A Mind-Body Physical Activity Program for Chronic Pain With or Without a Digital Monitoring Device: Proof-of-Concept Feasibility Randomized Controlled Trial

Jonathan Greenberg, Paula J Popok, Ann Lin, Ronald J Kulich, Peter James, Eric A Macklin, Rachel A Millstein, Robert R Edwards, Ana-Maria Vranceanu, Jonathan Greenberg, Paula J Popok, Ann Lin, Ronald J Kulich, Peter James, Eric A Macklin, Rachel A Millstein, Robert R Edwards, Ana-Maria Vranceanu

Abstract

Background: Chronic pain is associated with poor physical and emotional functioning. Nonpharmacological interventions can help, but improvements are small and not sustained. Previous clinical trials do not follow recommendations to comprehensively target objectively measured and performance-based physical function in addition to self-reported physical function.

Objective: This study aimed to establish feasibility benchmarks and explore improvements in physical (self-reported, performance based, and objectively measured) and emotional function, pain outcomes, and coping through a pilot randomized controlled trial of a mind-body physical activity program (GetActive) with and without a digital monitoring device (GetActive-Fitbit), which were iteratively refined through mixed methods.

Methods: Patients with chronic pain were randomized to the GetActive (n=41) or GetActive-Fitbit (n=41) programs, which combine relaxation, cognitive behavioral, and physical restoration skills and were delivered in person. They completed in-person assessments before and after the intervention. Performance-based function was assessed with the 6-min walk test, and step count was measured with an ActiGraph.

Results: Feasibility benchmarks (eg, recruitment, acceptability, credibility, therapist adherence, adherence to practice at home, ActiGraph wear, and client satisfaction) were good to excellent and similar in both programs. Within each program, we observed improvement in the 6-min walk test (mean increase=+41 m, SD 41.15; P<.001; effect size of 0.99 SD units for the GetActive group and mean increase=+50 m, SD 58.63; P<.001; effect size of 0.85 SD units for the GetActive-Fitbit group) and self-reported physical function (P=.001; effect size of 0.62 SD units for the GetActive group and P=.02; effect size of 0.38 SD units for the GetActive-Fitbit group). The mean step count increased only among sedentary patients (mean increase=+874 steps for the GetActive group and +867 steps for the GetActive-Fitbit group). Emotional function, pain intensity, pain coping, and mindfulness also improved in both groups. Participants rated themselves as much improved at the end of the program, and those in the GetActive-Fitbit group noted that Fitbit greatly helped with increasing their activity.

Conclusions: These preliminary findings support a fully powered efficacy trial of the two programs against an education control group. We present a model for successfully using the Initiative on the Methods, Measurement, and Pain Assessment in Clinical Trials criteria for a comprehensive assessment of physical function and following evidence-based models to maximize feasibility before formal efficacy testing.

Trial registration: ClinicalTrial.gov NCT03412916; https://ichgcp.net/clinical-trials-registry/NCT03412916.

Keywords: actigraphy; chronic pain; feasibility studies; meditation; walking.

Conflict of interest statement

Conflicts of Interest: EM served as a Data Safety Monitoring Board member for Novartis Pharmaceuticals and Shire Human Genetic Therapies; served on an advisory committee for Biogen; consulted for Cerevance, Intrance, Inventram, Lavin Consulting, and Myolex; and his institution received grants on his behalf from Amylyx Pharmaceuticals, GlaxoSmithKline, and Mitsubishi Tanabe Pharmaceuticals. All other authors declare that they have no relevant conflicts of interest.

©Jonathan Greenberg, Paula J Popok, Ann Lin, Ronald J Kulich, Peter James, Eric A Macklin, Rachel A Millstein, Robert R Edwards, Ana-Maria Vranceanu. Originally published in JMIR Formative Research (http://formative.jmir.org), 08.06.2020.

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