Martorella Geraldine, Boitor Madalina, Berube Melanie, Fredericks Suzanne, Le May Sylvie, Gélinas Céline
College of Nursing, Florida State University, Tallahassee, FL, United States.
Tallahassee Memorial Hospital Center for Research and Evidence-Based Practice, Tallahassee, FL, United States.
J Med Internet Res. 2017 Nov 10;19(11):e385. doi: 10.2196/jmir.8826.
Efforts have multiplied in the past decade to underline the importance of pain management. For both acute and chronic pain management, various barriers generate considerable treatment accessibility issues, thereby providing an opportunity for alternative intervention formats to be implemented. Several systematic reviews on Web-based interventions with a large emphasis on chronic pain and cognitive behavioral therapy have been recently conducted to explore the influence of these interventions on pain management However, to our knowledge, the specific contribution of tailored Web-based interventions for pain management has not been described and their effect on pain has not been evaluated.
The primary aim of this systematic review was to answer the following research question: What is the effect of tailored Web-based pain management interventions for adults on pain intensity compared with usual care, face-to-face interventions, and standardized Web-based interventions? A secondary aim was to examine the effects of these interventions on physical and psychological functions.
We conducted a systematic review of articles published from January 2000 to December 2015. We used the DerSimonian-Laird random effects models with 95% confidence intervals to calculate effect estimates for all analyses. We calculated standardized mean differences from extracted means and standard deviations, as outcome variables were measured on different continuous scales. We evaluated 5 different outcomes: pain intensity (primary outcome), pain-related disability, anxiety, depression, and pain catastrophizing. We assessed effects according to 3 time intervals: short term (<1 month), medium term (1-6 months), and long term (6-12 months).
After full-text review, we excluded 31 articles, resulting in 17 eligible studies. Only 1 study concerned acute pain and was removed from the meta-analysis, resulting in 16 studies available for quantitative assessment. Compared with standard care or a waiting list, tailored Web-based intervention showed benefits immediately after, with small effect sizes (<0.40) for pain intensity (10 randomized controlled trials [RCTs], n=1310, P=.003) and pain-related disability (6 RCTs, n=953, P<.001). No other improvements were observed at follow-up in the medium and long terms. Compared with the active control group, no improvements were found for the primary outcome (pain intensity) or any of the outcomes except for a small effect size on pain catastrophizing (2 RCTs, n=333, P<.001) immediately after the intervention.
Tailored Web-based interventions did not prove to be more efficacious than standardized Web-based interventions in terms of pain intensity, pain-related disability, anxiety, and depression. An interesting finding was that some efficacy was shown on pain catastrophizing compared with active control interventions. Considering the diversity of approaches used in tailored Web-based interventions for chronic pain management, their efficacy is yet to be explored. Moreover, their contribution to acute pain management is embryonic.
International prospective register of systematic reviews (PROSPERO): CRD42015027669; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027669 (Archived by WebCite at http://www. webcitation.org/6uneWAuyR).
在过去十年里，人们越来越多地强调疼痛管理的重要性。对于急性和慢性疼痛管理而言，各种障碍导致了严重的治疗可及性问题，从而为实施替代干预形式提供了契机。最近开展了几项关于基于网络干预的系统评价，这些评价主要侧重于慢性疼痛和认知行为疗法，以探讨这些干预对疼痛管理的影响。然而，据我们所知，针对疼痛管理的定制化网络干预的具体作用尚未得到描述，其对疼痛的影响也未得到评估。
本系统评价的主要目的是回答以下研究问题：与常规护理、面对面干预和标准化网络干预相比，针对成年人的定制化网络疼痛管理干预对疼痛强度有何影响？次要目的是研究这些干预对身体和心理功能的影响。
我们对2000年1月至2015年12月发表的文章进行了系统评价。我们使用带有95%置信区间的DerSimonian-Laird随机效应模型来计算所有分析的效应估计值。由于结果变量是在不同的连续量表上测量的，我们从提取的均值和标准差中计算标准化均值差异。我们评估了5种不同的结果：疼痛强度（主要结果）、疼痛相关残疾、焦虑、抑郁和疼痛灾难化。我们根据3个时间间隔评估效果：短期（<1个月）、中期（1 - 6个月）和长期（6 - 12个月）。
经过全文审查，我们排除了31篇文章，最终有17项符合条件的研究。只有1项研究涉及急性疼痛，并被从荟萃分析中剔除，最终有16项研究可用于定量评估。与标准护理或等待名单相比，定制化网络干预在干预后立即显示出益处，疼痛强度（10项随机对照试验[RCT]，n = 1310，P = 0.003）和疼痛相关残疾（6项RCT，n = 953，P < 0.001）的效应量较小（<0.40）。在中期和长期随访中未观察到其他改善。与积极对照组相比，除了干预后疼痛灾难化有较小的效应量（2项RCT，n = 333，P < 0.001）外，主要结果（疼痛强度）或任何其他结果均未发现改善。
在疼痛强度、疼痛相关残疾、焦虑和抑郁方面，定制化网络干预并未被证明比标准化网络干预更有效。一个有趣的发现是，与积极对照干预相比，定制化网络干预在疼痛灾难化方面显示出一定疗效。考虑到用于慢性疼痛管理的定制化网络干预方法的多样性，其疗效仍有待探索。此外，它们对急性疼痛管理的贡献尚处于萌芽阶段。
国际系统评价前瞻性注册库（PROSPERO）：CRD42015027669；http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027669（由WebCite存档于http://www.webcitation.org/6uneWAuyR）
