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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.
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.
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.
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 (
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.
Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0)
Chronic widespread pain (CWP) is a common cause of suffering in the adult population, with reported prevalence rates between 4% and 10% [
An increasing number of studies on Internet-based interventions, many based on CBT (iCBT), indicate their efficacy in supporting use of constructive self-management strategies in individuals living with chronic illness [
To date, research on the effects of iCBT for persons with pain beyond 6-month follow-up is limited. Additionally, only a few studies on iCBT have investigated the effect of an intervention aiming to support self-management following participation in a traditional pain management program [
Most iCBT interventions for chronic pain are based on weekly modules with self-help material and involve weekly written communication with a therapist [
In our randomized controlled study, 135 women with CWP completing a 4-week inpatient rehabilitation program were included [
The overall study design is shown in
All participants attended a 4-week inpatient multidimensional rehabilitation program for chronic pain. The program included education in pain mechanisms and CBT-based pain management (approximately 20 hours), various forms of aerobic exercise, stretching, relaxation, individual myofascial pain treatment, and medication was administered as needed (see [
The intervention group received a smartphone intervention for 4 weeks after completing the inpatient rehabilitation. Both groups were given access to an informational website with self-help pain-management material. Self-reported assessments on paper were gathered at five time-points: before (T1) and after (T2) the inpatient program, 4 weeks after discharge (T3) when the intervention group had completed their smartphone intervention, and 5 (T4) and 11 months (T5) after the smartphone intervention period (ie, 12 months after discharge from the inpatient rehabilitation program). The first two questionnaires were received and completed at the rehabilitation center and the others were completed at home and returned by mail. In this paper, results of the first two assessments (T1 and T2) and the last (11-month follow-up, T5) are reported. The customary self-report administration mode at the rehabilitation center was a paper-and-pencil format and was therefore used in this study.
Participants were recruited consecutively from Jeløy Kurbad Rehabilitation Centre in Moss, Norway. Patients were referred to the center by their general practitioner, a medical specialist, or from a hospital. The inclusion criteria for the study were: female, 18 years or older, participating in the inpatient program for persons with chronic pain, having suffered from CWP for more than 6 months (with or without a diagnosis of fibromyalgia), not participating in another research project at the rehabilitation centre, being able to use the smartphone, and not being diagnosed with a profound psychiatric disorder.
The study was approved by the Regional Ethics Committee in South-East Norway and by the Norwegian Social Science Services. All participants signed an informed consent form. The study is registered at ClinicalTrial.gov (NCT01236209).
The Pain Catastrophizing Scale (PCS [
The current levels (last couple of days) of pain, fatigue, sleep disturbance, and depression were assessed on visual analogue scales (VAS) from 0 (no pain/fatigue/sleep disturbance/depression) to 100 (worst imaginable). One question on subjective global improvement was included: “How do you feel now compared to before you attended the inpatient program?”
The main theoretical framework was based on the cognitive behavioral fear-avoidance model [
The intervention started with an approximately 1-hour individual session between a nurse and the participant. The session took place in the last week before discharge. The participants received information (name and qualifications) about their therapist for the intervention, which, in some cases was the nurse at the meeting. The nurse attending the face-to-face session summarized the meeting and passed this background information to the relevant therapist. For the duration of the study, the participant was lent a smartphone and could call a member of the research group (OBK, HE) for technical support.
The participant was asked to complete three diary entries per day using the smartphone. Examples of the smartphone’s screen display are shown in
At the time scheduled for diary completion, a short message service (SMS) message with a link to a secure website, where the diary could be opened and questions answered and posted, was received by the participant. The participants completed the first diary entry during the face-to-face session and continued during the last week before discharge with the goal of getting used to the diaries before discharge (a run-in period). After discharge, the diaries were completed every day for 4 weeks.
For 4 weeks after discharge, excluding weekends, participants received daily written feedback from a therapist. The feedback was empathic and personalized according to each participant’s situation as reported in the diary. It included repetition of content reported in the diaries, positive reinforcement, reminders of self-management information given at the rehabilitation center, ACT exercises, and reflective questions. The aim was to encourage nonjudgmental awareness of cognitions, feelings, and emotions and to stimulate mindfulness and willingness to engage in meaningful activities despite pain or other discouraging intrusions, eg, to reduce the impact of catastrophizing on self-management behavior. The instructions for the exercises were written directly in the feedback or the participant was referred to exercises available on the smartphone and/or the website (see below). The feedback was also personalized according to the summary of personal information given at the face-to-face session (eg, family situation and health-related goals) and results on self-reported discrepancy between values and values-based living assessed with the CPVI at the end of the rehabilitation program. The feedback was usually available for the participant within 90 minutes after they had completed the second diary of the day. If this diary was not submitted, feedback based on information from the latest submitted diary was sent. There was no limitation on the length of the feedback, which ranged from a few sentences to a few paragraphs.
The feedback was written by any of 3 of the authors (OBK, TLS, and HE); all with a background in health care sciences (nursing and/or psychology).
A few audio files with short mindfulness exercises guided by the authors were available on the smartphones.
All participants received access to a static website with information on self-management strategies for people with chronic pain. The website also included a few written ACT exercises and audio files with mindfulness exercises (as described above). See
To investigate differences in demographic variables and baseline characteristics, independent sample
Study flow chart.
The smartphone's screen showing a diary in Norwegian.
The smartphone's screen showing feedback in Norwegian.
265 women who were eligible for the study during the study period were invited to informational meetings about the project. Of these, 124 did not attend a meeting or declined to participate, and 1 did not meet the inclusion criteria. 140 were randomized to one of the two study arms (
Descriptive results for catastrophizing are shown in
At the 11-month follow-up (T5), there was no difference between the groups on the measure of catastrophizing (PCS); neither according to the ITT-analysis (LOCF
There were small positive within-group effects for the intervention group between T2 and T5 on catastrophizing by ITT (LOCF) and per protocol analyses,
No between-group differences were found at the 11-month follow-up;
When comparing baseline data for the inpatient program (T1) to the follow-up data (T5), improvement in acceptance, mental health measured by SF8, and values-based living was found in both groups (see
When the 5-month follow-up results (T4) were compared to the 11-month follow-up (T5), no changes were found for acceptance, pain level, functioning, and symptom level (measured by FIQ), sleep disturbance, fatigue, and mental health (all
Of the completers, 47.4% (n=18) in the intervention group and 40.0% (n=18) in the control group reported feeling better now than before the inpatient program. 13.1% (n=5) in the intervention group and 11.1% (n=5) in the control group reported feeling worse now compared to before the inpatient program. No change was reported by 39.5% (n=15) in the intervention group and by 48.9% (n=22) in the control group.
Of the 135 participants (of 140 randomized) that met the inclusion criteria, 112 completed the study period (
The response rate for all included participants (n=135) was 66.7% at 11-month follow-up (T5) (n=45 in the intervention group and n=45 in the control group). When only completers (n=112) were included, the response rate at T5 was 81.3% (n=39) in the intervention group and 70.3% (n=45) in the control group. Among the completers, those who returned the questionnaire at T5 had better physical functioning (M=34.60, SD 7.53), at admission to the inpatient program measured by SF8, compared to those who did not return them (M=31.19, SD 6.93),
Characteristics at admission to the inpatient rehabilitation center.
Characteristic | Smartphone intervention (n=69)a | Control (n=66)a | |
Age, mean (SD), n | 44.59 (11.13), 69 | 43.80 (11.20), 65 | |
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Married or cohabiting | 60.9% (n=42) | 68.2% (n=45) |
Divorced | 13.0% (n=9) | 9.1% (n=6) | |
Single | 18.8% (n=13) | 15.2% (n=10) | |
Widow | 5.8% (n=4) | 3.0% (n=2) | |
Unknown | 1.4% (n=1) | 4.5% (n=3) | |
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≤ 10 years (elementary) | 18.8% (n=13) | 12.1% (n=8) |
11-13 years (high school) | 27.5% (n=19) | 45.5% (n=30) | |
>13 years (College/University) | 43.5% (n=30) | 34.8% (n=23) | |
Unknown | 10.1% (n=7) | 7.6% (n=5) | |
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Working/studying | 21.7% (n=15) | 12.1% (n=8) |
Unemployed | 4.3% (n=3) | 1.5% (n=1) | |
On sick leave | 39.1% (n=27) | 51.5% (n=34) | |
On disability pension | 17.4% (n=12) | 19.7% (n=13) | |
Part time working/studying and part time sick leave | 11.6% (n=8) | 7.6% (n=5) | |
Other combination of the above | 5.8% (n=4) | 6.1% (n=4) | |
Unknown | 0% | 1.5% (n=1) | |
Diagnosed with fibromyalgia (valid %) | 80.9% (n=55) | 84.4% (n=54) | |
Duration of symptoms (years), mean (SD), n | 13.11 (8.78) | 15.47 (12.09) | |
PCSb, mean (SD), n | 21.24 (10.33), 63 | 20.80 (9.45), 62 | |
CPAQb, mean (SD), n | 56.48 (15.02), 58 | 53.87 (13.81), 57 | |
FIQb, mean (SD), n | 58.75 (16.39), 69 | 58.58 (16.04), 66 | |
SF-8, physicalb; mean (SD), n | 31.91 (7.57), 65 | 34.75 (7.35), 62 | |
SF-8, mentalb, mean (SD), n | 39.33 (10.49), 65 | 39.34 (9.61), 62 | |
GHQ-12b, mean (SD), n | 3.32 (3.38), 62 | 3.02 (3.38), 61 | |
CPVIb, mean (SD), n | 2.07 (0.95), 64 | 2.01 (0.73), 61 | |
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Pain, mean (SD), n | 67.08 (17.47), 69 | 57.85 (21.60), 66 |
Fatigue, mean (SD), n | 67.40 (23.73), 69 | 64.72 (21.02), 66 | |
Sleep disturbance, mean (SD), n | 57.24 (26.22), 68 | 55.16 (23.38), 66 | |
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Depression, mean (SD), n | 34.73 (29.15), 68 | 32.93 (29.26), 65 |
a Patients meeting exclusion criteria after randomization were not included in this analysis.
b VAS, visual analogue scale (0-100c); PCS, Pain Catastrophizing Scale (score range 0-52c); CPAQ, Chronic Pain Acceptance Questionnaire (score range 0c-120); FIQ, Fibromyalgia Impact Questionnaire (0-100c); SF-8 (0c-100), Short Form; GHQ-12, questions from the General Health Questionnaire (score range 0-12c); CPVI, Chronic Pain Values Inventory (success score, range 0c-6).
c Values that indicate maximum symptom scores/least health.
Means and standard deviations for the primary outcome at admission to the inpatient rehabilitation (T1), at discharge (T2), and 11 months (T5) after the intervention period.
Primary outcome measure, |
Group | T1a
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T2a, b
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T5a
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Intervention | 21.24 (10.33), 63 | 15.12 (9.61), 63 | 11.50 (8.68), 44 |
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Control | 20.80 (9.45), 62 | 15.41 (9.62), 59 | 14.73 (9.95), 43 |
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Intervention | 21.24 (10.33), 63 | 16.06 (10.37), 68 | 13.72 (10.02), 69 |
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Control | 20.80 (9.45), 62 | 15.33 (9.31), 65 | 15.57 (10.40), 66 |
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Intervention |
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12.80, 69 |
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Control |
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14.74, 66 |
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Intervention | 20.56 (10.08), 43 | 14.61 (8.93), 45 | 11.92 (8.97), 39 |
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Control | 20.78 (9.59), 60 | 15.46 (9.76), 57 | 14.73 (9.95), 43 |
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Intervention |
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12.25, 48 |
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Control |
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14.66, 64 |
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Intervention | 30.2%, 13 | 15.6%, 7 | 12.8%, 5 |
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Control | 33.3%, 20 | 17.5%, 10 | 18.6%, 8 |
a T1, at admission to the inpatient program; T2, at discharge from the inpatient program; T5, 11-month follow-up
b No differences between groups at T2 (all
Within-group differences and effect sizes (ES) for the primary outcome.
Primary outcome, PCS | Mean |
95% CI |
ES for T2-T5 |
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Mean |
95% CI |
ES for T1-T5 |
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Intervention | -2.60 (8.72), 42 | -5.32, .11 | .29 | .06 | -7.36 (7.87), 39 | -9.91, -4.81 | .80 | < .001 |
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Control | -.21 (7.32), 40 | -2.55, 2.13 | .02 | .86 | -5.30 (7.30), 41 | -7.60, -2.99 | .56 | < .001 |
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Intervention | -2.36 (8.41), 68 | -4.39, -.32 | .23 | .02 | -7.57 (8.23), 63 | -9.64, -5.50 | .76 | < .001 |
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Control | .40 (7.20), 65 | -1.39, 2.18 | -.04 | .66 | -4.65 (7.43), 62 | -6.54, -2.76 | .47 | < .001 |
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Intervention | -2.61, 63 | -5.33, .10 |
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.06 | -8.22, 63 | -10.86, -5.57 |
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< .001 |
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Control | -.15, 59 | -2.75, 2.46 |
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.91 | -5.79, 62 | -8.12, -3.46 |
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< .001 |
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Intervention | -3.04 (8.74), 37 | -5.95, -.12 | 0.33 | .04 | -7.23 (8.01), 34 | -10.03, -4.44 | .77 | < .001 |
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Control | -.21 (7.32), 40 | -2.55, 2.13 | 0.02 | .86 | -5.30 (7.30), 41 | -7.60, -2.99 | .56 | < .001 |
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Intervention | -2.45, 45 | -5.29, .38 |
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.09 | -7.93, 43 | -10.72, -5.14 |
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< .001 |
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Control | -.27, 57 | -2.84, 2.30 |
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.84 | -5.85,60 | -8.15, -3.54 |
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< .001 |
a T1, at admission to the inpatient program; T2, at discharge from the inpatient program; T5, 11-month follow-up.
b
Means and standard deviations for the secondary outcomes at admission to the inpatient rehabilitation (T1), at discharge (T2), and 11 months (T5) after the intervention period, for the completers.
Secondary outcome measures | Group | T1a
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T2a,b
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T5a
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Intervention | 56.45 (15.22), 40 | 62.00 (13.62), 44 | 71.62 (14.11), 39 |
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Control | 53.94 (13.92), 56 | 62.21 (10.15), 57 | 67.05 (15.18), 42 |
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Intervention | 58.46 (17.26), 48 | 46.38 (16.92), 47 | 49.24 (21.34), 38 |
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Control | 58.35 (16.18), 64 | 49.10 (17.32), 62 | 53.75 (17.73), 45 |
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Intervention | 32.12 (7.74), 45 | 36.68 (8.42), 40 | 34.38 (9.88), 39 |
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Control | 34.98 (7.13), 60 | 35.86 (8.24), 49 | 37.35 (7.65), 44 |
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Intervention | 39.50 (10.67), 45 | 45.70 (8.06), 40 | 45.50 (10.70), 39 |
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Control | 39.09 (9.61), 60 | 44.83 (9.69), 49 | 43.87 (9.09), 43 |
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Intervention | 3.19 (3.21), 43 | 1.20 (2.02), 45 | 1.95 (2.64), 38 |
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Control | 2.97 (3.43), 59 | 0.63 (1.01), 57 | 2.20 (2.82), 44 |
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Intervention | 2.05 (0.95), 44 | 2.47 (0.91), 46 | 2.78 (1.00), 39 |
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Control | 2.02 (0.74), 59 | 2.52 (0.68), 54 | 2.50 (0.77), 43 |
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Intervention | 66.59 (17.58), 48 | 53.07 (22.20), 47 | 56.28 (28.24), 38 |
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Control | 57.32 (21.56), 64 | 52.99 (21.27), 61 | 55.85 (22.73), 45 |
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Intervention | 69.29 (23.98), 48 | 51.38 (27.75), 47 | 60.79 (28.56), 38 |
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Control | 64.08 (21.01), 64 | 50.10 (24.28), 61 | 61.63 (23.63), 45 |
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Intervention | 54.77 (26.99), 47 | 43.97 (25.77), 47 | 51.68 (30.45), 38 |
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Control | 54.59 (23.31), 64 | 48.12 (24.57), 62 | 53.08 (25.95), 45 |
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Intervention | 30.68 (28.71), 47 | 19.84 (24.08), 47 | 22.82 (25.89), 38 |
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Control | 32.65 (29.29), 63 | 27.36 (28.51), 61 | 28.93 (27.71),45 |
a T1, at admission to the inpatient program; T2, at discharge from the inpatient program; T5, 11-month follow-up.
b No differences between groups at T2 (all P values >.05; GHQ and depression (VAS),
Mean differences for the secondary outcomes within-groups, confidence intervals (CI) and effect sizes (ES) for the completers.
Secondary outcome measures |
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Mean |
95% CI T2-T5a | ES for T2-T5a |
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Mean |
95% CI T1-T5a | ESa for T1-T5 |
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Intervention | 10.20 (9.57), 35 | 6.91, 13.49 | .73 | <.001 | 14.12 (12.46), 33 | 9.70, 18.54 | .95 | < .001 |
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Control | 2.15 (10.77), 39 | -1.34, 5.64 | .17 | .22 | 8.45 (14.00), 38 | 3.85, 13.05 | .62 | .001 |
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Intervention | 1.40 (21.15), 37 | -5.65, 8.45 | -.08 | .69 | -8.15 (21.95), 38 | -15.36, -.93 | .42 | .03 |
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Control | 7.05 (17.24), 44 | 1.81, 12.29 | -.40 | .01 | -2.27 (16.23), 45 | -7.15, 2.60 | .13 | .35 |
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Intervention | -3.20 (8.84), 33 | -6.33, -.06 | -.36 | .046 | 1.11 (8.99), 36 | -1.93, 4.15 | .12 | .46 |
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Control | .54 (8.18), 34 | -2.32, 3.39 | .06 | .71 | 1.01 (6.99), 42 | -1.17, 3.19 | .14 | .36 |
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Intervention | .39 (10.09), 33 | -3.19, 3.97 | .04 | .82 | 6.45 (11.71), 36 | 2.49, 10.42 | .58 | .002 |
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Control | -1.61 (11.53), 33 | -5.70, 2.48 | -.17 | .43 | 3.10 (6.99), 42 | .93, 5.28 | .36 | .006 |
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Intervention | .69 (3.06), 35 | -.36, 1.74 | -.28 | .19 | -1.12 (4.07), 34 | -2.54, .30 | .36 | .12 |
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Control | 1.68 (2.94), 40 | .74, 2.61 | -.85 | .001 | -.61, 3.39, 41 | -1.68, .46 | .20 | .26 |
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Intervention | .29 (.90), 37 | -.01, .59 | .30 | .06 | .56 (.72), 35 | .32, .81 | .59 | < .001 |
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Control | -.11 (.88), 36 | -.41, .19 | -.16 | .46 | .40 (.61), 41 | .21, .59 | .54 | < .001 |
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Intervention | 1.43 (32.58), 37 | -9.44, 12.29 | -.06 | .79 | -9.86 (25.54), 38 | -18.25, -1.46 | .43 | .02 |
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Control | 5.53 (20.73), 43 | -.85, 11.91 | -.25 | .09 | -1.82 (23.65), 45 | -8.92, 5.28 | .08 | .61 |
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Intervention | 8.71 (33.56), 37 | -2.48, 19.90 | -.32 | .12 | -8.94 (31.93), 38 | -19.43, 1.56 | .36 | .09 |
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Control | 14.96 (24.50), 43 | 7.42, 22.49 | -.61 | <.001 | -.93 (22.65), 45 | -7.73, 5.87 | .04 | .78 |
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Intervention | 5.55 (33.26), 37 | -5.54, 16.64 | -.20 | .32 | -2.29 (33.46), 37 | -13.45, 8.86 | .08 | .68 |
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Control | 7.43 (27.09), 44 | -.81, 15.66 | -.28 | .08 | .45 (30.11), 45 | -8.59, 9.50 | -.02 | .92 |
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Intervention | 1.11 (28.71), 37 | -8.46, 10.68 | -.05 | .82 | -8.13 (27.78), 37 | -17.40,1.13 | .29 | .08 |
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Control | 7.27 (27.43), 43 | -1.18, 15.71 | -.26 | .09 | .99 (23.13), 45 | -5.96, 7.94 | -.04 | .78 |
aT1, at admission to the inpatient program; T2, at discharge from the inpatient program; T5, 11-month follow-up.
b
The results of the study are ambiguous. On one hand, there were no significant differences in mean values on any variables between the groups at 11-month follow-up. Thus, the favorable effects previously reported on catastrophizing, acceptance, functioning, and symptom levels at 5-month follow-up were not evident at long-term follow-up. However, there was significantly more improvement in catastrophizing scores during the follow-up period in the intervention group compared to the control group. Moreover, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, revealed changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. Also, increase in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group. Additionally, effects on most variables were maintained in the intervention group from the 5-month follow-up to the 11-month follow-up. Unexpectedly, between the two follow-ups, the control group reported some improvement in several variables (catastrophizing, values-based living, and depression) whereas the intervention group did not. We have no data to support an explanation for this improvement. One could speculate that it takes time for changes in thoughts, behavior, and priorities promoted by the multidimensional inpatient rehabilitation program to settle and cause positive effects. The controls did not get the smartphone intervention that could promote these changes early after discharge, and thus the changes may have been achieved at an earlier stage in the intervention group. We do not have exact login information for visits to the website. As mentioned in our previous paper, most participants in the control group (26 of the 38 who reported this information) visited it rarely (2 times or less). The impression of the administrator of the website (HE) was that it was seldom accessed. Based on the limited use of the website, it is not assumed to have caused any changes seen in the control group. The spontaneous improvement in the control group, large variations within variables, relatively few participants, and small effect sizes may explain the lack of significant differences between the groups. It is important to acknowledge that the effects of the inpatient program were sustained at the long-term follow-up in the control group for many of the outcome variables, ie, catastrophizing, acceptance, mental health, and values-based living. Improvement in those variables indicates that the participants cope better with their situation.
Some of the limitations regarding the generalizability of the study have been discussed in the previous report, eg, the difference in the completers groups versus those withdrawing [
The withdrawal rate of 30% indicates that this type of secondary intervention may not be found feasible by all. The withdrawal rate is similar to those reported in many iCBT, where an average dropout rate of 27% has been reported [
Medications, education, CBT, and physical exercises are among the recommended treatment options for individuals with CWP and fibromyalgia [
To conclude, the results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, more improvement in catastrophizing scores was seen in the intervention group than the control group in the period between discharge from the inpatient program and the follow-up. Moreover, 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. Also, increases in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group. This kind of smartphone intervention may therefore be suited for providing self-management support following inpatient pain management program. Research on strategies to provide feasible self-management support on a long-term basis for individuals with CWP and ways to enhance cost-effectiveness is needed.
Screenshot from the website.
CONSORT-EHEALTH Checklist V1.6.2 [
acceptance and commitment therapy
cognitive behavioral therapy
chronic pain acceptance questionnaire
chronic pain values inventory
chronic widespread pain
effect size
fibromyalgia impact questionnaire
general health wuestionnaire
Internet-based cognitive behavioral therapy
intention-to-treat
last observation carried forward
mean
multiple imputations
pain catastrophizing scale
short-form health survey
short message service
visual analog scale
The study is primarily funded by the Research Council of Norway (Grant No. 182014) (OBK, HE, EE, and TLS). We would like to thank the women who were willing to participate in the trial and the staff at Jeløy Kurbad Rehabilitation Centre. We thank Are Pripp and Lien My Diep (Department for biostatistics and epidemiology, Oslo University Hospital) for statistical advice.
All authors participated in the development of the intervention. OBK and HE recruited participants and collected data, helped by SHW who was responsible for the patients’ diagnostics and data collection at the inpatient center. OBK, TLS, and HE performed the role of the therapist. EE was responsible for the design and development of the technological system. HE was project leader. All authors contributed to and approved the final manuscript.
None declared.