Currently submitted to: Journal of Medical Internet Research
Date Submitted: Aug 9, 2019
Open Peer Review Period: Aug 11, 2019 - Sep 30, 2019
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A Smartphone-based Healthcare Chatbot to Promote Self-Management of Chronic Pain (SELMA): A Pilot Randomized Control Trial
Ongoing pain is one of the most common diseases and has a major physical psychological, social and economic impact. A mobile health intervention utilizing a fully-automated text-based healthcare chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between participant and the THCB.
The objectives of this paper are twofold: (1) to describe the design and implementation of SELMA (painSELfMAnagement), a 2-month smartphone-based Cognitive Behavior Therapy (CBT) TBHC intervention for pain self-management of patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior and pain duration, working alliance, acceptance and adherence were evaluated.
Participants were recruited online and in collaboration with pain experts and randomized to interact with SELMA for 8 weeks, either every day or every other day, concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity and the bond scale of working alliance were measured at baseline and post-intervention, intention to change behavior and pain duration at baseline only, and acceptance post- intervention via self-report instruments. Adherence was assessed objectively via usage data.
From May 2018 till August 2018, 311 adults downloaded the SELMA app, 102 consented to participate and met the inclusion criteria. The average age of the 88 female (86.4%) and 14 male (13.6%) participants was 43.7 (SD=12.7) years. Baseline group comparison did not differ in any demographic or clinical variables. Pain intensity was reduced significantly (P=.05) and general well-being increased significantly (P=.01) in both groups. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the wait-list control group post-intervention. The intention to change behavior was related positively to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the THCB SELMA was comparable to working alliance in guided internet therapies with human coaches. Participants enjoyed using the app, perceived it as useful and easy to use, and would recommend it to others. Overall, 52% adhered to the program by self-selecting coaching modules actively. Participants’ comments revealed an appreciation of the empathic and responsible interaction with the THCB SELMA. A main criticism was that there was no option to enter free text for patients’ own comments.
SELMA is feasible, revealed mainly positive feedback and valuable suggestions for future revisions. For example, participants’ intention to change behavior or a more homogenous sample (e.g. with a specific type of chronic pain) should be considered in further tailoring SELMA. Clinical Trial: German Clinical Trials Register DRKS00017147; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017147, Swiss National Clinical Trial Portal: SNCTP000002712.
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