JMIR Publications

ABSTRACT

Background:

Spinal surgery patients report high levels of insecurity, pain, stress and anxiety, before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain and some spinal surgery patients do not experience (long-term) improvement in pain relief after surgery. Therefore, a focus on sustainable coping skills and resilience seems crucial for these patients. A digital health intervention, based on Acceptance and Commitment Therapy and positive psychology has been developed to enhance psychological flexibility and well-being and to reduce postsurgical pain.

Objective:

The objective of the current study is threefold: to explore the potential benefits for spinal surgery patients of the digital ACT and PP intervention “Strength Back” (Research Question 1), to explore the feasibility of a future RCT in terms of recruitment and drop-out (RQ2), and to assess the acceptability of “Strength Back” by spinal surgery patients (RQ3).

Methods:

We used a non-randomized experimental design with an intervention group (n=17) and a control group (n=20). To explore potential benefits for the intervention, participants of both groups filled in questionnaires before and after surgery. These questionnaires included measurements of pain intensity (NRS), pain interference (MPI), anxiety and depression (HADS), valued living (ELS), psychological flexibility (PIPS), and mental well-being (MHC-SF). Semi-structured interviews in combination with log data and scores on the TWente Engagement with Ehealth Technologies Scale (TWEETS) were used to assess acceptability of the intervention.

Results:

A significant improvement over time on emotional and overall well-being (MHC-SF) was only found for the intervention group (resp. V = 99, p = .026; V = 55, p = .004). In addition, the intervention group showed a significantly larger decline in pain intensity (NRS) than the control group (U = 75, p = .003). On average 75% of the available weekly modules were completed and 68% of the participants used the intervention until the final interview. The majority of the participants (n=15 out of 17) in the intervention group would recommend the intervention to future patients.

Conclusions:

This pilot feasibility study shows that combining Acceptance & Commitment Therapy and positive psychology in a digital health intervenion is promising for spinal surgery patients as the content was accepted by the majority of the participants and (larger) improvements on pain intensity and well-being were found for the intervention group. A digital intervention for (spinal) surgery patients can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterwards, to also provide patients with content that they may not have found or chosen themselves, but that is known to help them in the recovery process. A larger RCT is now warranted.