Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial

Casey, Máire-Bríd; Smart, Keith; Segurado, Ricardo; Hearty, Conor; Gopal, Hari; Lowry, Damien; Flanagan, Dearbhail; McCracken, Lance M.; Doody, Catherine

doi:10.1186/s13063-018-2543-5

Cited by 20 publications

(24 citation statements)

References 69 publications

(71 reference statements)

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“…The recommended treatments for chronic pain are physiotherapy, Cognitive Behavioral Therapy (CBT), or Acceptance Commitment Therapy (ACT), either in individualized or in specialized pain rehabilitation programs [ 43 , 44 ]. Pharmacological treatment is also used but ideally as a “door-opener” to reduce pain symptoms [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

2018

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Little is known about pain and pain treatment among people with intellectual disabilities (IDs). We aimed to describe pain and pain medications among older people with ID compared to the general population. Data on diagnoses and prescriptions were collected from national registers for the period between 2006 and 2012 for 7936 people with an ID and a referent cohort from the general population. IDs were associated with a decreased risk of being diagnosed with headaches, musculoskeletal pain, and pain related to the circulatory and respiratory systems, but they were associated with increased risk of being diagnosed with pain related to the urinary system. Among men, IDs were associated with an increased risk of being diagnosed with visceral pain. People with IDs were more likely to be prescribed paracetamol and fentanyl regardless of the type of pain but were less likely to be prescribed COX(1+2) and COX2 inhibitors and weak opioids. Healthcare staff and caregivers must be made aware of signs of pain among people with IDs who may not be able to communicate it themselves. Further research is needed to investigate whether people with IDs are prescribed paracetamol rather than other pain drugs due to physicians trying to avoid polypharmacy or if there are other reasons not to prescribe a greater range of pain treatments.

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Section: Discussionmentioning

confidence: 99%

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

2018

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“…The minimal clinically significant difference for the BPI-IS is 1 point (SD of improvement of 2 points). 34 This calculation yielded a suggested sample size of 64 patients per study arm. Allowing for a potential attrition rate of 15% our final sample size was 75 participants per group.…”

Section: Methods and Analysismentioning

confidence: 99%

Efficacy, cost-utility and physiological effects of Acceptance and Commitment Therapy (ACT) and Behavioural Activation Treatment for Depression (BATD) in patients with chronic low back pain and depression: study protocol of a randomised, controlled trial including mobile-technology-based ecological momentary assessment (IMPACT study)

et al. 2020

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IntroductionThe IMPACT study focuses on chronic low back pain (CLBP) and depression symptoms, a prevalent and complex problem that represents a challenge for health professionals. Acceptance and Commitment Therapy (ACT) and Brief Behavioural Activation Treatment for Depression (BATD) are effective treatments for patients with persistent pain and depression, respectively. The objectives of this 12 month, multicentre, randomised, controlled trial (RCT) are (i) to examine the efficacy and cost-utility of adding a group-based form of ACT or BATD to treatment-as-usual (TAU) for patients with CLBP and moderate to severe levels of depressive symptoms; (ii) identify pre–post differences in levels of some physiological variables and (iii) analyse the role of polymorphisms in the FKBP5 gene, psychological process measures and physiological variables as mediators or moderators of long-term clinical changes.Methods and analysisParticipants will be 225 patients with CLBP and moderate to severe depression symptoms recruited at Parc Sanitari Sant Joan de Déu (St. Boi de Llobregat, Spain) and Hospital del Mar (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs TAU+ACT versus TAU+BATD. A comprehensive assessment to collect clinical variables and costs will be conducted pretreatment, post-treatment and at 12 months follow-up, being pain interference the primary outcome measure. The following physiological variables will be considered at pretreatment and post-treatment assessments in 50% of the sample: immune-inflammatory markers, hair cortisol and cortisone, serum cortisol, corticosteroid-binding globulin and vitamin D. Polymorphisms in the FKBP5 gene (rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916) will be analysed at baseline assessment. Moreover, we will include mobile-technology-based ecological momentary assessment, through the Pain Monitor app, to track ongoing clinical status during ACT and BATD treatments. Linear mixed-effects models using restricted maximum likelihood, and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and disseminationThis study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu and Hospital del Mar. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities.Trial registration numberNCT04140838

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“…This case series was a pilot project, conducted to assist with planning and preparation of a future RCT that would investigate the effectiveness of a multidisciplinary PMP combining exercise with ACT, in comparison to a control intervention for people with chronic pain (Casey et al, ). Specifically, the aim of the study was to explore the acceptability of the group‐based intervention for participants and to investigate the impact of the programme on a range of self‐report health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One‐Year Follow‐Up

Casey

Cotter

Kelly

et al. 2020

Musculoskeletal Care

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Introduction There is growing evidence to support Acceptance and Commitment Therapy (ACT) in the management of chronic pain. However, there is a need for further research evaluating ACT combined with physical exercise, and few studies have assessed the long‐term impact of this type of intervention. This case series reports on the acceptability and impact of an ACT‐based multidisciplinary pain management programme on a range of health outcomes in both the short and long‐term. Methods Seventy‐three participants completed an 8‐week group‐based, pain management programme. The programme combined weekly sessions of ACT with education and exercise classes. Self‐report outcome measures were completed at baseline, post‐intervention and at one‐year follow‐up. The measures assessed pain intensity and interference, psychological distress, self‐efficacy, pain acceptance, values‐based action, pain catastrophizing, fear avoidance and healthcare utilization. Pedometers were worn to objectively measure physical activity. Data were analyzed using linear mixed modelling. Ethical approval for this study was granted by the Mater Misericordiae University Hospital (MMUH) Institutional Review Board (Reference 1/378/1541). Results Eighty‐six percent of respondents reported being satisfied with the intervention. Improvements were observed in most of the self‐report outcomes post‐intervention and many changes were maintained at one‐year. There was also a significant increase in average daily step‐count. Conclusion A pain management programme combining ACT with exercise appears to be an acceptable treatment option for people with chronic pain. While improvements were observed in both the short and long‐term, further fully powered RCTs with long‐term follow‐up are required to test the effectiveness of this type of intervention.

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Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial

Cited by 20 publications

References 69 publications

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One‐Year Follow‐Up

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