JMIR Publications

ABSTRACT

Background:

Non-pharmacological interventions for veterans are needed to help them manage chronic pain and posttraumatic stress disorder (PTSD) symptoms. Complementary and integrative health (CIH) interventions, such as Mission Reconnect (MR), seek to provide veterans the option of a partnered, self-directed intervention that remotely teaches CIH skills to support symptom management.

Objective:

The purpose of this study was to describe the physical, psychological, and social outcomes of a self-directed mobile and web based CIH intervention for veterans with comorbid chronic pain and PTSD and their partners, and qualitatively examine their MR user experience.

Methods:

Veteran-partner dyads (n=364) were recruited to participate in a mixed-methods multi-site waitlist control (WC) randomized-controlled trial to measure physical, psychological, and social outcomes, with pain as the primary outcome, and PTSD, depression stress, sleep, quality of life and relationships as secondary outcomes. Linear mixed models were constructed for primary and secondary patient reported outcomes. The quantitative analysis was triangulated with qualitative interviews from a subsample of dyads (n=35) to examine participants’ perceptions of their program experience.

Results:

Dyads were randomized to two groups: intervention (MR, n=140) and waitlist control (WC, n=136). No significant change was observed in overall pain; sleep; PTSD; quality of life; relationship satisfaction; overall self-compassion or compassion for others. Significant reduction in pain interference in mood (p=.008) and sleep (p=.008) was observed among the veteran MR group that was not observed in WC group (p<.01). We also observed a positive effect of the MR intervention on a reduction in negative affect associated with pain (p=.049). Significant improvements were also observed for partners, in affection (p= .007) and conflict (p= .001) subdomains of the consensus and satisfaction domains. In contrast to quantitative results, qualitative data indicate intervention impacts included improved sleep, and reduced pain, anxiety, stress, and in contrast to the survey data, overall improvement in PTSD symptoms, and social relationships. Participants’ overall impressions of MR, which highlight usability and navigation; perceptions on packaging and content; and barriers and facilitators to MR use.

Conclusions:

Adjunctive CIH modalities can be delivered using web and mobile based applications but should be developed and tailored using established best practices. MR may be beneficial for veterans with pain and PTSD and their partners. Further pragmatic trials and implementation efforts are warranted. Clinical Trial: Clinical Trial # NCT03593772