Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

Abstract

PURPOSEThis study investigated change processes resulting from a smartphone maintenance intervention with daily electronic diaries and personalized written feedback based on Acceptance and Commitment Therapy following a rehabilitation program for patients with chronic widespread pain. METHODSThe RCT included 48 women who, during a 5-week period, completed electronic diaries 3 times daily, totaling 3372 entries. In response to the completed diaries they received daily feedback from a therapist during 4 weeks, except during weekends, totaling 799 feedback messages. To analyze the change processes resulting from the smartphone intervention, we explored the associations between feedback and daily ratings of participant's physical activities, positive emotions, fear avoidance, acceptance and self-management. Commitment to physical activities and the participants' evaluation of feedback were also analyzed. Multilevel models were used in the statistical analyses. RESULTSParticipants' average "pain fear and avoidance" decreased over the intervention period (Mean -0.019, P = 0.05).Self-management, pain acceptance and positive feelings increased (Mean -0.030, P <.01, Mean -0.015, P = <.01and Mean -0.011, P = 0.01). Participants' performance of physical activities decreased slightly over time, but the level of commitment was high and they evaluated the feedback as supportive for staying sufficiently active. No correlation between diary contents and feedback messages was found, even though most of the participants evaluated the feedback as supportive. CONCLUSIONSNo support for a relationship between ACT consistent diary content and feedback was found. However, diary measures were consistent with the ACT model and may have influenced positively the change processes.3

A systematic review of internet-based interventions for women with chronic pain

“…In addition, there was no information on the age of specific groups in the study by Simister et al. (2018), and the mean age of participants in the control group was not reported in the study by Nes et al. (2017).…”

“…No overall summaries of age were included in the studies conducted by Salaffi et al. (2015), Nes et al. (2017) or Tavallaei et al.…”

“…Cognitive-behavioural therapy (Friesen et al., 2017; Vallejo et al. 2015), exposure therapy (Hedman-Lagerlöf et al., 2018), acceptance therapy (Nes et al., 2017), mindfulness (Tavallaei et al., 2018) and multicomponent therapy (Salaffi et al., 2015; Simister et al., 2018) were the main interventions. The authors proposed a multimodal approach including psychoeducation, information and exercise (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Nes et al., 2017; Salaffi et al., 2015; Simister et al., 2018; Vallejo et al., 2015).…”

“…The studies used web pages, internet software, applications or smartphones. The results of studies showed improvements in pain, self-efficacy, pain-related fear and avoidance, pain acceptance, positive feelings, fibromyalgia symptoms, disability, quality of life, anxiety, depression, fatigue and psychological flexibility when internet-delivered programmes were administered (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Nes et al., 2017; Salaffi et al., 2015; Simister et al., 2018; Tavallaei et al., 2018; Vallejo et al., 2015). Improvements were maintained at follow-up in the main outcomes (Friesen et al., 2017; Vallejo et al., 2015).…”

“…Five trials were at low risk of bias due to random sequence generation (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Salaffi et al., 2015; Simister et al., 2018; Vallejo et al., 2015) and incomplete outcome data (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Salaffi et al., 2015; Tavallaei et al., 2018; Vallejo et al., 2015). However, six studies were at high risk of bias in relation to the blinding of participants and personnel (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Nes et al., 2017; Salaffi et al., 2015; Simister et al., 2018; Tavallaei et al., 2018) and five were at high risk of bias regarding the blinding of the outcome assessment (Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Nes et al., 2017; Salaffi et al., 2015; Vallejo et al., 2015). In addition, four trials had an unclear risk of bias related to allocation concealment (Friesen et al., 2017; Nes et al., 2017; Tavallaei et al., 2018; Vallejo et al., 2015) and selective reporting (Nes et al., 2017; Salaffi et al., 2015; Tavallaei et al., 2018; Vallejo et al., 2015).…”