O. Deegan1, B. Fullen1, M.-B. Casey2, R. Segurado1, C. Hearty3, C. Doody1
1University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland, 2Trinity College Dublin, School of Medicine, Dublin, Ireland, 3Mater Misericordiae University Hospital, Department of Pain Medicine, Dublin, Ireland
Background: Pain management programmes (PMP) have been shown to be effective in reducing pain interference, pain intensity and distress associated with chronic pain (CP). Mindfulness-based stress reduction (MBSR) is an evidence-based intervention associated with reduced catastrophisation and improved self-efficacy in adults with CP. In addition, supervised group exercise is recommended for individuals with CP. Limited studies exist combining these interventions in an online PMP.
Purpose: This feasibility randomised controlled trial (RCT) explored the acceptability and feasibility of delivering a combined MBSR and exercise online PMP for adults with CP, and examined the feasibility of conducting a future RCT combining MBSR and exercise online programme compared to an online self-management guide.
Methods: Participants were randomised into an 8-week online synchronous MBSR and exercise programme (group A) or an 8-week online self-management guide (group B). Primary outcome measures included feasibility measures of recruitment, retention, adherence, and satisfaction with treatment. Secondary patient reported outcome measures (PROMs) at baseline, post intervention and 12-week follow-up included pain intensity and interference (BPI), self-efficacy (PSEQ), pain catastrophising (PCS), fear avoidance (FABQ), depression and anxiety (PHQ9, GAD-7), quality of life (SF-36), pain related disability (PDI) and patient global rating of change (PGIC). Participants wore a Fitbit watch during the study. Analysis was descriptive addressing outcomes relating to the feasibility and acceptability of the interventions and comparisons of clinical treatment effects.
Results: 96 participants (female n=79, mean age 50.5±12 years) were randomised and 80 participants (83.3%) completed the interventions. All baseline PROMs were completed with no missing items, 82.3% (n=79) post-intervention, 69.8% (n=67) at 12-week follow-up. Participants in group A attended a mean of 6/8 (SD2.6) sessions of MBSR and 5.55/8 (SD2.62) of exercise; group B participants attended a mean of 5.74/8 (SD 2.56) modules. 76.3% (n=73) of participants adhered to wearing the Fitbit watch for 8-weeks. The mean Client Satisfaction Questionnaire-8 score was higher in group A 26.2(±5.5) than group B 19.4(±5.6). The PGIC scale showed favourable changes with 65.1% of group A and 42.3% of group B reporting improvement.
Favourable within group differences were noted post-intervention in both groups for a number of PROMs; PSEQ, PDI, GAD-7, PCS, PHQ-9, BPI, FABQ (physical activity subscale) and SF-36 (mental component score). Between group differences in favour of group A post-intervention were found for GAD-7, PCS (magnification subscale), PHQ-9, BPI (interference subscale and composite severity subscales) and SF-36 (mental component score) and in favour of group B for PSEQ, PDI, PCS (rumination and helplessness subscale), FABQ, and SF-36 (physical component subscale).
Favourable within group differences were noted post-intervention in both groups for a number of PROMs; PSEQ, PDI, GAD-7, PCS, PHQ-9, BPI, FABQ (physical activity subscale) and SF-36 (mental component score). Between group differences in favour of group A post-intervention were found for GAD-7, PCS (magnification subscale), PHQ-9, BPI (interference subscale and composite severity subscales) and SF-36 (mental component score) and in favour of group B for PSEQ, PDI, PCS (rumination and helplessness subscale), FABQ, and SF-36 (physical component subscale).
Conclusions: The results of this study demonstrate the feasibility of both online MBSR and exercise and self-management guide interventions for people with CP. A fully powered future RCT with the BPI proposed as an appropriate primary outcome measure is merited.
Implications: The gap between CP treatment demands and resource availability in the form of PMPs can be potentially addressed using internet-based interventions as described in the current study. The data collected suggests that a further fully powered RCT is warranted to explore the effectiveness of a synchronous online mindfulness and exercise intervention.
Funding acknowledgements: This work is funded by the UCD Centre for Translational Pain Research.
Keywords:
Chronic pain
Pain management programme
eHealth
Chronic pain
Pain management programme
eHealth
Topics:
Pain & pain management
Health promotion & wellbeing/healthy ageing/physical activity
Disability & rehabilitation
Pain & pain management
Health promotion & wellbeing/healthy ageing/physical activity
Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: University College Dublin
Committee: Human Research Ethics Committee – Sciences
Ethics number: LS-20-76-Deegan-Doody
All authors, affiliations and abstracts have been published as submitted.
