A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial

Abstract

BackgroundInternet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited.ObjectiveThe aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program.MethodsA total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels.ResultsOf the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen’s d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen’s d=0.74, P=.003), acceptance of pain (Cohen’s d=0.54, P=.02), and functioning and symptom levels (Cohen’s d=0.75, P=.001).ConclusionsThe results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation.Trial RegistrationClinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY)

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Therapist guidance was provided in eight of these studies (Buhrman et al, 2013;Hesser et al, 2012;Kristjánsdóttir et al, 2013;Lappalainen et al, 2014;Lappalainen, Langrial, Oinas-Kukkonen, Tolvanen, & Lappalainen, 2015;Pots et al, 2015;Trompetter, Bohlmeijer, Veehof, & Schreurs, 2015;Weineland, Arvidsson, Kakoulidis, & Dahl, 2012), the duration FIGURE 1 Flow diagram of study selection. Note.…”

“…Participants rated the treatments as satisfactory (Trompetter et al, 2015;Lappalainen et al, 2014Lappalainen et al, , 2015, enjoyable (Glick & Orsillo, 2015), useful (Kristjánsdóttir et al, 2013), and helpful (Cukrowicz & Joiner, 2007), as measured by the Client Satisfaction Questionnaire (Attkisson & Zwick, 1982), visual analogue scales, and brief questionnaires, respectively. Four studies administered the Credibility/Expectancy Questionnaire (Borkovec & Nau, 1972;Devilly & Borkovec, 2000) and ratings indicated that participants perceived the third-wave eHealth treatments as credible (Kelly & Carter, 2015;Ljótsson et al, 2010;Ly et al, 2014).…”

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

“…The analyses of the present study are based on data from participants who were randomized to the treatment condition (48 women, see Table 2) in a previously reported RCT [28]. Data consisted of de-identified daily diaries (totaling 3372) and written feedbacks (totaling=799).…”

“…ACT shares important features with CBT, such as behavior activations, although acceptance and cognitive defusion strategies may be relatively unique for ACT [20,22]. Several studies based on ACT have demonstrated effects related to improvement of health outcomes in patients with chronic pain [18,[23][24][25][26], including internetbased interventions [27][28][29]. Studies have also investigated the impact of the different treatment components of ACT [26] as well as mediators of change, supporting the importance of both ACT consistent interventions and changes in processes related to PF [18].…”

“…The current paper builds upon a RCT smartphone maintenance intervention (SMI) with electronic diaries and therapist written feedback based on an ACT model to support women with chronic widespread pain after completing a 4-week rehabilitation program [28,30].…”