A smartphone-based intervention with diaries and therapist feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain. part 2: 11-month follow-up results of a randomized trial

Ólöf Birna Kristjánsdóttir, Egil A Fors, Erlend Eide, Arnstein Finset, Tonje Lauritzen Stensrud, Sandra van Dulmen, Sigrid Hørven Wigers, Hilde Eide, Ólöf Birna Kristjánsdóttir, Egil A Fors, Erlend Eide, Arnstein Finset, Tonje Lauritzen Stensrud, Sandra van Dulmen, Sigrid Hørven Wigers, Hilde Eide

Abstract

Background: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited.

Objective: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups.

Methods: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress.

Results: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen's d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen's d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up.

Conclusion: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention.

Trial registration: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0).

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
The smartphone's screen showing a diary in Norwegian.
Figure 3
Figure 3
The smartphone's screen showing feedback in Norwegian.

References

    1. Croft P, Rigby AS, Boswell R, Schollum J, Silman A. The prevalence of chronic widespread pain in the general population. J Rheumatol. 1993 Apr;20(4):710–3.
    1. Clauw DJ, Crofford LJ. Chronic widespread pain and fibromyalgia: what we know, and what we need to know. Best Pract Res Clin Rheumatol. 2003 Aug;17(4):685–701.
    1. Shipley M. Chronic widespread pain and fibromyalgia syndrome. Medicine. 2010;38(4):202–204.
    1. Lindell L, Bergman S, Petersson IF, Jacobsson LT, Herrström P. Prevalence of fibromyalgia and chronic widespread pain. Scand J Prim Health Care. 2000 Sep;18(3):149–53.
    1. Cöster L, Kendall S, Gerdle B, Henriksson C, Henriksson KG, Bengtsson A. Chronic widespread musculoskeletal pain - a comparison of those who meet criteria for fibromyalgia and those who do not. Eur J Pain. 2008 Jul;12(5):600–10. doi: 10.1016/j.ejpain.2007.10.001.
    1. Flor H, Turk DC. Chronic Pain: An Integrated Biobehavioral Approach. Chronic pain: IASP Press; 2011.
    1. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004 Nov 17;292(19):2388–95. doi: 10.1001/jama.292.19.2388.
    1. Morley S. Relapse prevention: still neglected after all these years. Pain. 2008 Feb;134(3):239–40. doi: 10.1016/j.pain.2007.12.004.
    1. Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. 2009 Feb 15;61(2):216–24. doi: 10.1002/art.24276.
    1. Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients--relapse, noncompliance, and adherence enhancement. Pain. 1991 Jan;44(1):5–28.
    1. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B. Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults. Cochrane Database Syst Rev. 2000;(2):CD001984. doi: 10.1002/14651858.CD001984.
    1. Barak A, Grohol JM. Current and Future Trends in Internet-Supported Mental Health Interventions. Journal of Technology in Human Services. 2011;29:155–196. doi: 10.1080/15228835.2011.616939.
    1. Barak A, Hen L, Boniel-Nissim M, Shapira N. A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions. Journal of Technology in Human Services. 2008 Jul 2008;26(2-4):109–160. doi: 10.1080/15228830802094429.
    1. McGeary DD, McGeary CA, Gatchel RJ, Allison S, Hersh A. Assessment of Research Quality of Telehealth Trials in Pain Management: A Meta-Analysis. Pain Pract. 2012 Sep 27;:1–10. doi: 10.1111/j.1533-2500.2012.00601.x.
    1. Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med. 2008 Apr;31(2):169–77. doi: 10.1007/s10865-007-9144-1.
    1. Bender JL, Radhakrishnan A, Diorio C, Englesakis M, Jadad AR. Can pain be managed through the Internet? A systematic review of randomized controlled trials. Pain. 2011 Aug;152(8):1740–50. doi: 10.1016/j.pain.2011.02.012.
    1. Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ. Internet-enhanced management of fibromyalgia: a randomized controlled trial. Pain. 2010 Dec;151(3):694–702. doi: 10.1016/j.pain.2010.08.034.
    1. Ruehlman LS, Karoly P, Enders C. A randomized controlled evaluation of an online chronic pain self management program. Pain. 2012 Feb;153(2):319–30. doi: 10.1016/j.pain.2011.10.025.
    1. Buhrman M, Fredriksson A, Edström G, Shafiei D, Tärnqvist C, Ljótsson B, Hursti T, Gordh T, Andersson G. Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: Randomized controlled trial. Eur J Pain. 2012 Nov 9; doi: 10.1002/j.1532-2149.2012.00244.x.
    1. Kristjánsdóttir OB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, Wigers SH, Eide H. A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial. J Med Internet Res. 2013;15(1):e5. doi: 10.2196/jmir.2249.
    1. Kristjánsdóttir ÓB, Fors EA, Eide E, Finset A, van Dulmen S, Wigers SH, Eide H. Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention. BMC Musculoskelet Disord. 2011;12:51. doi: 10.1186/1471-2474-12-51.
    1. Sorbi MJ, Mak SB, Houtveen JH, Kleiboer AM, van Doornen LJ. Mobile Web-based monitoring and coaching: feasibility in chronic migraine. J Med Internet Res. 2007;9(5):e38. doi: 10.2196/jmir.9.5.e38.
    1. Nes AA, van Dulmen S, Eide E, Finset A, Kristjánsdóttir OB, Steen IS, Eide H. The development and feasibility of a web-based intervention with diaries and situational feedback via smartphone to support self-management in patients with diabetes type 2. Diabetes Res Clin Pract. 2012 Sep;97(3):385–93. doi: 10.1016/j.diabres.2012.04.019.
    1. Oerlemans S, van Cranenburgh O, Herremans PJ, Spreeuwenberg P, van Dulmen S. Intervening on cognitions and behavior in irritable bowel syndrome: A feasibility trial using PDAs. J Psychosom Res. 2011 Mar;70(3):267–77. doi: 10.1016/j.jpsychores.2010.09.018.
    1. Wigers SH, Finset A. [Rehabilitation of chronic myofascial pain disorders] Tidsskr Nor Laegeforen. 2007 Mar 1;127(5):604–8.
    1. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524.
    1. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317–32.
    1. Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001 Mar;17(1):52–64.
    1. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997 Jan;27(1):191–7.
    1. McCracken LM, Yang SY. The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain. 2006 Jul;123(1-2):137–45. doi: 10.1016/j.pain.2006.02.021.
    1. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991 May;18(5):728–33.
    1. Saris-Baglama RN, Dewey CJ, Chisholm GB, Plumb E, King J, Rasicot P, Kosinski M, Bjorner JB, Ware JE. Quality Metric Outcomes Scoring Software 4.5. User's Guide. Quality Metric Incorporated: Lincoln; 2011.
    1. McCracken LM. Contextual cognitive-behavioral therapy for chronic pain. Seattle, Wash: IASP Press; 2005.
    1. Dahl J, Wilson KG, Luciano C, Hayes SC. Acceptance and commitment therapy for chronic pain. Reno, NV: Context Press; 2005.
    1. Vowles KE, McCracken LM, Eccleston C. Processes of change in treatment for chronic pain: the contributions of pain, acceptance, and catastrophizing. Eur J Pain. 2007 Oct;11(7):779–87. doi: 10.1016/j.ejpain.2006.12.007.
    1. Bailey KM, Carleton RN, Vlaeyen JW, Asmundson GJ. Treatments addressing pain-related fear and anxiety in patients with chronic musculoskeletal pain: a preliminary review. Cogn Behav Ther. 2010 Mar;39(1):46–63. doi: 10.1080/16506070902980711.
    1. Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain. 2011 Mar;152(3):533–42. doi: 10.1016/j.pain.2010.11.002.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Psychology Press; 1988.
    1. Blankers M, Koeter MW, Schippers GM. Missing data approaches in eHealth research: simulation study and a tutorial for nonmathematically inclined researchers. J Med Internet Res. 2010;12(5):e54. doi: 10.2196/jmir.1448.
    1. Macea DD, Gajos K, Daglia Calil YA, Fregni F. The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. J Pain. 2010 Oct;11(10):917–29. doi: 10.1016/j.jpain.2010.06.005.
    1. Walitt B, Fitzcharles MA, Hassett AL, Katz RS, Häuser W, Wolfe F. The longitudinal outcome of fibromyalgia: a study of 1555 patients. J Rheumatol. 2011 Oct;38(10):2238–46. doi: 10.3899/jrheum.110026.
    1. Rini C, Williams DA, Broderick JE, Keefe FJ. Meeting Them Where They Are: Using the Internet to Deliver Behavioral Medicine Interventions for Pain. Transl Behav Med. 2012 Jan 3;2(1):82–92. doi: 10.1007/s13142-011-0107-2.
    1. Ly KH, Dahl J, Carlbring P, Andersson G. Development and initial evaluation of a smartphone application based on acceptance and commitment therapy. SpringerPlus. 2012;1:11.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe