Kristjánsdóttir Olöf Birna, Fors Egil A, Eide Erlend, Finset Arnstein, Stensrud Tonje Lauritzen, van Dulmen Sandra, Wigers Sigrid Hørven, Eide Hilde
Institute of Nursing, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
J Med Internet Res. 2013 Jan 7;15(1):e5. doi: 10.2196/jmir.2249.
Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited.
The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program.
A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels.
Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen's d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen's d=0.74, P=.003), acceptance of pain (Cohen's d=0.54, P=.02), and functioning and symptom levels (Cohen's d=0.75, P=.001).
The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation.
Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY).
采用认知行为方法的基于互联网的干预措施，在促进慢性疼痛疾病的自我管理方面可能有效。通过智能手机提供的网络程序越来越多地用于支持各种健康疾病的自我管理，但针对慢性疼痛患者的智能手机干预研究有限。
本试验旨在研究在住院慢性疼痛康复项目之后，一项为期4周、通过智能手机提供的干预措施（包括书面日记和治疗师反馈）的疗效。
共有140名患有慢性广泛性疼痛的女性参与了为期4周的住院康复项目，她们被随机分为两组：康复后接受或不接受智能手机干预。智能手机干预包括1次面对面会议和4周通过智能手机进行的书面交流。参与者每天收到3条智能手机日记条目，以帮助他们了解和反思与疼痛相关的想法、感受及活动。注册的日记可供治疗师即时查看，治疗师会根据认知行为原则每天提交个性化书面反馈。两组患者出院后均可访问一个非交互式网站，以促进建设性的自我管理。通过自我报告问卷来测量结果。使用疼痛灾难化量表（评分范围0 - 52）确定灾难化的主要结局指标。次要结局指标包括对疼痛的接受程度、情绪困扰、功能状况和症状水平。
140名参与者中，112人完成了研究：干预组48人，对照组64人。在干预期结束后立即进行评估，干预组报告的灾难化程度（均值9.20，标准差5.85）低于对照组（均值15.71，标准差9.11，P <.001），对于研究完成者而言效应量较大（科恩d值 = 0.87）。在5个月的随访中，两组之间在灾难化程度（科恩d值 = 0.74，P =.003）、对疼痛的接受程度（科恩d值 = 0.54，P =.02）以及功能状况和症状水平（科恩d值 = 0.75，P =.001）方面的组间效应量仍为中等。
结果表明，对于住院康复后的慢性广泛性疼痛女性患者，一项通过智能手机提供的、包含日记和个性化反馈的干预措施可以减少灾难化，并防止功能障碍和症状水平增加。
Clinicaltrials.gov NCT01236209；http://www.clinicaltrials.gov/ct2/show/NCT01236209（由WebCite存档于http://www.webcitation.org/6DUejLpPY）
