Smartphone intervention with diaries and situational feedback for women with fibromyalgia – Randomized controlled trial of a smartphone intervention with therapist feedback to reduce pain-related catastrophizing using elements from Acceptance and Commitment Therapy following inpatient chronic pain rehabilitation
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Abstract
E-health involves the use of technology-based communication methods to provide health care. It is a rapidly expanding field.In this thesis, a four-week smartphone intervention given as after-care to women with fibromyalgia who had completed an inpatient chronic pain rehabilitation program is investigated. The aim was to support constructive self-management by the means of daily electronic diaries and written situational therapist-feedback focusing on thoughts, feelings and behavior related to self-management. The therapeutic framework was based on cognitive behavioral therapeutic principles from Acceptance and Commitment Therapy. The pilot testing of the intervention is described in Paper I. In Papers II and III, the short- and long-term (5- and 11-month) effects of the intervention were investigated in a randomized controlled trial, with pain-related catastrophizing - maladaptive cognitions - as the primary outcome. The participants’ experience of the intervention was assessed with self-report questionnaires (Papers I and II). Both the intervention group and the control group received access to a website with self-management information.
The smartphone intervention was generally well accepted and experienced as supportive and meaningful. 140 women were included in the trial and 112 completed the study; 48 in the intervention group and 64 in the control group. The effect on catastrophizing (measured with Pain Catastrophizing Scale) was large (Cohen’s d = .87, P < .001) for the study completers after the smartphone intervention and moderate (d = .74, P = .003) at a 5-month follow-up. At the 11-month follow-up there was no between-group difference on any of the outcome variables.
The lack of between-group effects at the 11-month follow-up may indicate a need for more continuity in interventions to support self-management in persons with fibromyalgia. However, the positive short- and midterm effects and the feasibility results suggest a promising intervention.
List of papers
Paper I: Kristjánsdóttir, ÓB, Fors EA, Eide E, Finset A, van Dulmen, S, Wigers SH, Eide H. Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention. BMC Musculoskeletal Disorders 2011; 12:51. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. https://doi.org/10.1186/1471-2474-12-51 |
Paper II: Kristjánsdóttir, ÓB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, Wigers SH, Eide H. A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: Randomized controlled trial. Journal of Medical Internet Research 2013; 15(1): e5. This is an open-access article distributed under the terms of the Creative Commons Attribution License. https://doi.org/10.2196/jmir.2249 |
Paper III: Kristjánsdóttir, ÓB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, Wigers SH, Eide H. A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain. Part 2: 11- month follow-up results of a randomized trial. Journal of Medical Internet Research 2013; 15(3): e72. This is an open-access article distributed under the terms of the Creative Commons Attribution License. https://doi.org/10.2196/jmir.2442 |