Outcomes of a Remotely Delivered Complementary and Integrative Health Partnered Intervention to Improve Chronic Pain and Posttraumatic Stress Disorder Symptoms: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Non-pharmacological interventions for veterans are needed to help them manage chronic pain and posttraumatic stress disorder (PTSD) symptoms. Complementary and integrative health (CIH) interventions, such as Mission Reconnect (MR), provide veterans the option of a partnered, self-directed intervention that remotely teaches CIH skills to support symptom management. OBJECTIVE The purpose of this study was to describe the physical, psychological, and social outcomes of a self-directed mobile and web-based CIH intervention for veterans with comorbid chronic pain and PTSD and their partners, and qualitatively examine their user experience. METHODS Veteran-partner dyads (n = 364) were recruited to participate in a mixed-methods multi-site waitlist control (WC) randomized-controlled trial (RCT) to measure physical, psychological, and social outcomes, with pain as the primary outcome, and PTSD, depression stress, sleep, quality of life and relationships as secondary outcomes. Latent profile analyses were used to examine possible chronic pain and PTSD profiles at baseline. Linear mixed models were constructed for primary and secondary patient reported outcomes (PROs). The quantitative analysis was triangulated with qualitative interviews from a subsample of dyads (n = 35) to examine participants’ perceptions of their program experience. RESULTS Dyads were randomized to two groups: intervention (MR, n = 140) and waitlist control (WC, n = 136) Significant reduction in pain interference in mood and sleep was observed among the veteran MR group that was not observed in WC group (p < .01). We also observed a positive effect of the MR intervention on a reduction in negative affect associated with pain (p = .045). For veterans, borderline significant improvement in over-identification with personal failures and shortcomings was seen in the MR group but not in WC group (p = .036). This effect was not observed in partners. No significant change was observed in overall pain; sleep; PTSD; quality of life; relationship satisfaction; overall self-compassion or compassion for others. Qualitative interviews, however, indicate intervention impacts included improved sleep, and reduced pain, anxiety, stress, and in contrast to the survey data, overall improvement in PTSD symptoms, and social relationships. Participants’ overall impressions of MR, which highlight usability and navigation; perceptions on packaging and content; and barriers and facilitators to MR use. CONCLUSIONS Adjunctive CIH modalities can be delivered using web/mobile based apps but should be developed and tailored using established best practices. MR may be beneficial for veterans with pain and PTSD and their partners. Further research and implementation efforts with larger samples are warranted. CLINICALTRIAL Clinical Trial # NCT03593772 INTERNATIONAL REGISTERED REPORT RR2-10.2196/13666