinical improvements were demonstrated. A significant correlation between dosage of the intervention and pain intensity and depression was demonstrated. After completing the educational program, more than half of the participants showed acceptance of and satisfaction with the program, and they were willing to recommend the program to others. Conclusions Our findings highlight the significant potential of this online education program in the treatment of pain. Trial Registration ClinicalTrials.gov NCT03952910; https://clinicaltrials.gov/ct2/show/NCT03952910
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Affiliation(s)
- Yajie Li
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Mun Yee Mimi Tse
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Vilardaga R, Davies PS, Vowles KE, Sullivan MD. Theoretical Grounds of Pain Tracker Self Manager: An Acceptance and Commitment Therapy Digital Intervention for Patients with Chronic Pain. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 15:172-180. [PMID: 32269915 PMCID: PMC7141572 DOI: 10.1016/j.jcbs.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the theoretical basis and design of a novel digital Acceptance and Commitment Therapy (ACT) intervention for people with chronic pain, the Pain Tracker Self Manager (PTSM), which had promising efficacy in a recent pilot trial. METHODS Content development by a multidisciplinary panel of experts in psychiatry, clinical psychology, nursing and social work, with feedback from a group of patients with chronic pain and their providers. Materials included paper-based sketching of a story character, visual metaphors, and a series of stories designed to deliver the theory-based components of our behavioral intervention. RESULTS This development and design process resulted in 4 digitally delivered clinical modules that combine visual and verbal cues. In addition, it generated a series of novel ACT metaphors specifically tailored to patients with chronic pain: Pain: Injury vs. Threat, Life Navigation System, The Fog of Pain, and Get Rhythm. Consistent with ACT theory and the contextual behavioral science framework, PTSM utilized: perspective-taking, values clarification, acceptance strategies, and nursing and psychological care recommendations. DISCUSSION Reports of the design and theoretical basis of digital health interventions are highly needed to increase the rigor of their development process and more progressively advance our body of knowledge. This pilot study developed and tested a series of ACT metaphors that can be readily used by ACT clinicians working with this population. CONCLUSION PTSM is a novel digital ACT intervention for patients with chronic pain with features directly linked to ACT processes and theory.
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Affiliation(s)
| | | | - Kevin E. Vowles
- School of Psychology, Queen’s University Belfast, Northern Island, UK
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Moman RN, Hooten WM. The Major Barrier Facing Patients and Clinicians Who Are Interested in Utilization of Electronic and Mobile Health Technologies. PAIN MEDICINE 2019; 21:e243-e246. [DOI: 10.1093/pm/pnz273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine
| | - W Michael Hooten
- Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Devan H, Perry MA, van Hattem A, Thurlow G, Shepherd S, Muchemwa C, Grainger R. Do pain management websites foster self-management support for people with persistent pain? A scoping review. PATIENT EDUCATION AND COUNSELING 2019; 102:1590-1601. [PMID: 30981410 DOI: 10.1016/j.pec.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/10/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality. METHODS Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification. RESULTS Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites. CONCLUSIONS The review identified 27 contemporary pain management websites that could be used for self-management skills training. PRACTICE IMPLICATIONS Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Greg Thurlow
- School of Physiotherapy, University of Otago, New Zealand
| | - Sam Shepherd
- School of Physiotherapy, University of Otago, New Zealand
| | - Carol Muchemwa
- School of Physiotherapy, University of Otago, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Moman RN, Dvorkin J, Pollard EM, Wanderman R, Murad MH, Warner DO, Hooten WM. A Systematic Review and Meta-analysis of Unguided Electronic and Mobile Health Technologies for Chronic Pain—Is It Time to Start Prescribing Electronic Health Applications? PAIN MEDICINE 2019; 20:2238-2255. [DOI: 10.1093/pm/pnz164] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Electronic (eHealth) and mobile (mHealth) technologies may be a useful adjunct to clinicians treating patients with chronic pain. The primary aim of this study was to investigate the effects of eHealth and mHealth interventions that do not require clinician contact or feedback on pain-related outcomes recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines in adults with chronic pain.
Methods
We searched four databases and included English language randomized controlled trials of ambulatory adults with chronic pain from January, 1 2000, to January 31, 2018, with interventions that are independent of clinician contact or feedback. In the meta-analysis, outcomes were assessed at short- (three months or less), intermediate- (four to six months), and long-term (seven or more months) follow-up.
Results
Seventeen randomized controlled trials (N = 2,496) were included in the meta-analysis. Both eHealth and mHealth interventions had a significant effect on pain intensity at short- and intermediate-term follow-up. Similarly, a significant but small effect was observed for depression at short- and intermediate-term follow-up and self-efficacy at short-term follow-up. Finally, a significant effect was observed for pain catastrophizing at short-term follow-up.
Conclusions
eHealth and mHealth interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the IMMPACT guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy.
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Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jodie Dvorkin
- Institute for Clinical Systems Improvement, Minneapolis, Minnesota
| | - E Morgan Pollard
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robalee Wanderman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Guidry JPD, Benotsch EG. Pinning to Cope: Using Pinterest for Chronic Pain Management. HEALTH EDUCATION & BEHAVIOR 2019; 46:700-709. [DOI: 10.1177/1090198118824399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic pain is an increasing public health concern, with an associated poor quality of life. Social media platforms play an increasing role in health communication issues, but visual platforms such as Pinterest are understudied. This study analyzed 502 Pinterest posts for chronic pain–related variables, including health belief model constructs, as well as measures of social support and coping mechanisms. Most pins mentioned the high severity of chronic pain, and a third mentioned self-efficacy related to self-care, while almost 50% referred to cues to action related to self-care. This study positions Pinterest as a social media platform with the potential to both transfer knowledge and provide social support for patients with chronic pain. Health care and public health practitioners should consider participating in these conversations as well as providing quality information to ensure that reputably sourced information is available.
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Slattery BW, Haugh S, O'Connor L, Francis K, Dwyer CP, O'Higgins S, Egan J, McGuire BE. An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network Meta-Analysis. J Med Internet Res 2019; 21:e11086. [PMID: 31317869 PMCID: PMC6668295 DOI: 10.2196/11086] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. OBJECTIVE The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. METHODS Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. RESULTS The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43% chance that mobile apps delivered the most effective interventions, followed by a 34% chance that interventions delivered via virtual reality were the most effective. CONCLUSIONS This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge.
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Affiliation(s)
- Brian W Slattery
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.,Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Stephanie Haugh
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Laura O'Connor
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Kady Francis
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Christopher P Dwyer
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Siobhán O'Higgins
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Jonathan Egan
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Ireland
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De Baets S, Calders P, Verhoost L, Coussens M, Dewandele I, Malfait F, Vanderstraeten G, Van Hove G, Van de Velde D. Patient perspectives on employment participation in the "hypermobile Ehlers-Danlos syndrome". Disabil Rehabil 2019; 43:668-677. [PMID: 31287330 DOI: 10.1080/09638288.2019.1636316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND "Ehlers-Danlos syndrome" (EDS) is a heritable connective disorder influencing multiple aspects of daily life. Most studies have focused on describing the physical symptoms and level of disability, but little knowledge exists about the psychosocial effects of the pathology. Participation in employment is an aspect that strongly influences quality of life of patients with chronic pathologies. This study, therefore, aimed to explore the lived experiences in employment participation of patients diagnosed with "hypermobile EDS". METHODS An inductive thematic analysis, using semi-structured interviews was used. Nine patients, purposively selected by a continuum sampling strategy, were included. Interviews were audio-recorded and transcribed verbatim. RESULTS Data analysis resulted in three main themes: (1) elements assisting participation in employment, (2) limitations in employment participation, and (3) unemployment due to the "hypermobile EDS". On the one hand, the results show that related health complaints can impede employment participation to an important extent. On the other hand, patients also report several aspects of work that can affect their well-being in a positive way. CONCLUSION There are specific reasons for a person with "hypermobile EDS" to participate in employment. These reasons are different for each person and may even vary in time.Implications for rehabilitation"Hypermobile EDS" greatly impacts activities and participation in daily life. "Living with limitations" is the central theme in the lives of "Hypermobile EDS" patients.Various aspects influence work participation in people with "Hypermobile EDS", such as work pressure, tasks, and transport to work.Work has positive effects in the lives of people with "Hypermobile EDS."Work can create difficulties when the job requirements and tasks do not match the functional abilities of a person with "Hypermobile EDS."
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Affiliation(s)
- Stijn De Baets
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Verhoost
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marieke Coussens
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Inge Dewandele
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Fransiska Malfait
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Geert Van Hove
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Campbell EA, Hynynen J, Burger B, Ala-Ruona E. Exploring the use of Vibroacoustic treatment for managing chronic pain and comorbid mood disorders: A mixed methods study. NORDIC JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1080/08098131.2019.1604565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Elsa A. Campbell
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
- VIBRAC Skille-Lehikoinen Centre for Vibroacoustic Therapy and Research, Eino Roiha Foundation, University of Jyväskylä, Finland
| | - Jouko Hynynen
- Seinäjoki Central Hospital, South Ostrobothnia Healthcare District, Seinäjoki, Finland
| | - Birgitta Burger
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
| | - Esa Ala-Ruona
- Finnish Centre for Interdisciplinary Music Research, Department of Music, Art and Culture Studies, University of Jyväskylä, Jyvaskyla, Finland
- VIBRAC Skille-Lehikoinen Centre for Vibroacoustic Therapy and Research, Eino Roiha Foundation, University of Jyväskylä, Finland
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Okifuji A, Neikrug A. Update and future perspective of behavioral medicine in the treatment for chronic pain. Pain Manag 2019; 9:161-173. [PMID: 30785366 DOI: 10.2217/pmt-2017-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chronic pain is a biopsychosocial condition, and behavioral medicine has made significant contributions to the understanding of the phenomenon and optimization of therapeutic outcomes. The objective of this article is to provide future perspectives of behavioral medicine in pain management based upon recent development in the field. We will briefly review the mainstream approach of cognitive-behavioral therapy, its variations and new and innovative approaches that are on the horizon. We also review strategies that address potential barriers to pain management. Behavioral medicine is a promising field in pain medicine. The future growth is likely to come from addressing how we incorporate the patient heterogeneity into our treatment approaches and a better understanding of its role in a multimodal treatment.
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Affiliation(s)
- Akiko Okifuji
- Department of Anesthesiology, Division of Pain Medicine, University of Utah, Salt Lake City, UT, USA 84108
| | - Ariel Neikrug
- Department of Psychiatry, University of California Irvine, CA 92868, USA 92868
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Devan H, Farmery D, Peebles L, Grainger R. Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e13080. [PMID: 30747715 PMCID: PMC6390192 DOI: 10.2196/13080] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Background Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality. Methods A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Devin Farmery
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Smartphone-Based Remote Self-Management of Chronic Low Back Pain: A Preliminary Study. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:4632946. [PMID: 30881606 PMCID: PMC6381588 DOI: 10.1155/2019/4632946] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/19/2017] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Objective To assess the additional effect of self-management on physiotherapy via the use of APPS on management of chronic low back pain. Method A single-blinded randomized control trial was conducted. 8 participants (male: 4; female: 4) were recruited from the Rehabilitation Clinic of The Hong Kong Polytechnic University. Participants in the treatment group received self-management plus physiotherapy and the control group received physiotherapy only. Assessment was carried out pretreatment, midterm (week 2), and posttreatment (week 4), including Visual Analog Scale (VAS), Pain Self-Efficacy Questionnaire (PSEQ), Roland Morris Disability Questionnaire (RMDQ), and SF36. Results Compared with the physiotherapy group, the self-management plus physiotherapy group had significance in PSEQ (p=0.035), RMDQ (p=0.035), SF36-Bodily Pain (p=0.008), and SF36-Mental Health (p=0.013). VAS showed a positive trend although there was no significant difference. Conclusion This pilot study indicated that smartphone APPS-based self-management program appears to bring additional benefits to physiotherapy for patients with CLBP. Self-management is a potential approach for people with CLBP.
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Guarino H, Fong C, Marsch LA, Acosta MC, Syckes C, Moore SK, Cruciani RA, Portenoy RK, Turk DC, Rosenblum A. Web-Based Cognitive Behavior Therapy for Chronic Pain Patients with Aberrant Drug-Related Behavior: Outcomes from a Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:2423-2437. [PMID: 29346579 PMCID: PMC6294413 DOI: 10.1093/pm/pnx334] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective There is high unmet need for effective behavioral treatments for chronic pain patients at risk for or with demonstrated histories of opioid misuse. Despite growing evidence supporting technology-based delivery of self-management interventions for chronic pain, very few such programs target co-occurring chronic pain and aberrant drug-related behavior. This randomized controlled trial evaluated the effectiveness of a novel, web-based self-management intervention, grounded in cognitive behavior therapy, for chronic pain patients with aberrant drug-related behavior. Methods Opioid-treated chronic pain patients at a specialty pain practice who screened positive for aberrant drug-related behavior (N = 110) were randomized to receive treatment as usual plus the web-based program or treatment as usual alone. The primary outcomes of pain severity, pain interference, and aberrant drug-related behavior, and the secondary outcomes of pain catastrophizing and pain-related emergency department visits, were assessed during the 12-week intervention and at one and three months postintervention. Results Patients assigned to use the web-based program reported significantly greater reductions in aberrant drug-related behavior, pain catastrophizing, and pain-related emergency department visits-but not pain severity or pain interference-relative to those assigned to treatment as usual. The positive outcomes were observed during the 12-week intervention and for three months postintervention. Conclusions A web-based self-management program, when delivered in conjunction with standard specialty pain treatment, was effective in reducing chronic pain patients' aberrant drug-related behavior, pain catastrophizing, and emergency department visits for pain. Technology-based self-management tools may be a promising therapeutic approach for the vulnerable group of chronic pain patients who have problems managing their opioid medication.
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Affiliation(s)
- Honoria Guarino
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Chunki Fong
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Michelle C Acosta
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Cassandra Syckes
- National Development and Research Institutes (NDRI), Inc., New York, New York
- U.S. Sentencing Commission, Washington, DC
| | | | - Ricardo A Cruciani
- Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Rosenblum
- National Development and Research Institutes (NDRI), Inc., New York, New York
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50
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Wilson M, Finlay M, Orr M, Barbosa-Leiker C, Sherazi N, Roberts MLA, Layton M, Roll JM. Engagement in online pain self-management improves pain in adults on medication-assisted behavioral treatment for opioid use disorders. Addict Behav 2018; 86:130-137. [PMID: 29731244 DOI: 10.1016/j.addbeh.2018.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Persistent pain has been recognized as an important motivator that can lead individuals to misuse opioids. New approaches are needed to test pain treatments that can improve outcomes for people with persistent pain in medication-assisted behavioral treatment for opioid use disorder. This study piloted an online pain self-management program to explore acceptability and treatment effects. METHODS A sample of 60 adults diagnosed with chronic non-cancer pain and receiving medication-assisted behavioral treatment at one of two clinics were randomized into either treatment group with access to an online pain management program or waitlist attention control. Participants received online surveys via email at baseline and post-treatment at week 8. RESULTS The majority of participants (n = 44; 73%) reported that their first use of opioids was in response to a painful event. Those who engaged in the online program had significantly lower pain interference, pain severity, opioid misuse measures, and depressive symptoms after eight weeks while pain self-efficacy was increased. CONCLUSION Our results suggest the online pain self-management program content may be helpful for managing physical and emotional symptoms experienced by individuals with co-occurring pain and opioid use disorders. To improve online engagement, more support is necessary to assist with technology access and completion of online activities.
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