Cheng Abby L, Agarwal Mansi, Armbrecht Melissa A, Abraham Joanna, Calfee Ryan P, Goss Charles W
Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, United States.
Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St Louis, MO, United States.
JMIR Form Res. 2023 Nov 17;7:e51422. doi: 10.2196/51422.
Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood.
The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health.
In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants' engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale-Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P<.20 was considered significant for this pilot study.
Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect -0.4, 80% CI -0.7 to -0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well.
In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health.
ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722.
初步证据表明，数字心理健康干预（用于慢性疼痛的Wysa）可以改善患有慢性肌肉骨骼疼痛并伴有抑郁或焦虑症状的人群的身心健康。然而，这种干预起作用的行为机制尚未完全明确。
本研究旨在确定在慢性肌肉骨骼疼痛的骨科治疗过程中，使用用于慢性疼痛的Wysa可能介导身心健康变化的行为机制。我们假设行为激活、疼痛接受度和睡眠质量的改善介导了自我报告的身心健康的改善。
在这项前瞻性队列的初步中介分析中，患有慢性（≥3个月）颈部或背部疼痛的成年人接受了用于慢性疼痛的Wysa数字干预，该干预使用对话代理和基于文本的方式联系人类咨询师，以提供认知行为疗法及相关治疗内容。在基线和1个月时收集患者报告的结局和拟议的中介变量。感兴趣的暴露因素是参与者与数字干预的参与度（即总互动次数）。使用抑郁症行为激活量表简版、慢性疼痛接受问卷和雅典失眠量表评估拟议的中介变量。结局包括患者报告结局测量信息系统焦虑、抑郁、疼痛干扰和身体功能评分。采用Baron和Kenny方法进行中介分析，并对年龄、性别以及基线中介变量和结局值进行调整。对于这项初步研究，P<0.20被认为具有统计学意义。
在30例患者（平均年龄59岁，标准差14岁；21例[70%]为女性）中，行为激活对干预参与度增加与焦虑症状改善之间关系的中介效应达到了预定义的统计学显著性阈值（间接效应-0.4，80%CI -0.7至-0.1；P=0.13，占总效应的45%）。中介效应的方向在所有其他拟议的中介变量或结局关系中通常也与我们的假设一致。
在一项针对慢性肌肉骨骼疼痛患者的全规模随机对照试验中，行为激活、疼痛接受度和睡眠质量可能在介导数字心理健康干预（用于慢性疼痛的Wysa）的使用与身心健康改善之间的关系中发挥重要作用。
ClinicalTrials.gov NCT05194722；https://clinicaltrials.gov/ct2/show/NCT05194722 。
