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Patel KH, Chrisinger B. Effectiveness of primary care interventions in conjointly treating comorbid chronic pain and depression: a systematic review and meta-analysis. Fam Pract 2024; 41:234-245. [PMID: 37530738 DOI: 10.1093/fampra/cmad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Chronic pain and depression are highly comorbid, but the lack of consensus on the best treatment strategies puts patients at high risk of suboptimal care-coordination as well as health and social complications. Therefore, this study aims to quantitatively assesses how effective different primary care interventions have been in treating the comorbid state of chronic pain and depression. In particular, this study evaluates both short-term outcomes-based specifically on measures of chronic pain and depression during an intervention itself-and long-term outcomes or measures of pain and depression in the months after conclusion of the formal study intervention. METHODS This study is a systematic review and meta-analysis of randomised-controlled trials (RCTs) enrolling patients with concurrent chronic pain and depression. Intensity and severity of pain and depression symptoms were the primary outcomes. The main inclusion criteria were RCTs that: (i) enrolled patients diagnosed with depression and chronic pain, (ii) occurred in primary care settings, (iii) reported baseline and post-intervention outcomes for chronic pain and depression, (iv) lasted at least 8 weeks, and (v) used clinically validated outcome measures. Risk of bias was appraised with the Risk of Bias 2 tool, and GRADE guidelines were used to evaluate the quality of evidence. RESULTS Of 692 screened citations, 7 multicomponent primary care interventions tested across 891 patients were included. Meta-analyses revealed significant improvements in depression at post-intervention (SMD = 0.44, 95% CI [0.17, 0.71], P = 0.0014) and follow-up (SMD = 0.41, 95% CI [0.01, 0.81], P = 0.0448). Non-significant effects were observed for chronic pain at post-intervention (SMD = 0.27, 95% CI [-0.08, 0.61], P = 0.1287) and follow-up (SMD = 0.13, 95% CI [-0.3, 0.56], P = 0.5432). CONCLUSIONS Based on the results of the meta-analysis, primary care interventions largely yielded small to moderate positive effects for depressive symptoms and no significant effects on pain. In one study, stepped-care to be more effective in treatment of comorbid chronic pain and depression than other interventions both during the intervention and upon post-intervention follow-up. As such, depression appears more amenable to treatment than pain, but the number of published RCTs assessing both conditions is limited. More research is needed to further develop optimal treatment strategies.
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Affiliation(s)
- Krishna H Patel
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Benjamin Chrisinger
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
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Chew MT, Ilhan E, Nicholson LL, Kobayashi S, Chan C. An online pain management program for people with hypermobile Ehlers-Danlos Syndrome or hypermobility spectrum disorder: a three-staged development process. Disabil Rehabil 2024:1-11. [PMID: 38738812 DOI: 10.1080/09638288.2024.2351180] [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: 12/22/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD) are painful, chronic and multi-systemic conditions. No online pain management programs for hEDS/HSD currently exist. We aimed to develop one by exploring what people with hEDS/HSD want in such programs. MATERIALS AND METHODS A Delphi was conducted via online surveys of stakeholders: participants with hEDS/HSD and healthcare professionals (HCP). In survey 1, participants were asked if a hEDS/HSD-specific online pain management program was important, listing up to 20 topics important to know about pain. In survey 2, participants rated the importance of those topics. Consensus was set as ≥75% rating of at least "important". Using topics that reached consensus, the online program was developed. Usability testing was performed using the Systems Usability Scale (SUS). RESULTS 396 hEDS/HSD and 29 HCP completed survey 1; 151 hEDS/HSD and 12 HCP completed survey 2. 81% of hEDS/HSD and 69% of HCP rated a hEDS/HSD-specific program as at least "important". Thirty-five topics reached consensus to guide content for the HOPE program (Hypermobile Online Pain managemEnt). SUS score was 82.5, corresponding to "high acceptability". CONCLUSIONS A hEDS/HSD-specific online pain management program is important to stakeholders. Utilising a Delphi approach to incorporate stakeholder input, an evidence-informed and user appropriate program was developed.
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Affiliation(s)
- Min Tze Chew
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Emre Ilhan
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Leslie L Nicholson
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Kobayashi
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Cliffton Chan
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Mayo AL, Fung V, Hitzig SL, Gould S, Posa S, Summers deLuca L, Kayssi A. Exploring the psychosocial needs of persons with lower extremity amputation and feasibility of internet cognitive behavioural therapy: a qualitative study. Disabil Rehabil 2023; 45:4025-4034. [PMID: 36377342 DOI: 10.1080/09638288.2022.2144492] [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: 10/19/2021] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. METHODS Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). RESULTS Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. CONCLUSIONS Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content.IMPLICATIONS FOR REHABILITATIONFollowing lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression.Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population.The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.
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Affiliation(s)
- Amanda L Mayo
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vera Fung
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Gould
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Posa
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Leslie Summers deLuca
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Ahmed Kayssi
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Vascular Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Dear BF, Walker J, Karin E, Asrianti L, England J, Feliciano I, Bisby MA, Nielssen O, Kayrouz R, Cross S, Staples LG, Hadjistavropoulos HD, Titov N. Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1372-1385. [PMID: 37540210 DOI: 10.1093/pm/pnad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. METHODS The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. RESULTS Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. DISCUSSION These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.
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Affiliation(s)
- Blake F Dear
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jennie Walker
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Eyal Karin
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Lia Asrianti
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Jonathan England
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Ivy Feliciano
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Madelyne A Bisby
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Olav Nielssen
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Rony Kayrouz
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Shane Cross
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren G Staples
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Nickolai Titov
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Toonders SAJ, van der Meer HA, van Bruxvoort T, Veenhof C, Speksnijder CM. Effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders: a systematic review. Disabil Rehabil 2023; 45:3620-3638. [PMID: 36369923 DOI: 10.1080/09638288.2022.2135775] [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: 04/25/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders. MATERIALS AND METHODS Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity. RESULTS From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups. CONCLUSIONS There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. Implications for rehabilitationThis review shows that e-Health can be an effective way of reducing pain in some populations.Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain.Autonomous e-Health is more effective than no treatment in patients with chronic pain.There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.
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Affiliation(s)
- Suze A J Toonders
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Physical Therapy Research Group, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hedwig A van der Meer
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Thijs van Bruxvoort
- Product Management, Thijs van Bruxvoort, Founda B.V, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Physical Therapy Research Group, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Hohenschurz-Schmidt D, Scott W, Park C, Christopoulos G, Vogel S, Draper-Rodi J. [Remote management of musculoskeletal pain : A pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. German version]. Schmerz 2023; 37:360-371. [PMID: 35834004 PMCID: PMC9281242 DOI: 10.1007/s00482-022-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. OBJECTIVES This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. METHODS Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. RESULTS The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. CONCLUSION This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Department, Surgery and Cancer, Pain Research Group, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, 4th Floor, 369 Fulham Road, SW10 9NH, London, Großbritannien.
| | - Whitney Scott
- Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, Großbritannien
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, Großbritannien
| | - Charlie Park
- IPRS Triage and Remote Management Team, IPRS Health Limited, Little Blakenham, Suffolk, Großbritannien
| | - Georgios Christopoulos
- First Contact Practitioner, MSc Neuromusculoskeletal Care, BSc (Hons) Physiotherapy, HCPC CSP, Staffordshire, Großbritannien
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, Großbritannien
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, Großbritannien
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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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Ong AD, Wilcox KT, Moskowitz JT, Wethington E, Addington EL, Sanni MO, Kim P, Reid MC. Feasibility, Acceptability, and Preliminary Efficacy of a Positive Affect Skills Intervention for Adults With Fibromyalgia. Innov Aging 2023; 7:igad070. [PMID: 38094931 PMCID: PMC10714916 DOI: 10.1093/geroni/igad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives To examine the feasibility, acceptability, and preliminary efficacy of a positive affect skills intervention for middle-aged and older adults with fibromyalgia syndrome (FMS). Research Design and Methods Ninety-five participants with FMS aged 50 and older (94% female) were randomized to 1 of 2 conditions: (a) Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR; n = 49) or (b) emotion reporting/control (n = 46). LARKSPUR included 5 weeks of skill training that targeted 8 skills to help foster positive affect, including (a) noticing positive events, (b) savoring positive events, (c) identifying personal strengths, (d) behavioral activation to set and work toward attainable goals, (e) mindfulness, (f) positive reappraisal, (g) gratitude, and (h) acts of kindness. Outcome data were collected via online surveys at baseline, postintervention, and 1-month follow-up. Results Completion rates (88%) and satisfaction ratings (10-point scale) were high (LARKSPUR: M = 9.14, standard deviation (SD) = 1.49; control: M = 8.59, SD = 1.97). Improvements were greater in LARKSPUR participants compared with control participants on measures of positive affect (Cohen's d = 0.19 [0.15, 0.24]), negative affect (Cohen's d = -0.07 [-0.11, -0.02]), and pain catastrophizing (Cohen's d = -0.14 [-0.23, -0.05]). Improvements in positive affect (Cohen's d = 0.17 [0.13, 0.22]) and negative affect (Cohen's d = -0.11 [-0.15, -0.06]) were maintained at 1-month follow-up. Dose-response analyses indicated that intervention engagement significantly predicted pre-to-post and post-to-follow-up reductions in pain catastrophizing. Discussion and Implications The current preliminary findings add to existing literature and highlight the specific potential of internet-delivered positive affect skills programs for adults with FMS. Clinical Trial Registration NCT04869345.
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Affiliation(s)
- Anthony D Ong
- Department of Psychology, Cornell University, Ithaca, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | | | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elaine Wethington
- Department of Psychology, Cornell University, Ithaca, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mubarak O Sanni
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, USA
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Donisi V, De Lucia A, Pasini I, Gandolfi M, Schweiger V, Del Piccolo L, Perlini C. e-Health Interventions Targeting Pain-Related Psychological Variables in Fibromyalgia: A Systematic Review. Healthcare (Basel) 2023; 11:1845. [PMID: 37444679 DOI: 10.3390/healthcare11131845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium-high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) (n = 13), and the majority of them focused exclusively on adult patients with FMS (n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based (n = 19), mobile application (m-Health) (n = 3), virtual reality (VR) (n = 2), and video consulting (n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach (n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Marialuisa Gandolfi
- UOC Neurorehabilitation, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
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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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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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12
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Wu YQ, Long Y, Peng WJ, Gong C, Liu YQ, Peng XM, Zhong YB, Luo Y, Wang MY. The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e42090. [PMID: 37097721 PMCID: PMC10170363 DOI: 10.2196/42090] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Fibromyalgia is a chronic pain syndrome characterized by persistent and widespread musculoskeletal pain. Telerehabilitation is a promising treatment for patients with fibromyalgia through long-term monitoring, intervention, supervision, consultation, and education. OBJECTIVE This study aimed to perform a comprehensive systematic review and meta-analysis of the efficacy and safety of telerehabilitation in patients with fibromyalgia. METHODS Randomized controlled trials (RCTs) related to fibromyalgia and telerehabilitation were systematically searched in the PubMed, PEDro, Cochrane Library, ScienceDirect, Ovid MEDLINE, Embase, and Web of Science databases from inception to November 13, 2022. Two independent researchers screened the literatures and evaluated the methodological quality using the Cochrane Risk of Bias Tool. The outcome measures included the Fibromyalgia Impact Questionnaire scale, pain intensity, depression, pain catastrophizing, quality of life (QoL), and adverse events. Pooled effect sizes were calculated by Stata SE 15.1; a fixed effects model was used when I2<50%, whereas a random effects model was used when I2≥50%. RESULTS A total of 14 RCTs with 1242 participants were included in this meta-analysis. The pooled results indicated that the telerehabilitation improved the Fibromyalgia Impact Questionnaire score (weighted mean difference -8.32, 95% CI -11.72 to -4.91; P<.001), pain intensity (standardized mean difference [SMD] -0.62, 95% CI -0.76 to -0.47; P<.001), depression levels (SMD -0.42, 95% CI -0.62 to -0.22; P<.001), pain catastrophizing (weighted mean difference -5.81, 95% CI -9.40 to -2.23; P=.001), and QoL (SMD 0.32, 95% CI 0.18 to 0.47; P<.001) in patients with fibromyalgia compared to control interventions. Only 1 RCT reported a mild adverse event of telerehabilitation; the other 13 RCTs did not mention this. CONCLUSIONS Telerehabilitation can improve the symptoms and QoL of fibromyalgia. However, the safety of telerehabilitation remains uncertain due to the lack of sufficient evidence for the management of fibromyalgia. More rigorously designed trials are needed in the future to verify the safety and efficacy of telerehabilitation in fibromyalgia. TRIAL REGISTRATION PROSPERO CRD42022338200; https://tinyurl.com/322keukv.
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Affiliation(s)
| | - Yi Long
- Gannan Medical University, GanZhou, China
| | | | - Cheng Gong
- Gannan Medical University, GanZhou, China
| | - Yue-Quan Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | | | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, GanZhou, China
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13
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Chew MT, Chan C, Kobayashi S, Cheng HY, Wong TM, Nicholson LL. Online pain management programs for chronic, widespread musculoskeletal conditions: A systematic review with meta-analysis. Pain Pract 2023. [PMID: 37051894 DOI: 10.1111/papr.13227] [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: 09/01/2022] [Revised: 02/09/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
Face-to-face pain management programs demonstrate positive clinical outcomes in the chronic pain population by improving pain intensity and attitudes, depression, and functional disability scores. The effects of this modality carried out online is less known, particularly in subgroups of chronic pain. This systematic review assessed the effects of online pain management programs in chronic, widespread musculoskeletal conditions on pain measurements (intensity, interference, coping, and catastrophizing), health-related quality of life, depression, and anxiety scores immediately post-intervention. Five electronic databases (Embase, Medline, CINAHL, Scopus, and PEDro) were searched with 3546 studies identified. Eighteen randomized controlled trials fulfilled the inclusion criteria. Included studies had moderate methodological quality (using the Effective Public Health Practice Project (EPHPP) quality assessment tool) but high risk of bias (using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2)). There were significant improvements in pain intensity (11 studies, 1397 participants, SMD -0.30, 95% CI -0.50 to -0.10, p = 0.004), health-related quality of life (eight studies, 1054 participants, SMD 0.41, 95% CI 0.08 to 0.75, p = 0.02), and depression (nine studies, 1283 participants, SMD -0.32, 95% CI -0.55 to -0.08, p = 0.008). However, effect sizes were small and did not meet their respective measure's minimal clinically important change score. Guided interventions (regular interaction with an instructor) appeared to be superior to self-completed interventions. Future research should standardize outcome measures for assessing pain, use active control groups, and analyze other outcome measures such as cost and long-term effects. This study was registered with Prospero on August 15, 2021 (CRD42021267565).
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Affiliation(s)
- Min Tze Chew
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Cliffton Chan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Sarah Kobayashi
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Hoi Yan Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tsz Ming Wong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Leslie L Nicholson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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14
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de Rezende DRB, Neto IA, Iunes DH, Carvalho LC. Analysis of the effectiveness of remote intervention of patients affected by chronic diseases: A systematic review and meta-analysis. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231197316. [PMID: 37781504 PMCID: PMC10540568 DOI: 10.1177/27550834231197316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Objectives The aim of the study was to verify the effectiveness of telemedicine in randomized controlled trials (RCTs) in terms of its influence on physical conditioning, quality of life, and health conditions in adults/elderly people affected by chronic diseases. Design This was a systematic review and meta-analysis. Methods The search covered RCTs published from 2011 to 2021 and was conducted using the PubMed, Embase, PEDro, Lilacs, and Cochrane Library databases, on volunteers of both sexes, that were rehabilitated, and/or monitored, and/or evaluated, specifically, via remote care. The extraction, quality of studies, and risk of bias were assessed using the RoB2 (risk of bias) tool, for analysis of the strength of evidence, the GRADE (Grading of Recommendations Assessment, Developing, and Evaluation) method was used, and for the preparation of meta-analysis was used at RevMan 5.4 (Review Manager) was used. Results The database search identified 3949 potential articles for screening, 13 of which were eligible for the present systematic review, involving 1469 participants with chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, heart failure, diabetes mellitus, and fibromyalgia). Through the meta-analysis, an advantage was identified for the remote intervention on physical conditioning (p = 0.001), with an estimated effect of 0.29 (0.11, 0.46) and on health conditions (p = 0.0004), -0.30 (-0.47, -0.14), while for quality of life, no significant difference was identified (p = 0.90), 0.01 (-0.13, 0.14). Conclusion Telemedicine has clinical effectiveness for the outcome of physical conditioning and general health conditions in adults with chronic diseases when compared to usual care without face-to-face intervention.
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Affiliation(s)
| | | | - Denise Hollanda Iunes
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Leonardo César Carvalho
- Department of Postgraduate Program in Applied Health Biosciences, Federal University of Alfenas, Alfenas, Brazil
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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15
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Terpstra JA, van der Vaart R, van Beugen S, van Eersel RA, Gkika I, Erdős D, Schmidt J, Radstake C, Kloppenburg M, van Middendorp H, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Internet Interv 2022; 30:100587. [PMID: 36406977 PMCID: PMC9672957 DOI: 10.1016/j.invent.2022.100587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized. OBJECTIVE The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery. METHODS Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes. RESULTS The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills. CONCLUSIONS Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.
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Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Sylvia van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Roxy A. van Eersel
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Ioanna Gkika
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Dorottya Erdős
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Jana Schmidt
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Caroline Radstake
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands,Medical Delta, Huismansingel 4, 2629 JH Delft, the Netherlands
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16
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Ong AD, Moskowitz JT, Wethington E, Addington EL, Sanni M, Goktas S, Sluys E, Swong S, Kim P, Reid MC. Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR): Design of a randomized controlled trial to increase positive affect in middle-aged and older adults with fibromyalgia. Contemp Clin Trials 2022; 120:106880. [PMID: 35964867 PMCID: PMC9752979 DOI: 10.1016/j.cct.2022.106880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a leading cause of functional limitations and disability for which there is no cure. Positive psychological interventions for improving health have received increasing attention, but evidence of the feasibility, acceptability, and impact of such interventions in adult populations with FMS is limited. OBJECTIVES To describe the rationale and design of a 5-week, online positive affect skills intervention, LARKSPUR: Lessons in Affect Regulation to Keep Stress and Pain UndeR control. METHODS FMS participants (N = 90) will be randomized to one of two conditions: (1) LARKSPUR or (2) emotion reporting/attention control. LARKSPUR is an online multicomponent intervention that targets eight skills to help foster positive affect: (1) noticing positive events, (2) savoring positive events, (3) identifying personal strengths, (4) behavioral activation to set and work toward attainable goals, (5) mindfulness, (6) positive reappraisal, (7) gratitude, and (8) acts of kindness. The primary outcomes include feasibility (i.e., recruitment, retention, adherence) and acceptability (i.e., helpfulness, usability, satisfaction). Secondary outcomes include pain intensity and pain interference. SIGNIFICANCE If feasibility and acceptability metrics are met and reductions in pain outcomes are achieved, we will undertake future efficacy and effectiveness trials of LARKSPUR among older adults with FMS. TRIAL REGISTRATION NCT04869345.
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Affiliation(s)
- Anthony D Ong
- Department of Psychology, Cornell University, USA; Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA.
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, USA
| | - Elaine Wethington
- Department of Psychology, Cornell University, USA; Department of Sociology, Cornell University, USA; Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, USA
| | - Mubarak Sanni
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Selin Goktas
- Department of Psychology, Cornell University, USA
| | - Erica Sluys
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Sarah Swong
- Grossman School of Medicine, New York University, USA
| | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
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17
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Mehta SH, Nugent M, Peynenburg V, Thiessen D, La Posta G, Titov N, Dear BF, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: self-guided versus team-guided. J Behav Med 2022; 45:674-689. [PMID: 35921055 PMCID: PMC9362581 DOI: 10.1007/s10865-022-00346-x] [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: 10/28/2021] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Abstract
There is growing interest in offering Internet-delivered cognitive behaviour therapy (ICBT) to individuals with chronic health conditions, with this process often being guided by a single clinician. Due to lack of full time personnel, it is sometimes necessary to have multiple clinicians offer guidance or for no guidance to be offered. In this randomized trial, we compared team-guided ICBT (n = 90) to self-guided ICBT (n = 88). Participants completed measures at pre-, post-, and 3-months post-ICBT. Both groups showed similar rates of treatment completion and large improvements on depression and anxiety at post-treatment and follow-up. Unexpectedly, more participants in the self-guided versus team-guided condition showed clinically significant improvement on depression at post-treatment (76.5% vs 49.2%) and follow-up (70% vs 45.6%). Thus, team-guided ICBT may not provide significant benefits compared to self-guided ICBT. However, it may be an alternative approach to consider among a population of high risk individuals that wants or requires closer monitoring of symptoms. Trail registration TRN: NCT03500237; Date: April 18, 2018.
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Affiliation(s)
- S H Mehta
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - V Peynenburg
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - D Thiessen
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - G La Posta
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N Titov
- School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - B F Dear
- School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
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18
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Kundakci B, Kaur J, Goh SL, Hall M, Doherty M, Zhang W, Abhishek A. Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:1432-1445. [PMID: 34813518 DOI: 10.1097/j.pain.0000000000002500] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
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Affiliation(s)
- Burak Kundakci
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- cCentre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jaspreet Kaur
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Siew Li Goh
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Michelle Hall
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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19
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Marques A, Bosch P, de Thurah A, Meissner Y, Falzon L, Mukhtyar C, Bijlsma JW, Dejaco C, Stamm TA. Effectiveness of remote care interventions: a systematic review informing the 2022 EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases. RMD Open 2022; 8:rmdopen-2022-002290. [PMID: 35523520 PMCID: PMC9083395 DOI: 10.1136/rmdopen-2022-002290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Objective To perform a systematic literature review (SLR) on different outcomes of remote care compared with face-to-face (F2F) care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases (RMDs). Methods A search strategy was developed and run in Medline (PubMed), Embase and Cochrane Library. Two reviewers independently performed standardised data extraction, synthesis and risk of bias (RoB) assessment. Results A total of 2240 references were identified. Forty-seven of them fulfilled the inclusion criteria. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Of the 34 studies investigating outcomes of remote care, the majority addressed efficacy and user perception; 34% and 21% of them, respectively, reported a superiority of remote care as compared with F2F care. Time and cost savings were reported as major benefits, technical aspects as major drawback in the 13 studies that investigated drivers and barriers of remote care. No study addressed remote care implementation. The main limitation of the studies identified was the heterogeneity of outcomes and methods, as well as a substantial RoB (50% of studies with high RoB). Conclusions Remote care leads to similar or better results compared with F2F treatment concerning efficacy, safety, adherence and user perception outcomes, with the limitation of heterogeneity and considerable RoB of the available studies.
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Affiliation(s)
- Andréa Marques
- Higher School of Nursing of Coimbra Health Sciences Research Unit Nursing, Coimbra, Portugal .,Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Philipp Bosch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark.,Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | - Louise Falzon
- Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Chetan Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Johannes Wj Bijlsma
- Rheumatology, University Medical Center Utrecht Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
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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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Thurah AD, Marques A, Souza SD, Crowson CS, Myasoedova E. Future challenges in rheumatology – is telemedicine the solution? Ther Adv Musculoskelet Dis 2022; 14:1759720X221081638. [PMID: 35321119 PMCID: PMC8935581 DOI: 10.1177/1759720x221081638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8240, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Marques
- Health Sciences Research Unit: Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Savia de Souza
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Cynthia S. Crowson
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
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22
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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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23
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Hadjistavropoulos HD, Peynenburg V, Thiessen DL, Nugent M, Karin E, Staples L, Dear BF, Titov N. Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:192-206. [PMID: 33840264 PMCID: PMC8935601 DOI: 10.1177/07067437211006873] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years. METHODS Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed. RESULTS A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences. CONCLUSIONS As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.
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Affiliation(s)
| | - Vanessa Peynenburg
- Online Therapy Unit, Department of Psychology, 6846University of Regina, Saskatchewan, Canada
| | - David L Thiessen
- Department of Mathematics & Statistics, 6846University of Regina, Saskatchewan, Canada
| | - Marcie Nugent
- Online Therapy Unit, Department of Psychology, 6846University of Regina, Saskatchewan, Canada
| | - Eyal Karin
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentre Clinic, Department of Psychology, 7788Macquarie University, Sydney, Australia
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24
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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: 25] [Impact Index Per Article: 12.5] [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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25
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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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26
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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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Behavioral Health, Telemedicine, and Opportunities for Improving Access. Curr Pain Headache Rep 2022; 26:919-926. [PMID: 36418847 PMCID: PMC9684808 DOI: 10.1007/s11916-022-01096-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments. RECENT FINDINGS Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care. Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.
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28
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The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program. Pain 2021; 163:1388-1401. [PMID: 34609359 DOI: 10.1097/j.pain.0000000000002507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
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Hadjistavropoulos HD, Peynenburg V, Thiessen D, Schneider LH, Nugent M, Wilhelms A, Karin E, Titov N, Dear BF. Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic. Eur J Pain 2021; 26:390-404. [PMID: 34592026 PMCID: PMC9293405 DOI: 10.1002/ejp.1866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Internet-delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes. METHODS Patients (N = 293) were offered a previously validated 8-week Internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3 months. RESULTS There was growth in demand for an Internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-to-large improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. CONCLUSIONS This longitudinal observational study provides support for Internet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. SIGNIFICANCE This 5-year observational study provides support for Internet-delivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years. Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self-efficacy and lower pain severity were associated with greater post-treatment improvements on depression, anxiety and disability.
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Affiliation(s)
| | - Vanessa Peynenburg
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - David Thiessen
- Department of Mathematics & Statistics, University of Regina, Saskatchewan, Canada
| | - Luke H Schneider
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Andrew Wilhelms
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Eyal Karin
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Blake F Dear
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
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Terpstra JA, van der Vaart R, Ding HJ, Kloppenburg M, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review. Internet Interv 2021; 26:100444. [PMID: 34485094 PMCID: PMC8391057 DOI: 10.1016/j.invent.2021.100444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Rheumatic conditions have a large impact on both patients and society. Many patients experience adjustment problems, such as symptoms of anxiety and depression and sleep problems, contributing to high healthcare costs. Internet-based cognitive-behavioral therapy (iCBT) has shown to support patients with somatic conditions in coping with their disease, with therapist-guided iCBT usually showing larger effects than unguided iCBT. However, the specific relevance of guided iCBT for rheumatic conditions has not been reviewed yet, which could have important implications for implementation. OBJECTIVES The objective of our review was to give an overview of evaluations of guided iCBT for rheumatic conditions, including physical, psychological, and impact on daily life outcomes. METHODS This review is registered with PROSPERO with registration number CRD42020154911. The review followed PRISMA guidelines and included an assessment of risk of bias. PubMed, PsycINFO, Embase, Cochrane Library, Web of Science, and Emcare were searched until 5 October 2020. Inclusion criteria were: patients ≥18 years old with a rheumatic condition, randomized controlled trial, accessible full-text English article, original data, inclusion of psychological, and/or physical and/or impact outcomes, and therapist-guided iCBT. Study and sample characteristics, as well as clinical variables were extracted. RESULTS A systematic search identified 6089 studies, of which 8 trials were included, comprising of 1707 participants in total. Significant medium to large between-group effects were found for psychological outcomes (depression, anxiety, catastrophizing, self-efficacy) and impact on daily life outcomes (impact on daily life, quality of life), whilst results for physical outcomes (pain intensity, fatigue) were mixed. CONCLUSION Whilst more research is warranted, for instance regarding physical outcomes, cost-effectiveness, safety of the intervention, and moderators of iCBT success, our results show that guided iCBT could be an important addition to medical treatment for rheumatic conditions. Guided iCBT can improve psychological and impact on daily life outcomes in patients with rheumatic conditions, which is promising for iCBT implementation in clinical practice.
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Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Leiden University, Dpt. of Health, Medical, and Neuropsychology, PO Box 9555, 2300 RB Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - He Jie Ding
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials. PAIN MEDICINE 2021; 22:481-498. [PMID: 32989450 DOI: 10.1093/pm/pnaa331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This systematic review aimed to evaluate the effectiveness of different interventions at reducing pain-related fear in people with fibromyalgia and to analyze whether the included trials reported their interventions in full detail. DESIGN Systematic review. SETTING No restrictions. METHODS The Cochrane Library, CINAHL, EMBASE, PsycINFO, PubMed, and Scopus were searched from their inception to April 2020, along with manual searches and a gray literature search. Randomized clinical trials were included if they assessed pain-related fear constructs as the primary or secondary outcome in adults with fibromyalgia. Two reviewers independently performed the study selection, data extraction, risk-of-bias assessment, Template for Intervention Description and Replication (TIDieR) checklist assessment, and grading the quality of evidence. RESULTS Twelve randomized clinical trials satisfied the eligibility criteria, including 11 cohorts with a total sample of 1,441 participants. Exercise, multicomponent, and psychological interventions were more effective than controls were in reducing kinesiophobia. However, there were no differences in decreasing kinesiophobia when self-management and electrotherapy were used. There were also no differences between groups with regard to the rest of the interventions and pain-related constructs (fear-avoidance beliefs, fear of pain, and pain-related anxiety). However, a serious risk of bias and a very serious risk of imprecision were detected across the included trials. This caused the overall certainty of the judged evidence to be low and very low. Additionally, the included trials reported insufficient details to allow the full replication of their interventions. CONCLUSIONS This systematic review shows that there are promising interventions, such as exercise, multicomponent, and psychological therapies, that may decrease one specific type of fear in people with fibromyalgia, i.e., kinesiophobia. However, because of the low-very low certainty of the evidence found, a call for action is needed to improve the quality of randomized clinical trials, which will lead to more definitive information about the clinical efficacy of interventions in this field.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Mar Flores-Cortes
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain
| | - Jose Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.,Department of Nursing, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
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Huang L, Shen Q, Fang Q, Zheng X. Effects of Internet-Based Support Program on Parenting Outcomes for Primiparous Women: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094402. [PMID: 33919112 PMCID: PMC8122326 DOI: 10.3390/ijerph18094402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/17/2021] [Accepted: 04/18/2021] [Indexed: 12/27/2022]
Abstract
(1) Background: Some primiparous women are usually confronted with many parenting problems after childbirth, which can negatively influence the wellbeing of some mothers and infants. Evidence identified that internet interventions can include more tailored information, reach a larger research group, and supply more anonymity than face-to-face traditional interventions. Therefore, the internet-based support program (ISP) was designed to improve the parenting outcomes for Chinese first-time mothers. (2) Methods: A multicenter, single-blinded, pilot randomized controlled trial was conducted. From May to October 2020, a total of 44 participants were recruited in the obstetrical wards of two tertiary hospitals in China. Eighteen women in the control group received routine postnatal care; while eighteen women in the intervention group accessed to the ISP and routine postnatal care. The duration of intervention was not less than three months. Intervention outcomes were assessed through questionnaires before randomization (T0), immediately after intervention (T1), and three months after intervention (T2). The Self-efficacy in Infant Care Scale (SICS), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Social Support Scale (PSSS) were included to measure MSE, postpartum depression (PPD), and social support, respectively. (3) Results: No significant difference between the two groups were found in terms of the baseline social-demographic characteristics; and the scores of SICS, EPDS and PSSS at T0 (p > 0.05). Repeated measures multivariate analysis of covariance found that women in the intervention group had a higher MSE score at T1 (6.63, p = 0.007), and T2 (5.75, p = 0.020); a lower EPDS score at T1 (3.11, p = 0.003), and T2 (2.50, p = 0.005); and a higher PSSS score at T1 (4.30, p = 0.001); and no significant difference at T2 (0.35, p = 0.743), compared with women in the control group. (4) Conclusion: The effect of ISP was evaluated to significantly increase primiparous women’s MSE, social support, and to alleviate their PPD symptoms. However, the small sample in pilot study restricted the research results. Therefore, the ISP should be further investigated with a larger, diverse sample to confirm whether it should be adopted as routine postnatal care to support primiparous women on parenting outcomes and mental wellbeing in the early stage of motherhood.
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Affiliation(s)
- Lingling Huang
- Health Science Centre, Shenzhen University, Shenzhen 518060, China; (L.H.); (Q.F.)
| | - Qu Shen
- Department of Nursing, School of Medicine, Xiamen University, Xiamen 361102, China;
| | - Qiyu Fang
- Health Science Centre, Shenzhen University, Shenzhen 518060, China; (L.H.); (Q.F.)
| | - Xujuan Zheng
- Health Science Centre, Shenzhen University, Shenzhen 518060, China; (L.H.); (Q.F.)
- Correspondence:
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Piwowarczyk P, Kaczmarska A, Kutnik P, Hap A, Chajec J, Myśliwiec U, Czuczwar M, Borys M. Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084098. [PMID: 33924523 PMCID: PMC8068817 DOI: 10.3390/ijerph18084098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.
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Affiliation(s)
- Paweł Piwowarczyk
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
- Correspondence:
| | - Agnieszka Kaczmarska
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Paweł Kutnik
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Aleksandra Hap
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Joanna Chajec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Urszula Myśliwiec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Mirosław Czuczwar
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Michał Borys
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
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Kong KR, Lee EN. [Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial]. J Korean Acad Nurs 2021; 51:347-362. [PMID: 34215712 DOI: 10.4040/jkan.21025] [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: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program's clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey. METHODS To confirm the program's effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA. RESULTS The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts. CONCLUSION This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.
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Affiliation(s)
| | - Eun Nam Lee
- College of Nursing, Dong-A University, Busan, Korea.
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Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. Pain Rep 2020; 5:e878. [PMID: 33344873 PMCID: PMC7743834 DOI: 10.1097/pr9.0000000000000878] [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: 05/20/2020] [Revised: 08/24/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
Video and phone consultations for musculoskeletal pain are effective, safe, and appreciated by patients. Implementation and execution require special consideration and such guidance is provided. Introduction: Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. Objectives: This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. Methods: Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. Results: The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. Conclusion: This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
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Dear BF, Karin E, Fogliati R, Dudeney J, Nielssen O, Scott AJ, Gandy M, Bisby MA, Heriseanu AI, Hathway T, Staples L, Titov N, Schroeder L. A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial. THE JOURNAL OF PAIN 2020; 22:344-358. [PMID: 33227510 DOI: 10.1016/j.jpain.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404--$808 AUD) or an optional-guided format (ICER range: -$314--$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88-$225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE: This study examines the cost-effectiveness of an internet-delivered PMP provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rhiannon Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Madelyne A Bisby
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andreea I Heriseanu
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Taylor Hathway
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Liz Schroeder
- Centre for Health Economy, Macquarie University, Sydney, Australia
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Ariza-Mateos MJ, Cabrera-Martos I, Prados-Román E, Granados-Santiago M, Rodríguez-Torres J, Carmen Valenza M. A systematic review of internet-based interventions for women with chronic pain. Br J Occup Ther 2020. [DOI: 10.1177/0308022620970861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction To evaluate the effects of internet-based interventions on physical and psychosocial outcomes in women with chronic pain through a systematic review. Method A search of the following electronic databases: PubMed/MEDLINE, ScienceDirect, and Web of Science. Two different authors separately tabulated the indices selected in identical predetermined forms. The methodological quality of all randomised trials was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias. Results Seven articles were finally included. The main features of interventions included online cognitive-behavioural and/or psychoeducation therapy to improve health with an interactive component. The methodological quality showed a high risk of bias, mainly from a lack of blinding. Conclusion There are indicators that suggest that internet-based interventions may be useful for women with chronic pain. However, the validity of such a conclusion is limited as most trials included had a high risk of bias. More rigorous research is required before stating that such interventions can overcome the current limitations of traditional face-to-face care.
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Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants. J Orthop Sports Phys Ther 2020; 50:418-430. [PMID: 32736497 DOI: 10.2519/jospt.2020.9319] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019. STUDY SELECTION CRITERIA Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain. DATA SYNTHESIS We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively. RESULTS Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication. CONCLUSION There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.
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Li Z, Tse M, Tang A. The Effectiveness of a Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144966. [PMID: 32660159 PMCID: PMC7400324 DOI: 10.3390/ijerph17144966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023]
Abstract
Background: Chronic pain is a major health problem among older adults and their informal caregivers, which has negative effects on their physical and psychological status. The dyadic pain management program (DPMP) is provided to community-dwelling older adults and informal caregivers to help the dyads reduce pain symptoms, improve the quality of life, develop good exercise habits, as well as cope and break the vicious circle of pain. Methods: A pilot randomized controlled trial was designed and all the dyads were randomly divided into two groups: the DPMP group and control group. Dyads in the DPMP group participated in an 8-week DPMP (4-week face-to-face program and 4-week home-based program), whereas dyads in the control group received one page of simple pain-related information. Results: In total, 64 dyads participated in this study. For baseline comparisons, no significant differences were found between the two groups. After the interventions, the pain score was significantly reduced from 4.25 to 2.57 in the experimental group, respectively. In the repeated measures ANOVA, the differences in pain score (F = 107.787, p < 0.001, d = 0.777) was statistically significant for the group-by-time interaction. After the interventions, the experimental group participants demonstrated significantly higher pain self-efficacy compared with the control group (F = 80.535, p < 0.001, d = 0.722). Furthermore, the elderly increased exercise time significantly (F = 111.212, p < 0.001, d = 0.782) and reported developing good exercise habits. Conclusions: These results provide preliminary support for the effectiveness of a DPMP for relieving the symptoms of chronic pain among the elderly.
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Affiliation(s)
| | - Mimi Tse
- Correspondence: ; Tel.: +85-2-2766-6541
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Abstract
Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. For many patients, these symptoms persist for years and lead to frequent health care use; for some, fibromyalgia and its symptoms can be debilitating. Although many treatments are available, management remains challenging. This article highlights the clinical features of fibromyalgia, discusses diagnostic criteria and their evolution, and reviews treatment options.
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Affiliation(s)
- Matthew J Bair
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana (M.J.B.)
| | - Erin E Krebs
- Minneapolis VA Health Care System, Minneapolis, Minnesota (E.E.K.)
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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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Li Y, Tse MMY. Pain situations among working adults and the educational needs identified: an exploratory survey via WeChat. BMC Public Health 2019; 19:1149. [PMID: 31438930 PMCID: PMC6704659 DOI: 10.1186/s12889-019-7503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this study is to 1) investigate the pain situation among working adults in China; 2) explore the self-initiate pain reliving strategies applied by working adults; and 3) collect people's interests and suggestions to the topics of the online pain education program. METHODS This is an exploratory survey through WeChat. The study was conducted from May 2018 to December 2018. Participants were recruited following the snowball sampling. In total of 664 people were recruited and 502 satisfied the criteria. SPSS was used for data analysis. Descriptive statistical analysis were used to present the utilization of pain treatments and suggested topics. Chi-square test, independent multiple logistic regression and Spearman's correlation were used to analysis the data. RESULTS The overall incidence of pain among the participants is 45% and higher among female (63%) than male (37%). Neck (68.72%, 4.10 ± 2.31), shoulder (62.56%, 3.78 ± 2.41) and head (49.34%, 4.23 ± 2.52) are reported as the most common and severe pain sites. Working is affected by pain and the results show that there is a negative correlation between pain intensity and work (rs = - 0.194) among the working population. Non-pharmacological treatments (55.77%) were chosen more by pain suffers. Totally 63.39% of participants show interests in the online pain education program and physical and psychological impact of pain is the most suggested topic (22.51%). CONCLUSION The pain prevalence is high among working adults in China. Impact of pain on work is a significant problem for the working adults. It is important to identify people at risk and deliver timely intervention to reduce pain. People showed their willingness in joining the online program. Therefore, future online pain education program can be developed.
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Affiliation(s)
- Yajie Li
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Mimi M Y Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
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The Pain Course: Exploring the Feasibility of an Internet-delivered Pain Management Program When Offered by a Tertiary Pain Management Service. Clin J Pain 2019; 34:505-514. [PMID: 29077622 DOI: 10.1097/ajp.0000000000000565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study examined the acceptability and preliminary outcomes of an internet-delivered pain management program, the Pain Course, when offered by a specialist pain management clinic in a large public hospital. METHODS A single-group feasibility open-trial design was used and 39 patients participated in the program, which ran for 8 weeks. Participants were supported through the program with weekly contact from a Clinical Psychologist at the clinic. RESULTS All participants provided data at posttreatment and >90% of participants completed all 5 lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M=71.99 min/participant; SD=32.82 min) was required to support patients through the program. Preliminary evidence of clinical improvements in depression symptoms (avg. improvement=38%; Cohen d=0.74), but not disability levels or anxiety symptoms, was observed in the overall sample. However, evidence of improvements was observed across all the primary outcomes among patients who had clinical levels of difficulties with disability (n=20; avg. improvement=11%; Cohen d=0.64), depression (n=17; avg. improvement=35%; Cohen d=1.24) and anxiety (n=8; avg. improvement=29%; Cohen d=0.57). CONCLUSIONS These findings highlight the potential value of internet-delivered programs when provided by specialist pain management clinics as a part of their services and the value of larger scale studies in this area.
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Whether chronic pain is medically explained or not does not moderate the response to cognitive-behavioural therapy. J Psychosom Res 2019; 121:29-36. [PMID: 30928209 DOI: 10.1016/j.jpsychores.2019.03.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether pain-related treatment outcomes, following an online Cognitive Behavioural Therapy (CBT) intervention for chronic pain, were moderated by the pain etiology of a medically explained or unexplained origin. METHODS Data were available from 471 participants who completed the online pain management program between March 2013 and August 2014. Participants' pain symptoms were classified as being medically explained symptoms (MES: n = 292) or medically unexplained symptoms (MUS: n = 222) via analysis of clinical data. Outcome variables were pain-related disability, average pain intensity, depression and anxiety. RESULTS Moderation analyses were non-significant for all dependent variables. Between group differences (CBT and control) were larger for depression in those classified with MES, compared with MUS (MUS: mean change = -3.50 [95% CI = -4.98 to -2.22]; MES: mean change = -5.72 [95% CI = -7.49 to -4.09]). However, between group differences were small for pain intensity (MUS: mean change = -0.03 [95% CI = -0.83 to 0.81]; MES: mean difference = -1.12 [95% CI = -1.84 to 0.40]). CONCLUSION The therapeutic outcomes examined in this study associated with an online CBT program do not appear to be altered by whether the participants' pain symptoms are medically explained or unexplained.
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Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers. Pain 2019; 160:1156-1165. [DOI: 10.1097/j.pain.0000000000001496] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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McNaughton DT, Hush JM, Beath AP, Dear BF, Jones MP. No moderating impact of a medically unexplained etiology on the relationship between psychological profile and chronic pain. J Psychosom Res 2018; 115:87-93. [PMID: 30470323 DOI: 10.1016/j.jpsychores.2018.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability. METHODS N = 471 chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups. RESULTS Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ2 (3) = 0.45, p = 0.93 and χ2 (3) = 7.07, p = 0.07 respectively). CONCLUSION These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in individuals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms.
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Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med 2018; 42:169-187. [DOI: 10.1007/s10865-018-9984-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
AbstractThis systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.Trial Registration PROSPERO registration number: CRD42018087292.
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Abstract
PURPOSE OF REVIEW We reviewed research on computer-assisted cognitive-behavior therapy (CCBT) performed in medical settings with the goals of assessing the effectiveness of this newer method of treatment delivery, evaluating the need for clinician support of therapeutic computer programs, and making suggestions for future research and clinical implementation. RECENT FINDINGS The overall results of randomized, controlled trials suggest that CCBT can be an effective treatment for depression in primary care patients and health care anxiety. Also, it can be a useful component of treatment for somatic conditions including irritable bowel syndrome, diabetes, fibromyalgia, and chronic pain. The amount and type of clinician support needed for maximizing effectiveness remains unclear. CCBT offers promise for overcoming barriers to delivering effective psychotherapy in medical settings. We recommend that next steps for researchers include more definitive studies of the influence of clinician support, investigations focused on implementation in clinical practices, cost-benefit analyses, and use of technological advances.
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The Pain Course: 12- and 24-Month Outcomes From a Randomized Controlled Trial of an Internet-Delivered Pain Management Program Provided With Different Levels of Clinician Support. THE JOURNAL OF PAIN 2018; 19:1491-1503. [PMID: 30099209 DOI: 10.1016/j.jpain.2018.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023]
Abstract
Little is known about the long-term outcomes of emerging Internet-delivered pain management programs. The current study reports the 12- and 24-month follow-up data from a randomized controlled trial (n = 490) of an Internet-delivered pain management program, the Pain Course. The initial results of the trial to the 3-month follow-up have been reported elsewhere. There were significant improvements in disability, depression, anxiety, and pain levels across 3 treatment groups receiving different levels of clinician support compared with a treatment as the usual control. No marked or significant differences were found between the treatment groups either after treatment or at the 3-month follow-up. The current study obtained long-term follow-up data from 78% and 79% of participants (n = 397) at the 12-month and 24-month follow-up marks, respectively. Clinically significant decreases (average percent reduction; Cohen's d effect sizes) were maintained at the 12- and 24-month follow-ups for disability (average reduction ≥27%; d ≥ .67), depression (average reduction ≥36%; d ≥ .80), anxiety (average reduction ≥38%; d ≥ .66), and average pain levels (average reduction ≥21%; d ≥ .67). No marked or consistent differences were found among the 3 treatment groups. These findings suggest that the outcomes of Internet-delivered programs may be maintained over the long term. PERSPECTIVE: This article presents the long-term outcome data of an established Internet-delivered pain management program for adults with chronic pain. The clinical improvements observed during the program were found to be maintained at the 12- and 24-month follow-up marks. This finding indicates that these programs can have lasting clinical effects.
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Bernardy K, Klose P, Welsch P, Häuser W. Efficacy, acceptability and safety of Internet‐delivered psychological therapies for fibromyalgia syndrome: A systematic review and meta‐analysis of randomized controlled trials. Eur J Pain 2018; 23:3-14. [DOI: 10.1002/ejp.1284] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2018] [Indexed: 01/20/2023]
Affiliation(s)
- K. Bernardy
- Department of Pain Medicine BG University Hospital Bergmannsheil GmbH Ruhr University Bochum Germany
| | - P. Klose
- Department Internal and Integrative Medicine Faculty of Medicine Kliniken Essen‐Mitte University of Duisburg‐Essen Germany
| | - P. Welsch
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
| | - W. Häuser
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
- Department Internal Medicine I Klinikum Saarbrücken Germany
- Department Psychosomatic Medicine and Psychotherapy Technische Universit€at Müunchen Germany
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