Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial

Abstract

Background: Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain.

Objective: This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries.

Methods: Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups.

Results: A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone-based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04).

Conclusions: In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference.

Trial registration: ClinicalTrials.gov NCT03991546; https://ichgcp.net/clinical-trials-registry/NCT03991546.

Keywords: acceptance and commitment therapy; chatbot; conversational agents; mHealth; opioid crisis; orthopedics; patient-reported outcome measures; postoperative pain; text messaging.

Conflict of interest statement

Conflicts of Interest: CA reports personal fees from McKinsey & Company, outside the submitted work. MW reports nonfinancial support from Zimmer Biomet, outside the submitted work. MK reports stock or stock options from Iowa Simulation Solutions LLC and stock or stock options from Mortise Medical LLC, outside the submitted work. JM reports stock or stock options from Zimmer Biomet, stock or stock options from FxRedux, nonfinancial support and stock or stock options from Oxford Press, and stock or stock options from Tornier, outside the submitted work.

©Chris A Anthony, Edward Octavio Rojas, Valerie Keffala, Natalie Ann Glass, Apurva S Shah, Benjamin J Miller, Matthew Hogue, Michael C Willey, Matthew Karam, John Lawrence Marsh. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.07.2020.

Figures

Figure 1

Consolidated Standards of Reporting Trials flowchart detailing the selection of eligible patients for study enrollment and their status through study completion. ACT: acceptance and commitment therapy.