Clinical utility of a mHealth assisted intervention for activity modulation in chronic pain: The pilot implementation of pain ROADMAP

Abstract

Background: Being able to successfully self-regulate one's activity levels is a key adaptation strategy for many people with chronic pain. This study aimed to explore the clinical utility of a mobile health platform (Pain ROADMAP) for assisting with the delivery of a tailored activity modulation intervention for people with persistent pain. Methods: Twenty adults with chronic pain undertook 1-week monitoring intervals which involved wearing an Actigraph activity monitor and entering pain, opioid use, and activity participation data into a custom-made phone app. The Pain ROADMAP online portal integrated and analysed the data to detect activities that caused a severe pain exacerbation and provided summary statistics pertaining the data collected. As part of a 15-week treatment protocol, participants received feedback from three dispersed Pain ROADMAP monitoring periods. Treatment focused on adapting pain-provoking activities, gradually increase goal-related activity and optimizing routine. Results: Results revealed good participant acceptability of monitoring procedures and reasonable adherence to both monitoring procedures and clinical follow-up appointments. Preliminary efficacy was established through clinically meaningful decreases in overactivity behaviour, pain variation, opioid use, depression, activity avoidance, and increases in productivity. No adverse outcomes were observed. Conclusion: The results of this study provide initial support for the clinical utility of mHealth assisted activity modulation interventions that involve remote monitoring.Significance: This is the first study to demonstrate how mHealth innovations that utilise ecological momentary assessment can be successfully integrated with wearable technologies to provide a tailored activity modulation intervention that is both highly valued by people with chronic pain and assists individuals to make

Content and Quality of Mobile Apps for the Monitoring of Musculoskeletal or Neuropathic Pain in Australia: Systematic Evaluation

“…Although this may not be entirely unexpected, considering the considerable costs and time investments necessary to undertake such research, it hampers the ability of consumers and health care professionals to make well-informed decisions when selecting or endorsing such apps. Finally, none of the included apps allowed clinicians to tailor any management components to the individual, despite there being some evidence that tailored technology interventions [ 54 ] and individualized pain management interventions [ 55 , 56 ] may be more effective and are valued by patients [ 57 ].…”

“…For example, clients demonstrating high levels of pain catastrophizing may not be suitable candidates for ongoing pain monitoring, especially not without supervision and reassurance from clinicians, as pain monitoring may lead to increased focus on and worry about pain symptoms [ 63 ]. On the other hand, clients who are “overactive” and experience pain flare-ups may be able to use self-monitoring to better pace themselves [ 57 , 64 ]. Similarly, for clients who avoid activity due to the fear of provoking pain, the regular monitoring of pain may lead to improved confidence by correcting exaggerated predictions of pain provocation [ 65 ].…”

Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing

“…Dolores was designed to be embedded in the Pain ROADMAP monitoring app [ 22 , 23 ]. The idea for Dolores resulted from a working group with researchers and clinicians who discussed how to adapt Pain ROADMAP to a pediatric setting.…”