Bendelin Nina, Gerdle Björn, Blom Marie, Södermark Martin, Andersson Gerhard
Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden.
Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden.
J Clin Med. 2021 Dec 14;10(24):5872. doi: 10.3390/jcm10245872.
Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP ( = 12 groups) or to MMRP with added IACT ( = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.
通过为居家的慢性疼痛患者提供优质的个性化心理护理，基于互联网的干预措施有望使疼痛康复更容易获得且更具适应性。接纳与承诺疗法（ACT）已在心理功能和疼痛接纳方面显示出有前景的结果。到目前为止，在初级保健中将基于互联网的ACT（IACT）添加到多模式疼痛康复计划（MMRP）中，并未显示出比单独的MMRP更好的效果。这项整群随机对照研究的目的是调查在专科护理中，在MMRP期间及之后添加IACT对心理结果的影响。总共122名在专科疼痛诊所登记的患者被整群随机分组，分为MMRP组（n = 12组）或添加IACT的MMRP组（n = 12组）。添加IACT包括在MMRP期间进行6周的治疗以及在MMRP之后进行11周的心随访。在四个时间点收集疼痛接纳、心理僵化、自我效能以及疼痛的心理社会后果的在线和纸笔自我报告测量数据：MMRP之前和之后、随访干预之后以及1年随访时。失访情况严重，治疗后有25%的患者失访，随访后又有35%的患者失访，1年随访时有29%的患者失访。在治疗后和随访后，发现两组之间在疼痛接纳方面有中等程度的治疗效果，有利于接受添加IACT的MMRP组。随访后在心理僵化和自我效能方面有较大效果。随访后在情感困扰方面有中等效应大小。此外，在1年随访时在自我效能方面发现有中等效应。结果表明，在MMRP期间添加IACT可能会增强对与疼痛相关的心理结果的治疗效果。结果还表明，IACT作为随访护理可能会加强MMRP的长期效果。然而，在已经广泛的疼痛治疗MMRP基础上再添加第二种疼痛治疗IACT，可能会被认为过于全面，因此可能会对完成率产生负面影响。对不良事件和负面影响的进一步研究可能有助于提高依从性。实施试验的下一步可以集中在在MMRP之前添加IACT以改善心理功能，以及在MMRP之后添加IACT以延长其效果。
