Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 9, 2020
Date Accepted: May 20, 2020
Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot Decreases Postoperative Opioid Utilization in Orthopaedic Trauma Patients: Randomized Control Trial
ABSTRACT
Background:
Acceptance and Commitment Therapy (ACT) is a pragmatic approach to help individuals decrease avoidable suffering and pain.
Objective:
To evaluate the effects of Acceptance and Commitment Therapy (ACT) delivered via an automated mobile messaging robot on postoperative opioid utilization and patient reported outcomes (PROs) in orthopaedic trauma patients who underwent operative intervention for their injuries.
Methods:
Adult patients presenting to a Level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who utilized mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first two weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after operative intervention, follow-up was obtained in the form of an opioid medication pill count and postoperative administration of PROs. Mean number of opioid tablets utilized by patients were calculated and compared between groups. Mean PRO scores were also compared between groups.
Results:
Eighty-two subjects were enrolled in the study. Seventy-six (38 ACT, 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group utilized an average of 26.1±21.4 opioid tablets while the control group utilized 41.1±22.0 tablets, resulting in 36.5% less tablets utilized by subjects receiving the mobile phone-based ACT intervention (P= .004). Intervention group subjects reported a lower postoperative PROMIS Pain Intensity score of 45.9±7.2 compared to the control group’s 49.7±8.8 (P= .04).
Conclusions:
In this study the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid utilization in selected orthopaedic trauma patients. Subjects receiving the ACT-based intervention also reported lower pain intensity after two weeks, though this may not represent a clinically important difference. Clinical Trial: ClinicalTrials.gov registry number: NCT03991546
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