Ólöf Birna Kristjánsdóttir

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

Background Internet-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. Objective The 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. Methods A 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. Results Of 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). Conclusions The 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 Registration Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY)

The development and feasibility of a web-based intervention with diaries and situational feedback via smartphone to support self-management in patients with diabetes type 2.

AIMS The aim of the study was to develop and test the feasibility of a three months web-based intervention, delivered by a smartphone to support self-management in patients with type 2 diabetes. METHODS The intervention included use of a smartphone enabling access to daily web-based diaries and individualized written situational feedback. The participants registered their eating behavior, medication taking, physical activities and emotions three times daily using the mobile device. They also registered their fasting blood glucose level in the morning diary. A therapist had immediate access to submitted diaries and used the situational information to formulate a personalized feedback based on Acceptance Commitment Therapy. The purpose of the diaries and the situational feedback was to stimulate self-management. RESULTS Eleven of the fifteen participants included in the study completed the intervention, which was evaluated as supportive and meaningful. Most of the participants reported positive life style changes. The response rate to the daily registration entries was good and few technical problems were encountered. CONCLUSIONS The described intervention is feasible and should be tested out in a large-scale study. The developed smartphone application seems a promising tool for supporting patients with type 2 diabetes to make important life style changes.

Written online situational feedback via mobile phone to support self-management of chronic widespread pain : a usability study of a Web-based intervention

BackgroundThis pretrial study aimed to develop and test the usability of a four-week Internet intervention delivered by a Web-enabled mobile phone to support self-management of chronic widespread pain.MethodsThe intervention included daily online entries and individualized written feedback, grounded in a mindfulness-based cognitive behavioral approach. The participants registered activities, emotions and pain cognitions three times daily using the mobile device. The therapist had immediate access to this information through a secure Web site. The situational information was used to formulate and send a personalized text message to the participant with the aim of stimulating effective self-management of the current situation. Six women participated and evaluated the experience.ResultsThe intervention was rated as supportive, meaningful and user-friendly by the majority of the women. The response rate to the daily registration entries was high and technical problems were few.ConclusionThe results indicate a feasible intervention. Web-applications are fast becoming standard features of mobile phones and interventions of this kind can therefore be more available than before.Trial registration numberClinicalTrials.gov: NCT01236209

A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial

Background Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. Objective The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. Methods 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress. Results By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. Conclusion The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. Trial Registration Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0)

Web-based, self-management enhancing interventions with e-diaries and personalized feedback for persons with chronic illness: A tale of three studies

OBJECTIVE Chronic illness places high demands on patients. Interventions supporting self-management and providing personalized feedback might help patients to gain new perspectives and enhance use of constructive self-management strategies. We developed three comparable web-based CBT-grounded interventions including e-diaries and feedback delivered through PDAs/smartphones. The feasibility and efficacy of these interventions have been investigated for patients with irritable bowel syndrome (in an RCT), chronic widespread pain (RCT) and type 2 diabetes (feasibility study). METHODS This is a descriptive study that summarizes the content, feasibility and efficacy of the interventions and discusses issues relevant for implementing this type of web-based therapeutic interventions in clinical practice. RESULTS The web-based interventions appear feasible, acceptable and supportive. In a short and midterm time frame, the interventions promote self-management. CONCLUSION Booster sessions may be needed for prolonged effects. Given the physical and mental symptoms of the patients under study and the nature of the intervention, providers who deliver the feedback need a health care background and training in this specific way of counseling. PRACTICE IMPLICATIONS The results of the three studies suggest that personalized web-based interventions are effective and have the potential to support self-management in daily healthcare. Studies concerning clinical significance and implementation are needed.

86 WEB-BASED SITUATIONAL FEEDBACK TO SUPPORT THE USE OF POSITIVE COPING STRATEGIES IN WOMEN WITH GENERALIZED CHRONIC PAIN — A FEASIBILITY STUDY

Introduction: Determining predicting factors of disability in low back pain patients may help proposing preventive and rehabilitative interventions. Aims: To identify independent predictors of disability in low back pain patients. Methods: Cross-sectional study with 215 adults (outpatients and workers) recruited in São Paulo (Brazil). Participants (age 44.7±11.1 years, 65.1% female, schooling 11.2±3.5 years) filled out Socio Demographic and Clinic Profile, Oswestry Disability Index (ODI), Chronic Pain Self-Efficacy Scale, Tampa Scale for Kinesiophobia, Beck Depression Inventory, Piper Fatigue Scale and Baecke Physical Activity Questionnaire. Disability patients presented moderate or severe scores in ODI (>21) and 30 days or more of sick listed/last year. Results: Disability was observed in 53.5% (95%IC 46.6–60.3). Logistic regression identified six predictors, adjusted by sex: pain intensity (OR: 7.5; 95%CI 1.8–31.3, p = 0.005), self-efficacy (OR=5.1; 95%CI 2.3–11.4, p < 0.001), pain fear and avoidance (OR: 3.4; 95%CI 1.5–7.5, p = 0.002), depression (OR: 3.4; 95%CI 1.4–8.3, p = 0.005), age (OR: 2.8; 95%CI 1.3–6.2, p = 0.007), and marital status (OR: 2.3; 95%CI 1.0–5.3, p = 0.047). Body mass, physical activity and fatigue do not showed significance in multiple regression analyses. Conclusions: Different beliefs and psychosocial variables were predictors of disability and it is relevant because these aspects can be changed.