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Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial
Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Primary Health Care, Norrbotten County Council.ORCID iD: 0000-0001-6032-665X
Luleå University of Technology, Department of Health Sciences, Health and Rehab.ORCID iD: 0000-0003-0112-4657
Luleå University of Technology, Department of Health Sciences, Health and Rehab.ORCID iD: 0000-0001-6975-8344
Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Primary Health Care, Norrbotten County Council.ORCID iD: 0000-0001-8963-2247
Number of Authors: 4
2016 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 10, 265Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR).

OBJECTIVE:

The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated.

METHODS:

A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items.

RESULTS:

Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003).

CONCLUSIONS:

Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable.

Place, publisher, year, edition, pages
2016. Vol. 18, no 10, 265
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:ltu:diva-59603DOI: 10.2196/jmir.5634PubMedID: 27707686ScopusID: 2-s2.0-84994475068OAI: oai:DiVA.org:ltu-59603DiVA: diva2:1033792
Note

Validerad; 2016; Nivå 2; 2016-10-10 (andbra); OBS

Available from: 2016-10-10 Created: 2016-10-10 Last updated: 2016-12-08Bibliographically approved

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Nordin, CatharinaMichaelson, PeterGard, GunvorEriksson, Margareta K.
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