Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial

Herbert, Matthew S.; Afari, Niloofar; Liu, Lin; Heppner, Pia; Rutledge, Thomas; Williams, Kathryn E; Eraly, Satish A.; VanBuskirk, Katie; Nguyen, Cathy; Bondi, Mark W.; Atkinson, J. Hampton; Golshan, Shahrokh; Wetherell, Julie Loebach

doi:10.1016/j.jpain.2016.10.014

Cited by 110 publications

(146 citation statements)

References 47 publications

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“…Therefore, a more useful strategy for a future trial would be to compare face‐to‐face and online ACT. A recent noninferiority trial compared ACT delivered via video teleconferencing (using more intensive therapist support than the current study), to in‐person delivery in US veterans (Herbert et al., ). Support for noninferiority of remote delivery was found; however, there was greater attrition in the teleconferencing arm (Herbert et al., ).…”

Section: Discussionmentioning

confidence: 96%

Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom

Scott

Chilcot

Guildford

et al. 2018

European Journal of Pain

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Section: Discussionmentioning

confidence: 96%

Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom

Scott

Chilcot

Guildford

et al. 2018

European Journal of Pain

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“…In order to determine if there was a difference between the standard treatment and the experimental treatment, a minimum of 62 patients (31 per group) was required to be 80% sure that the lower limit of a onesided 95% confidence interval (or equivalently a 90% twosided confidence interval) will be above the predetermined noninferiority limit of −1 [34]. e noninferiority limit was determined using standard deviation (SD) of the difference in change in pain interference from a previously published noninferiority trial examining chronic pain [35].…”

Section: Sample Sizementioning

confidence: 99%

Group versus Individual Acupuncture (AP) for Cancer Pain: A Randomized Noninferiority Trial

Reed

Landmann²,

Oberoi

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Background. A service delivery model using group acupuncture (AP) may be more cost-effective than individual AP in general, but there is little evidence to assess whether group AP is a comparable treatment in terms of efficacy to standard individual AP. The study aimed to compare the group to individual delivery of 6-week AP among cancer patients with pain. Methods. The study design was a randomized noninferiority trial of the individual (gold standard treatment) vs. group AP for cancer pain. The primary outcome was pain interference and severity, measured through the Brief Pain Inventory (BPI). Secondary outcomes included measures of mood, sleep, fatigue, and social support. Changes in outcomes from pre- to postintervention were examined using linear mixed effects modeling and noninferiority was inferred using a noninferiority margin, a difference of change between the two arms and 95% CIs. Pain interference was tested with a noninferiority margin of 1 on the BPI, while pain severity and secondary outcomes were compared using conventional statistical methods. Results. The trial included 74 participants randomly allocated to group (35) or individual (39) AP. The noninferiority hypothesis was supported for pain interference [Ө − 1, Δ 1.03, 95% CI: 0.15–2.20] and severity [Ө − 0.81, Δ 0.52, 95% CI:.33–1.38] as well as for mood [Ө − 7.52, Δ 9.86, 95% CI: 0.85–18.86], sleep [Ө − 1.65, Δ 2.60, 95% CI: 0.33–4.88], fatigue [Ө 8.54, Δ − 15.57, 95% CI: 25.60–5.54], and social support [Ө.26, Δ − 0.15, 95% CI: − 0.42–0.13], meaning that group AP was not inferior to individual AP treatment. Both arms evidenced statistically significant improvements across all symptoms before and after the intervention. Effect sizes for the group vs. individual AP on outcomes of pain, sleep, mood, and social support ranged from small to very large and were consistently larger in the group condition. The total average cost-per-person for group AP ($221.25) was almost half that of individual AP ($420). Conclusions. This is the first study to examine the noninferiority of group AP with the gold standard individual AP. Group AP was noninferior to individual AP for treating cancer pain and was superior in many health outcomes. Group AP is more cost-effective for alleviating cancer pain and should be considered for implementation trials.

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“…In a 2018 randomized controlled clinical trial, Rutledge et al documented that cognitive behavioral therapy for lower back pain delivered by telephone was associated with significant improvement in pain interference and an approximately 1.2‐point (24%) reduction in pain intensity, with more than 33% of participants achieving a ≥30% reduction in pain intensity on a numeric rating scale of 0 to 10 at 8 weeks . Similar reductions in pain intensity and pain interference have also been shown in randomized trials of behavioral therapy for pain in other settings and via other delivery modalities (eg, nurses vs. therapists, group vs. individual, face‐to‐face vs. virtual) . The improvements in behavioral health symptoms experienced by this cohort were correlated with reductions in pain; this co‐occurrence is of clinical importance because improvements in behavioral health symptoms predict better pain outcomes …”

Section: Discussionmentioning

confidence: 73%

“…14 Similar reductions in pain intensity and pain interference have also been shown in randomized trials of behavioral therapy for pain in other settings and via other delivery modalities (eg, nurses vs. therapists, group vs. individual, face-to-face vs. virtual). [30][31][32][33] The improvements in behavioral health symptoms experienced by this cohort were correlated with reductions in pain; this co-occurrence is of clinical importance because improvements in behavioral health symptoms predict better pain outcomes. 34,35 Extending the reach of evidence-based, nonpharmacologic therapies for chronic pain is of particular importance given the pervasiveness of chronic pain and the concurrent and growing epidemic of opioid misuse.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Workplace Outcomes From a Virtually Delivered Cognitive Behavioral Therapy Program for Pain

Mochari‐Greenberger¹,

Andreopoulos²,

Peters³

et al. 2020

Pain Practice

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Objectives To evaluate clinical and workplace outcomes from an evidence‐based virtual behavioral therapy program for individuals with pain and behavioral health issues. Methods This was a retrospective de‐identified data analysis among a cohort of 1,086 participants enrolled in a standardized, evidence‐based telebehavioral therapy program between September 1, 2016, and August 31, 2017 (mean age 53 ± 11.5 years; 29% male). The program was delivered over approximately 8 weeks by licensed therapists and behavior coaches by telephone or video, and tailored to the pain management and behavioral health goals of each participant. Structured measurements were documented in the electronic clinical record, including demographics, comorbidities, pain severity (Pain Intensity, Enjoyment of Life, General Activity tool), behavioral health symptoms (Depression, Anxiety and Stress Scale short form), and productivity (Work Productivity and Activity Impairment survey). Results At baseline, participants had high average pain severity (5.8/10 points), high frequencies of behavioral health symptoms (68%), and activity impairment (90%); absenteeism (34%) and presenteeism (75%) were observed among employed individuals. Pain severity and pain interference improved by 17% and 27%, respectively, over 8 weeks (P < 0.0001). Reductions in depression, anxiety, and stress symptoms were significant and associated with reductions in pain interference (P < 0.0001). Absenteeism, presenteeism, and activity impairment ratings each improved by more than 25% (P < 0.0001). Discussion Participants in a virtually delivered behavioral therapy program for pain experienced significant improvements in pain intensity, pain interference, behavioral health symptoms, and work productivity.

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Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial

Cited by 110 publications

References 47 publications

Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom

Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom

Group versus Individual Acupuncture (AP) for Cancer Pain: A Randomized Noninferiority Trial

Clinical and Workplace Outcomes From a Virtually Delivered Cognitive Behavioral Therapy Program for Pain

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