JMIR Publications

ABSTRACT

Background:

Chronic back pain (CBP) is a prevalent condition with substantial individual and socioeconomic impact. Pain catastrophizing is a key psychological factor associated with pain persistence and poor outcomes. Just-in-time adaptive interventions (JITAIs) represent a promising digital approach by delivering context-sensitive, personalized support in daily life. To inform early intervention design, it is important to understand how patients and clinicians prioritize candidate intervention components and delivery features.

Objective:

This study aimed to identify areas of alignment and divergence between patients with chronic back pain and clinicians regarding the prioritization of candidate micro-interventions and key JITAI design features to inform the development of a stakeholder-informed digital intervention targeting pain catastrophizing.

Methods:

Candidate micro-interventions were identified through a targeted, non-systematic literature review. Fifteen patients with chronic back pain and fifteen clinicians with experience in pain treatment participated in structured in-person interviews. Participants prioritized candidate micro-interventions across psychotherapy, relaxation, and physiotherapy domains and separately rated their anticipated effectiveness and expected applicability. They also evaluated symptom-trigger thresholds, preferred intervention frequency, and motivational and interface-related features. Data were summarized descriptively.

Results:

Prioritization patterns varied across interventions and stakeholder groups, and ranking priorities did not consistently correspond to ratings of anticipated effectiveness or expected applicability. Walking and progressive muscle relaxation were highly prioritized relaxation options in both groups, while additional differences emerged for interventions such as breath surfing and body trip. Music Distraction received the highest psychotherapy ranking among patients and shared the highest clinician ranking with Safe Place, although its VAS ratings were more moderate. Yoga received the highest physiotherapy priority in both groups; however, patients rated its expected applicability lower than clinicians and lower than the three strengthening clusters. Patients also preferred lower symptom thresholds for intervention delivery and fewer daily micro-interventions than clinicians. Technical reliability, flexibility, feedback, and motivational features were identified as additional design considerations.

Conclusions:

Patient and clinician responses showed both convergence and divergence across intervention content and delivery preferences. Importantly, relative prioritization, anticipated effectiveness, and expected applicability represented distinct dimensions and should not be treated interchangeably. The findings provide preliminary stakeholder-informed inputs for selecting and adapting candidate components, but do not demonstrate actual applicability or clinical effectiveness. Prospective testing and experimental optimization are required to determine which micro-interventions are beneficial for whom and under which conditions.