Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy  (PACT-A)

Abstract

Musculoskeletal symptoms are increased in farmers, whereas the prevalence of chronified pain is unknown. Online interventions based on acceptance and commitment therapy (ACT) have shown encouraging results in the general population, representing a promising approach for reducing pain interference in green professions (i.e., farmers, foresters, gardeners). We conducted a pragmatic RCT comparing a guided ACT-based online intervention to enhanced treatment-as-usual in entrepreneurs, contributing spouses, family members and pensioners in green professions with chronic pain (CPG: ≥grade II, ≥6 months). Recruitment was terminated prematurely after 2.5 years at N = 89 (of planned N = 286). Assessments were conducted at 9 weeks (T1), 6 months (T2) and 12 months (T3) post-randomization. The primary outcome was pain interference (T1). The secondary outcomes encompassed pain-, health- and intervention-related variables. No treatment effect for reduction of pain interference was found at T1 (β = −0.16, 95%CI: −0.64–0.32, p = 0.256). Improvements in cognitive fusion, pain acceptance, anxiety, perceived stress and quality of life were found only at T3. Intervention satisfaction as well as therapeutic and technological alliances were moderate, and uptake and adherence were low. Results are restricted by low statistical power due to recruitment issues, high study attrition and low intervention adherence, standing in contrast to previous studies. Further research is warranted regarding the use of ACT-based online interventions for chronic pain in this occupational group. Trial registration: German Clinical Trial Registration: DRKS00014619. Registered: 16 April 2018.

Using the Consolidated Framework for Implementation Research to evaluate a nationwide depression prevention project (ImplementIT) from the perspective of health care workers and implementers: Results on the implementation of digital interventions for farmers

“…However, the current power of the study as well as the unequal number in the groups did not allow for a significance test. As the results of the accompanying randomized controlled trials show ( 28 – 30 , 34 ), both interventions effectively reduce depressive symptoms posttreatment.…”

“…At the same time, “time-consuming work life” and “time-consuming private life” were the most often mentioned barriers regarding intervention use ( 32 ). However, besides RCT participation, in which low adherence regarding intervention use ( 28 , 29 ) and recruitment difficulties ( 34 ) are reported for IBIs, not much is known about routine care use. Therefore, it is critical to understand the factors that influence the uptake and implementation of both digital health interventions.…”

Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life

“…Only two studies reported ACT training specifically for the trial [46,56]. Thirteen studies documented whether client engagement checks were conducted during the trial [28,29,46,47,49,50,52,53,[56][57][58][59][60].…”

“…Moreover, by combining Mindfulness-Based Stress Reduction and ACT in the tailored intervention, the research not only enhanced the intervention's relevance and effectiveness but also offered valuable methodological insights for future ACT research in chronic pain management [28]. Lina's 2022 research used an automated web program for individual-level crossover block randomization to ensure fair allocation across study arms [29]. A blinded third party unconnected to the research conducted the randomization and allocation, while data collectors were kept unaware of participant groups [29].…”

“…Lina's 2022 research used an automated web program for individual-level crossover block randomization to ensure fair allocation across study arms [29]. A blinded third party unconnected to the research conducted the randomization and allocation, while data collectors were kept unaware of participant groups [29]. Despite the inability to blind participants, the study effectively minimized bias and optimized follow-up through regular online assessments and detailed flowcharts.…”