Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study

Abstract

Background Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients’ daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. Objective This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. Methods The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior–based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. Results Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, “totally agree” or “agree”; 39/45, 87%) and easy to use (42/45, 93%), and as having easily understandable exercises (44/45, 98%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). Conclusions Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. Trial Registration ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104

Patients’ Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study

“…Screenshot examples from the EPIO intervention program are shown in Figure 1 . The EPIO program has so far been tested in a feasibility pilot study with 50 participants, where the results showed EPIO to be perceived as useful and easy to use, with easily understandable content and excellent system usability [ 43 ].…”

Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care

“…Other validation studies that used the original SUS had reported higher mean scores. These include studies among patients with type 2 diabetes mellitus in Utah which showed a mean score of 80.5 (SD ± 11.5) [39] and among patients living with chronic pain in Norway which showed mean score of 85.7 (SD ± 12.9) [40]. In contrast, a usability study of a cognitive behavioural therapy app using SUS among mental healthcare providers in six European countries yielded a lower mean score of 67.9 (SD ± 18.8) [41].…”

An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study

“…We chose this design for its suitability to the study’s objectives of user engagement, acceptability, and clinical safety and preliminary effectiveness, which together focused on assessing proof of concept before justifying native app development and more rigorous testing of a final product via a randomized design [ 35 ]. These objectives and the study design were informed by a combination of the Bowen et al [ 36 ] feasibility study design recommendations, as used in comparable mobile app feasibility trials [ 37 , 38 ]; the UK Medical Research Council guidance on developing and testing complex interventions [ 39 , 40 ]; and the Obesity-Related Behavioral Intervention Trials model for developing behavioral interventions in long-term health conditions [ 35 ]. As is the case in this study, both the UK Medical Research Council and Obesity-Related Behavioral Intervention Trials models recognize that there is often an overlap between the later objectives of the development phase, in which an intervention is refined, and the early feasibility objectives of the testing phase.…”