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Solberg Nes L, Børøsund E, Varsi C, Eide H, Waxenberg LB, Weiss KE, Morrison EJ, Støle HS, Kristjansdottir ÓB, Bostrøm K, Strand EB, Hagen MCS, Stubhaug A, Schreurs KM. Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO. Pain Rep 2024; 9:e1174. [PMID: 38962688 PMCID: PMC11221858 DOI: 10.1097/pr9.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Chronic pain affects a wide range of physical and psychological aspects of life for those impacted. Psychosocial treatment approaches may be of support, but outreach is still limited. Objectives To evaluate the efficacy of EPIO, an evidence-informed, user-centered digital self-management intervention for people with chronic pain, in a 12-month randomized controlled trial. Methods People living with chronic pain (N = 266) were randomized to the EPIO intervention (n = 132) or a usual-care control group (n = 134). The intervention was delivered in a simple blended care model, and outcome measures collected at baseline, 6 months, and 12 months. Generalized linear models for repeated measures were fitted to compare groups over time. Results Participants were primarily female (81%), median age 49 years (range 22-78), with heterogeneous pain conditions, and had lived with pain >5 years (77.6%). A mixed linear model with all timepoints included revealed no statistically significant group differences for the primary outcome of pain interference. Significant psychological benefits in favor of the intervention group were however detected for depression (P = 0.022), self-regulatory fatigue (P = 0.024), vitality (P = 0.016), and mental health (P = 0.047). Baseline to 12-month changes showed additional favorable effects for anxiety (between-group mean differences [MDs] = 0.79, P = 0.047), depression (MD = 1.08, P = 0.004), self-regulatory fatigue (MD = 2.42, P = 0.021), pain catastrophizing (MD = 2.62, P = 0.009), and health-related quality of life. Conclusions The EPIO program aims to improve outreach of evidence-based pain self-management interventions. Findings demonstrate how using EPIO can lead to sustainable psychological change, enhancing mental health and health-related quality of life for people suffering from pain, providing a chance to live well with the pain.
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Affiliation(s)
- Lise Solberg Nes
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Elin Børøsund
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Cecilie Varsi
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lori B. Waxenberg
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Karen E. Weiss
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Eleshia J. Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Hanne Stavenes Støle
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Ólöf B. Kristjansdottir
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Mental Health Team West, Primary Care of the Capital Area, Reykjavik, Iceland
| | - Katrine Bostrøm
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
| | - Elin Bolle Strand
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Institute of Health, Faculty of Health Science, VID—Scientific University, Oslo, Norway
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Karlein M.G. Schreurs
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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2
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Nielsen SS, Skou ST, Larsen AE, Polianskis R, Arendt-Nielsen L, Østergaard AS, Kjær-Staal Petersen K, Vægter HB, Søndergaard J, Christensen JR. Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain. Scand J Pain 2024; 24:sjpain-2023-0043. [PMID: 38037749 DOI: 10.1515/sjpain-2023-0043] [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: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention. METHODS This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status. RESULTS Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity. CONCLUSIONS This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.
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Affiliation(s)
- Svetlana Solgaard Nielsen
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anette Enemark Larsen
- Department of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Romanas Polianskis
- Multidisciplinary Pain Centre, Department of Anesthesiology, Naestved Hospital, Naestved, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Skov Østergaard
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Bjarke Vægter
- Pain Research Group/Pain Centre, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- User Perspectives, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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3
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Al-Arfaj SK, Abdallah AF, Abdulla FA. Psychometric properties of an Arabic translation of the chronic pain acceptance questionnaire (CPAQ) in a sample of patients with chronic pain. Disabil Rehabil 2023:1-12. [PMID: 38100318 DOI: 10.1080/09638288.2023.2293987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Chronic pain (CP) acceptance is a major factor in determining the well-being of patients with chronic pain. The chronic pain acceptance questionnaire (CPAQ) was translated and validated into Arabic (CPAQ-Ar). METHODS 244 patients with CP completed the CPAQ-Ar, the Beck Depression Inventory-II (BDI-II), the short form health survey (SF-36), the Pain Catastrophizing Scale (PCS), the Pittsburgh Sleep Quality Index (PSQI), the Modified Fatigue Impact Scale (MFIS), and the Depression Anxiety Stress Scale 21 (DASS-21). 110 patients completed the CPAQ-Ar twice separated by two weeks to investigate test-retest reliability. RESULTS Cronbach's α was 0.902 while the intraclass correlation coefficient (ICC) was 0.917. The standard error measurement (SEM) was seven points while the minimal detectable change with 95% confidence interval (MDC95) was seventeen points. The CPAQ-Ar showed moderate to high correlations with the PCS, the BDI-II, the SF-36, the MFIS, the PSQI, and the DASS-21 indicating a good concurrent validity. Exploratory factor analysis confirmed that the CPAQ-Ar consists of two subscales. Better pain acceptance associated with male gender, older people, employed participants, low pain intensity, and single pain site. CONCLUSIONS The CPAQ-Ar is a valid and reliable tool for the measurement of pain acceptance in Arabic speaking patients with CP.
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Affiliation(s)
- Safiah K Al-Arfaj
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Fuad A Abdulla
- Department of physical therapy, Faculty of Allied Medical Sciences, Philadelphia University, Amman, Jordan
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4
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Bostrøm K, Børøsund E, Eide H, Varsi C, Kristjansdottir ÓB, Schreurs KMG, Waxenberg LB, Weiss KE, Morrison EJ, Stavenes Støle H, Cvancarova Småstuen M, Stubhaug A, Solberg Nes L. Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial. J Med Internet Res 2023; 25:e47284. [PMID: 37624622 PMCID: PMC10492177 DOI: 10.2196/47284] [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: 03/14/2023] [Revised: 04/23/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Chronic pain conditions involve numerous physical and psychological challenges, and while psychosocial self-management interventions can be of benefit for people living with chronic pain, such in-person treatment is not always accessible. Digital self-management approaches could improve this disparity, potentially bolstering outreach and providing easy, relatively low-cost access to pain self-management interventions. OBJECTIVE This randomized controlled trial aimed to evaluate the short-term efficacy of EPIO (ie, inspired by the Greek goddess for the soothing of pain, Epione), a digital self-management intervention, for people living with chronic pain. METHODS Patients (N=266) were randomly assigned to either the EPIO intervention (n=132) or a care-as-usual control group (n=134). Outcome measures included pain interference (Brief Pain Inventory; primary outcome measure), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue 18 scale), health-related quality of life (SF-36 Short Form Health Survey), pain catastrophizing (Pain Catastrophizing Scale), and pain acceptance (Chronic Pain Acceptance Questionnaire). Linear regression models used change scores as the dependent variables. RESULTS The participants were primarily female (210/259, 81.1%), with a median age of 49 (range 22-78) years and a variety of pain conditions. Analyses (n=229) after 3 months revealed no statistically significant changes for the primary outcome of pain interference (P=.84), but significant reductions in the secondary outcomes of depression (mean difference -0.90; P=.03) and self-regulatory fatigue (mean difference -2.76; P=.008) in favor of the intervention group. No other statistically significant changes were observed at 3 months (all P>.05). Participants described EPIO as useful (ie, totally agree or agree; 95/109, 87.2%) and easy to use (101/109, 92.7%), with easily understandable exercises (106/109, 97.2%). CONCLUSIONS Evidence-informed, user-centered digital pain self-management interventions such as EPIO may have the potential to effectively support self-management and improve psychological functioning in the form of reduced symptoms of depression and improved capacity to regulate thoughts, feelings, and behavior for people living with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.
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Affiliation(s)
- Katrine Bostrøm
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ólöf Birna Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Mental Health Team West, Primary Care of the Capital area, Reykjavik, Iceland
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Karen E Weiss
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Hanne Stavenes Støle
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
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5
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Simoncsics E, Konkolý Thege B, Stauder A. Pain acceptance and illness intrusiveness in low-back pain: A longitudinal study. Front Psychiatry 2022; 13:925251. [PMID: 36032245 PMCID: PMC9412953 DOI: 10.3389/fpsyt.2022.925251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In chronic pain syndromes, acceptance of pain may be a better approach than pain control. So far, little data have been available on how pain and its acceptance affect illness intrusiveness among patients with low-back pain (LBP). OBJECTIVE The present longitudinal study evaluates the impact of pain acceptance on illness intrusiveness in patients with LBP. METHODS Study participants were asked to complete the following questionnaires during their visit (T1) at one of four diverse rheumatologic outpatient clinics, and then 2-3 months later (T2) via phone or online: Chronic Pain Acceptance Questionnaire (CPAQ), Illness Intrusiveness Rating Scale (IIRS), Roland-Morris Disability Questionnaire (RMDQ), Patient Health Questionnaire Depression subscale (PHQ9), and socioeconomic data. RESULTS One hundred and twenty-seven individuals completed the questionnaires at baseline (31 having acute, 15 subacute and 81 chronic low back pain) and 97 at follow-up. Illness intrusiveness was negatively correlated with chronic pain acceptance both at T1 (r = -0.39) and T2 (r = -0.44). Illness intrusiveness scores have not changed significantly from T1 (M = 28.59 SD = 13.08) to T2 (M = 28.24, SD = 15.76). In a multiple regression model-including pain intensity, functional status, pain acceptance, depression severity, age, sex and educational level-the independent predictors of follow-up illness intrusiveness scores were lower pain acceptance and higher depression scores. CONCLUSIONS In our study, patients with acute, subacute and chronic low back pain reported similar levels of illness intrusiveness. In addition, illness intrusiveness scores have not changed significantly during the 2-month follow-up period and pain acceptance proved to be a significant independent predictor of illness intrusiveness among patients with chronic low-back pain.
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Affiliation(s)
- Eszter Simoncsics
- Doctoral School of Semmelweis University, Budapest, Hungary.,Mission Medical Center, Veresegyház, Hungary
| | - Barna Konkolý Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Adrienne Stauder
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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6
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Tangen SF, Helvik AS, Eide H, Fors EA. Pain acceptance and its impact on function and symptoms in fibromyalgia. Scand J Pain 2021; 20:727-736. [PMID: 32759409 DOI: 10.1515/sjpain-2020-0049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 12/30/2022]
Abstract
Objectives Fibromyalgia is a chronic widespread pain (CWP) syndrome of unknown etiology with substantial burden of illness and functional impairment. Pain acceptance has emerged as an interesting target of therapy in chronic pain populations, but few studies have yet been done on the effect of pain acceptance on patients with fibromyalgia. The aim of the present study was to examine the relationship between pain acceptance and its impact on function and symptoms in fibromyalgia with both a cross-sectional and longitudinal design. Methods Three hundred and sixty five participants aged 22-70 with fibromyalgia were recruited from the Norwegian Fibromyalgia Association (NFA). They filled out a questionnaire containing the Fibromyalgia Impact Questionnaire (FIQ), measurement of function and symptoms, and Chronic Pain Acceptance Questionnaire (CPAQ), measurement of pain acceptance, in addition to sociodemographic and clinical variables such as degree of fibromyalgia, depression and pain duration (T1 measures). One year after, 87 of the participants filled out the FIQ and clinical measures once again (T2 measures). Unadjusted and adjusted linear regression analyses were performed both for cross-sectional measures at T1 and for longitudinal measures from T1 to T2, with FIQ score as the outcome variable and CPAQ score at T1 as one of the main independent variables. Results Higher CPAQ score was significantly associated with a lower FIQ score at T1, also when adjusting for age, education, work, depression and Fibromyalgianess Score (p<0.01). Lower FIQ score indicate less impact of fibromyalgia on functioning. In addition, two adjusted linear regression models found higher pain acceptance (CPAQ score) at T1 to be associated with lower negative impact of fibromyalgia on function and symptoms (FIQ score) at T2 (p<0.01). Conclusions Higher pain acceptance is associated with better functional level and less symptoms in fibromyalgia, both cross-sectionally and when measurements are separated in time. Further research should include experimental studies with acceptance-based interventions for this patient group.
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Affiliation(s)
- Synne Flatlandsmo Tangen
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne-Sofie Helvik
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Egil A Fors
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, General Practitioner Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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7
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Bostrøm K, Børøsund E, Varsi C, Eide H, Flakk Nordang E, Schreurs KM, Waxenberg LB, Weiss KE, Morrison EJ, Cvancarova Småstuen M, Stubhaug A, Solberg Nes L. Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study. JMIR Form Res 2020; 4:e23893. [PMID: 33094734 PMCID: PMC7647816 DOI: 10.2196/23893] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients' daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. OBJECTIVE This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. METHODS The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior-based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. RESULTS Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, "totally agree" or "agree"; 39/45, 87%) and easy to use (42/45, 93%), and as having easily understandable exercises (44/45, 98%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). CONCLUSIONS Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. TRIAL REGISTRATION ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.
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Affiliation(s)
- Katrine Bostrøm
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elise Flakk Nordang
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Karlein Mg Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
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8
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Sánchez-Rodríguez E, de la Vega R, Racine M, Roy R, Jensen MP, Miró J. Support for the Spanish version of the CPAQ-8 as a measure of chronic pain acceptance. J Eval Clin Pract 2019; 25:881-888. [PMID: 30592117 DOI: 10.1111/jep.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/30/2022]
Abstract
AIM AND OBJECTIVE To provide evidence regarding the psychometric properties of the Spanish eight-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8). METHOD Three hundred adults with chronic pain completed measures of pain acceptance, committed action, fear of movement, anxiety, depression, and health-related quality of life. A confirmatory factor analysis (CFA) of the CPAQ-8 was performed. Reliability and validity were also evaluated. RESULTS The CFA confirmed a two-factor structure. The CPAQ-8 Total and subscale scores showed acceptable-to-good internal consistency. Furthermore, the Total and the Activity Engagement scale scores showed moderate associations with Committed Action scores, supporting construct validity. Both the Total and the two subscale scores showed good criterion validity. CONCLUSION The findings provide further support for the reliability and validity of the Spanish version of the CPAQ-8 Total and subscale scores.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Rocío de la Vega
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mélanie Racine
- Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Rubén Roy
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
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Akmaz HE, Uyar M, Kuzeyli Yıldırım Y, Akın Korhan E. Validity and Reliability of the Turkish Chronic Pain Acceptance Questionnaire. Balkan Med J 2018; 35:238-244. [PMID: 29843496 PMCID: PMC5981120 DOI: 10.4274/balkanmedj.2016.1998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pain acceptance is the process of giving up the struggle with pain and learning to live a worthwhile life despite it. In assessing patients with chronic pain in Turkey, making a diagnosis and tracking the effectiveness of treatment is done with scales that have been translated into Turkish. However, there is as yet no valid and reliable scale in Turkish to assess the acceptance of pain. Aims: To validate a Turkish version of the Chronic Pain Acceptance Questionnaire developed by McCracken and colleagues. Study Design: Methodological and cross sectional study. Methods: A simple randomized sampling method was used in selecting the study sample. The sample was composed of 201 patients, more than 10 times the number of items examined for validity and reliability in the study, which totaled 20. A patient identification form, the Chronic Pain Acceptance Questionnaire, and the Brief Pain Inventory were used to collect data. Data were collected by face-to-face interviews. In the validity testing, the content validity index was used to evaluate linguistic equivalence, content validity, construct validity, and expert views. In reliability testing of the scale, Cronbach’s α coefficient was calculated, and item analysis and split-test reliability methods were used. Principal component analysis and varimax rotation were used in factor analysis and to examine factor structure for construct concept validity. Results: The item analysis established that the scale, all items, and item-total correlations were satisfactory. The mean total score of the scale was 21.78. The internal consistency coefficient was 0.94, and the correlation between the two halves of the scale was 0.89. Conclusion: The Chronic Pain Acceptance Questionnaire, which is intended to be used in Turkey upon confirmation of its validity and reliability, is an evaluation instrument with sufficient validity and reliability, and it can be reliably used to examine patients’ acceptance of chronic pain.
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Affiliation(s)
- Hazel Ekin Akmaz
- Clinic of Anesthesiology and Reanimation, Manisa State Hospital, Manisa, Turkey
| | - Meltem Uyar
- Department of Algology, Ege University School of Medicine, İzmir, Turkey
| | | | - Esra Akın Korhan
- Department of Nursing, İzmir Katip Çelebi University School of Health Science, İzmir, Turkey
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