Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial

Abstract

BackgroundWeb-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR).ObjectiveThe objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated.MethodsA total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items.ResultsOf 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003).ConclusionsAdding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuabl...

Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review

“…Sample size ranged from 45 to 463 participants. A total of 17 interventions were targeted on changing pain thinking and pain behavior related to chronic pain [ 20 , 21 ], irritable bowel syndrome [ 22 , 23 ], chronic tinnitus [ 24 ], diabetes mellitus [ 25 ], multiple sclerosis [ 26 ], rheumatoid arthritis [ 27 ], fibromyalgia [ 28 ], psoriasis [ 29 ], and cancer [ 30 ]. Furthermore, 12 studies were targeted on changing lifestyle behavior (ie, physical activity, nutrition, and sedentary behavior) for patients with obesity [ 31 , 32 ], diabetes mellitus [ 33 , 34 ], chronic obstructive pulmonary disease [ 34 ], multiple sclerosis [ 35 , 36 ], and rheumatoid arthritis [ 37 ].…”

“…In total, 25 studies were rated as high quality [ 20 , 21 , 23 - 35 , 37 , 39 , 41 - 49 ] and 4 studies as low quality [ 22 , 36 , 38 , 40 ]. The most frequent sources of bias were not reporting blinding of the outcome assessor (90% of studies) and information about patients’ use of cointerventions (93% of studies).…”

“…In contrast, 6 studies did not mention any theory [ 34 , 35 , 37 - 39 , 47 ]. In 11 studies, the therapeutic guidance was delivered through face-to-face contact[ 21 , 30 - 33 , 37 - 39 ], mostly in combination with email or phone communication [ 27 , 29 , 30 , 32 - 34 , 37 - 39 ]. In 18 studies, the therapeutic guidance was non face-to-face [ 20 , 22 - 26 , 28 , 34 , 38 , 40 - 48 ].…”

Effects of a self‐guided, web‐based activity programme for patients with persistent musculoskeletal pain in primary healthcare: A randomized controlled trial

“…Ludden et al (2015) has proposed that such a design has an inherent risk of low flexibility, dissatisfaction, low adherence, and dropout, as the web programme cannot adjust to each participant's unique needs and expectations. On the other hand, the Web-BCPA treatment satisfaction and feasibility was rated good to excellent by the participants (Nordin et al, 2016). Ludden et al (2015) and Moore et al (2013) propose benefits of engaging MMR-web Base 44% (n = 24) 2% (n = 1) 14% (n = 8) 4% (n = 2) 36% (n = 20) 4 months 38% (n = 21) 4% (n = 2) 16% (n = 9) 2% (n = 1) 40% (n = 22) 12 months 36% (n = 19) 4% (n = 2) 11% (n = 6) 6% (n = 3) 43% (n = 23) MMR Base 43% (n = 19) 5% (n = 2) 18% (n = 8) 2% (n = 1) 32% (n = 14) 4 months 34% (n = 15) 5% (n = 2) 18% (n = 8) 0% (n = 0) 43% (n = 19) 12 months 25% (n = 11) 2% (n = 1) 23% (n = 10) 7% (n = 3) 43% (n = 19)…”

“…Web-BCPA adherence was assessed as minutes spent in each module, and summarized as total time spent in the programme. Further details of the Web-BCPA are described in Nordin et al (2016). There were no changes to methods after trial commencement.…”