JMIR Publications

ABSTRACT

Background:

Chronic pain can be complex and taxing to live with. Treatment and support require a multi-component approach that considers biopsychosocial factors, but such treatment may not always be available, and new, innovative ideas and solutions are needed. Smartphones, tablets, and personal computers are already incorporated into patients’ daily lives, and therefore have the potential to facilitate a way to communicate, educate, and support self-management. Research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is however still limited.

Objective:

The current feasibility pilot study aimed to explore system use, perceived usefulness, and ease of use and preliminary effects of EPIO, an application (app) based cognitive-behavioral pain self-management intervention program for patients living with chronic pain.

Methods:

The EPIO intervention was delivered in a blended-care model containing: (a) one face-to-face introduction session, (b) nine cognitive behavioral-based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (c) one follow-up phone call at 2-3 weeks post introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and at 3-months post introduction session, with registration of system use (i.e., log-data) until 6-months post introduction session. Use, perceived usefulness and ease of use of the EPIO program were examined through system use log-data as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effect included the Brief Pain Inventory (BPI), Health-Related Quality of Life (RAND-36), the Hospital Anxiety and Depression Scale (HADS), Self-regulatory Fatigue (SRF-18), the Pain Catastrophizing Scale (PCS) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analyses included paired samples t-tests.

Results:

Participants (N=50) were median 52 (range: 29-74) years old at inclusion, and mainly female (40/50, 80%). Thirty-one participants completed at least 6 of the 9 modules of the EPIO program within the 3-months study period, yielding a 62% intervention completion rate. Forty-five participants completed outcome measures at 3-months, and the EPIO program was rated as useful (i.e., “totally agree” or “agree”; 39/45, 87%), easy to use (42/45, 93%), and with easily understandable exercises (44/45, 98%). The average overall system usability (SUS) score was 85.7, indicating a grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily non-significant pre-post intervention improvements at 3-months, but with statistically significant positive effects related to some aspects of health-related quality of life (Bodily Pain and Change).

Conclusions:

Digital self-management intervention programs may be of use and support for patients living with chronic pain. In the current feasibility study, EPIO, a digital cognitive-behavioral pain self-management intervention program for patients living with chronic pain, showed acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large scale randomized controlled trial is warranted and in progress. Clinical Trial: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104