JMIR Publications

ABSTRACT

Background:

Digital health interventions can improve access and outreach of evidence-based support for people living with chronic pain. How to best deliver such interventions remains unclear, however, and while guided or blended care models show promise, digital interventions are primarily delivered without support or follow-up in real life.

Objective:

To compare the use and effect of the evidence-based digital pain self-management intervention EPIO, when 1) Delivered through digital download without follow-up (ie, EPIONoFollowUp), compared with 2a) Delivery through a simple blended-care model (ie, EPIOBlendedCare), or 2b) Care-as-usual controls.

Methods:

People (n=73) living with chronic pain received access to the EPIO program through individual download (ie, EPIONoFollowUp). Program use and outcome measures were collected over 12 months and compared with findings from a separate randomized controlled trial with people with chronic pain (n=266) either assigned to receive EPIO through a simple blended care model (EPIOBlendedCare), or to a care-as-usual control group. Outcome measures were collected at baseline, 3-, 6-, and 12-month, and included pain interference (BPI; primary outcome), pain severity (BPI), anxiety and depression (HADS), self-regulatory fatigue (SRF-18), health-related quality of life (HRQoL; SF/RAND-36), pain catastrophizing (PCS), and pain acceptance (CPAQ). Program use data (e.g., program progress, frequency of use) were collected through a secure server. Generalized linear models for repeated measures were fitted to explore between-group differences over time. Interviews with the EPIONoFollowUp group (n=15) exploring program use and impact were analyzed using rapid analysis.

Results:

Participants (total N=332) were median 49 years old (range 20-81), primarily women (84%), with a variety of pain conditions. Statistically significant between-group differences in favor of the EPIONoFollowUp group compared to the control group were detected in terms of improved HRQoL and pain acceptance and reduced pain catastrophizing. Comparison of the two intervention groups revealed only significant between-group difference for self-regulation in favor of EPIOBlendedCare. Participants receiving the EPIONoFollowUp delivery model displayed lower program use, averaging 10 (range 1-201) days of use versus 30 (range 1-315) days for EPIOBlendedCare. Similarly, 26% of participants in the EPIONoFollowUp group completed ≥7/9 modules, compared to 62% in EPIOBlendedCare. Education level impacted outcome, with participants with higher education in the EPIONoFollowUp group reporting statistically significant improvements in pain severity, anxiety, HRQoL and pain catastrophizing, and higher module completion. Education level did not have similar impact in EPIOBlendedCare. Qualitative findings identified a penchant for more follow-up, as well as positive changes in awareness, acceptance and coping for the EPIONoFollowUp group.

Conclusions:

Delivery model should be considered when providing access to digital pain self-management, and models with guidance appear the most helpful. When healthcare resources are limited, blended care delivery should be chosen for those who need it the most, for example those with lower education or health literacy. Clinical Trial: ClinicalTrials.gov NCT03705104