Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Acceptance and Commitment Therapy (ACT) is a pragmatic approach to help individuals decrease avoidable suffering and pain. OBJECTIVE To evaluate the effects of Acceptance and Commitment Therapy (ACT) delivered via an automated mobile messaging robot on postoperative opioid utilization and patient reported outcomes (PROs) in orthopaedic trauma patients who underwent operative intervention for their injuries. METHODS Adult patients presenting to a Level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who utilized mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first two weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after operative intervention, follow-up was obtained in the form of an opioid medication pill count and postoperative administration of PROs. Mean number of opioid tablets utilized by patients were calculated and compared between groups. Mean PRO scores were also compared between groups. RESULTS Eighty-two subjects were enrolled in the study. Seventy-six (38 ACT, 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group utilized an average of 26.1±21.4 opioid tablets while the control group utilized 41.1±22.0 tablets, resulting in 36.5% less tablets utilized by subjects receiving the mobile phone-based ACT intervention (P= .004). Intervention group subjects reported a lower postoperative PROMIS Pain Intensity score of 45.9±7.2 compared to the control group’s 49.7±8.8 (P= .04). CONCLUSIONS In this study the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid utilization in selected orthopaedic trauma patients. Subjects receiving the ACT-based intervention also reported lower pain intensity after two weeks, though this may not represent a clinically important difference. CLINICALTRIAL ClinicalTrials.gov registry number: NCT03991546.

Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review

“…The identified studies (n=29) were mostly conducted in the USA (n=10), Sweden (n=6), and the UK (n=6). The studies included a diverse sample of adults (n=22), college students and young adults (n=4), anonymous users (n=2), and adolescents (n=1) ( 28 – 33 , 41 , 73 – 94 ). Eight studies reported on the ethnicity of the participants ( 30 , 32 , 41 , 74 , 76 , 77 , 80 , 83 ), and in most of the studies between 31% and 91% of the participants identified as White.…”

“…The studies included a diverse sample of adults (n=22), college students and young adults (n=4), anonymous users (n=2), and adolescents (n=1) ( 28 – 33 , 41 , 73 – 94 ). Eight studies reported on the ethnicity of the participants ( 30 , 32 , 41 , 74 , 76 , 77 , 80 , 83 ), and in most of the studies between 31% and 91% of the participants identified as White. The studies focused on a population with moderate psychiatric symptoms including depression, anxiety, obsessive-compulsive disorder (OCD), insomnia, stress, body dysmorphic disorder (BDD), opioid misuse, social anxiety disorder (SAD), and bipolar personality disorder.…”

“…The meta-analysis assessing the impact of AI-augmented interventions on mental health symptoms considered n=10 studies ( 41 , 73 – 78 , 80 , 84 , 90 ) presenting pre- and post-intervention outcomes. The results of this meta-analysis showed that these interventions had a significantly large effect size in the reduction of mental health symptoms.…”

“…The sub-group analysis showed that AI-self-guided eCBT had a significant medium effect size, AI-guided eCBT effect had a non-significant effect, and AI-modified eCBT, AI-self-guided ACT and Combined had a significant large effect size in the reduction of mental health symptoms ( Figure 3A ). The NMA considered n=6 RCTs ( 41 , 73 , 74 , 76 – 78 ). The head-to-head comparisons against AI-self-guided eCBT determined that this intervention was significantly more effective than AI chatbot with a large effect and psychoeducation with a medium effect size for the reduction of mental health symptoms.…”

“…No specific trends were identified when comparing the attrition rates with intervention length or whether the online intervention was therapist guided or not ( Table 1 ). The NMA considered n=6 RCTs ( 41 , 73 , 74 , 76 – 78 ). The head-to-head comparisons against AI-self-guided eCBT determined that this intervention had a 14% lesser risk of dropping out compared to psychoeducation, this comparison was statistically significant.…”