Olöf Birna Kristjansdottir*, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Oslo, Norway Egil A Fors, St.Olavs Hospital, Division of Psychiatry. Center for Pain and Complex Disorder, Department of Anaesthesia. Norwegian University of Science and Technology, Department of Public Health and General Practice, Faculty of Medicine., Trondheim, Norway Sandra Van Dulmen, Netherlands Institute for Health Services Research. Radboud University Nijmegen Medical Center, Utrecht, Netherlands Arnstein Finset, University of Oslo, Department of Behavioral Sciences, Institute of Basic Medical Sciences, Oslo, Norway Sigrid Hørven Wigers, Jeløy Kurbad Rehabilitation Center, Moss, Norway Erlend Eide, edesign, Tønsberg, Norway Hilde Eide, Buskerud University College, Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Drammen, Norway Track: Research Presentation Topic: e-Coaching Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: Auditorium Date: 2012-09-16 02:45 PM – 03:30 PM Last modified: 2012-09-12 Free Full Paper

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Background: Multidimensional rehabilitation with graded physical exercises and psychoeducation is recommended for patients with chronic widespread pain (CWP) but relapse of symptoms is not uncommon. Studies on web-based interventions to support self-management of chronic pain conditions show promising results but research on web-based interventions following rehabilitation is lacking.
Objective: The aim of this trial was to study the efficacy of a smartphone intervention following an inpatient multidimensional rehabilitation on catastrophizing, acceptance and functioning in women with CWP.
Methods: Women (n=140) with CWP completing a four-week inpatient rehabilitation program were randomized into two groups; with or without a smartphone intervention following the inpatient program. The smartphone intervention included one face-to-face session and four weeks of written communication with a therapist via a smartphone. The intervention was based on acceptance and commitment therapy. Participants in the intervention group filled out three smartphone diaries daily to support self-monitoring and reflection on pain-related thoughts, feelings and self-management behavior. The registered diaries were immediately available to a therapist who responded with one tailored feedback daily. Diaries and feedback were submitted on a secure website accessible only to the researchers and therapists; and on the participant’s smartphone. SMS was used to remind of diary submission and to signal available feedback. The aim of the feedback was to support willingness to engage in meaningful activities despite pain or other discouraging intrusions (eg. catastrophizing) by providing situation specific message including positive reinforcement, reflective questions and exercises based on ACT (eg. mindfulness exercises and values reflections). Additionally, both groups received access to a non-interactive static website with material on self-management of pain and a few mindfulness exercises. Self-report questionnaires were filled out before and after the inpatient program and 5 and 11 months after the smartphone intervention. These included Pain Catastrophizing Scale (primary outcome), Chronic Pain Acceptance Questionnaire, Chronic Pain Values Inventory, and Fibromyalgia Impact Questionnaire.
Results: 112 participants completed the study; 48 in the intervention group and 64 in the control group. The response rates to the 5 and 11-month follow-up questionnaires were 77% and 81% for the completers in the intervention group, and 63% and 70% for the control group. Per protocol analysis for the 5 months follow-up shows moderate between group effect sizes (ES) on catastrophizing (ES=0.74, p=0.003), pain acceptance (ES=0.54, p=0.024) and functioning and symptom level (ES=0.75, p=0.001). With-in group analysis from pre-intervention to 11-month follow-up showed improvements in catastrophizing and acceptance (p<0.05) for the intervention group but not the control group. Impact of illness was increased in this period in the control group (p=0.001) but not in the intervention group. No between group differences were evident at the 11-month follow-up.
Conclusion: The study gives preliminary evidence for the mid-term (5 month) effects of a smartphone-based intervention with diaries and feedback on catastrophizing, acceptance, functioning and symptom level for women with CWP, following an inpatient rehabilitation program.