Background & Aims
Current best practice recommends group-based pain management programmes (PMPs) for long-term improvements in chronic non-capain-related disability. However, there are barriers (e.g. long waiting times, transport costs and lack of trained professionals) for people to access in-person delivered PMPs in New Zealand. Further, people from Indigenous and non-Western backgrounds are poorly represented in these programmes despite having a high prevalence of persistent pain. We co-designed an online version of an existing hospital-based PMP (iSelf-help) and to ensure cultural appropriateness of the iSelf-help for M?ori – 1,2 the Indigenous population of New Zealand. Using a non-inferiority randomised trial design, we evaluated the clinical and cost-effectiveness of a group-based, online-delivered iSelf-help compared to in-person PMP in reducing pain-related disability at 6 months.3
Methods
The iSelf-help non-inferiority randomised controlled trial (RCT) is a pragmatic, assessor-blinded, two-arm RCT. Adults (age ?18 years) with chronic non-cancer pain referred to a tertiary pain service deemed eligible for a pain management programme were recruited and block randomised to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help group participated in two 60-minute video-conferencing sessions weekly for 12 weeks (first session led by a peer-support facilitator with lived experience of pain; second session led by clinician) with access to resources via smartphone application and a password-protected website. The control participants received 12-week group-based, in-person PMP. Primary outcome was pain-related disability assessed via modified Roland Morris Disability Questionnaire at 6 months post intervention.
Results
We recruited 113 participants (56 iSelf-help and 57 in person) with a mean age of 38.2 (13.7) years. The participants were 75% (n=85) female, 8% (n=9 gender diverse), 16% (n=18) M?ori. Based on an Intention to treat analysis on the primary outcome (Modified Roland Morris Disability Questionnaire) at 6 months (N=73), iSelf-help was non-inferior to the in-person group with a point estimate of -0.4 (?, 1.5). It was also non-inferior for the secondary outcomes of Anxiety, Depression, Stress, Activity interference, Quality of life and Self-efficacy. Economic evaluation: iSelf-help was cheaper, had similar overall satisfaction, but higher accessibility scores.
Conclusions
This is the first on-line, peer support facilitated group PMP, culturally tailored to M?ori with comparable clinical effectiveness in improving pain-related disability in people with chronic non-cancer pain. Offering people a choice between online or in-person delivery provides a more person-centred approach to supporting pain self-management. The up-scaling and implementation of iSelf-help nationally requires further exploration and funding.
References
Help: a co-designed, culturally appropriate, online pain management programme in Aotearoa. Research involvement and engagement. 2022;8:1-15.
2. Devan H, Perry MA, Yaghoubi M, Hale L. “A coalition of the willing”: experiences of co-designing an online pain management programme (iSelf-help) for people with persistent pain. Research Involvement and Engagement. 2021;7:28.
3. Hale L, Devan H, Davies C, et al. Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain—protocol for a non-inferiority randomised controlled trial (iSelf-help trial). BMJ Open. 2021;11.
Presenting Author
Hemakumar Devan
Poster Authors
Hemakumar Devan
PhD
Rehabilitation Teaching and Research Unit (RTRU), Department of Medicine, University of Otago, Welli
Lead Author
Meredith Perry
PhD
School of Physiotherapy, University of Otago, Wellington, New Zealand
Lead Author
Andrew Gray
MSc
Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Lead Author
Sarah Dean
PhD
College of Medicine and Health, University of Exeter Medical School, Exeter, UK
Lead Author
William Leung
MSc
Department of Public Health, University of Otago, Wellington, New Zealand
Lead Author
Dagmar Hempel
MSc
Pain Management Service, Te Whatu Ora (Health New Zealand), Capital, Coast and Hutt Valley, Wellingt
Lead Author
Cheryl Davies
T? Kotahi M?ori Asthma and Research Trust, Wellington, New Zealand
Lead Author
Antony Dowell
PhD
Department of Primary Care, University of Otago, Wellington, New Zealand
Lead Author
Rebecca Grainger
PhD
Department of Medicine, University of Otago, Wellington, New Zealand
Lead Author
Tristram Ingham
MB ChB
Department of Medicine, University of Otago, Wellington, New Zealand
Lead Author
Bernadette Jones
MPH
Department of Medicine, University of Otago, Wellington, New Zealand
Lead Author
Barbara Saipe
Pain Management Service, Te Whatu Ora (Health New Zealand), Capital, Coast and Hutt Valley, Welling
Lead Author
Suranga Dassanayake
School of Physiotherapy, University of Otago, Dunedin, New Zealand
Lead Author
Leigh Hale
PhD
School of Physiotherapy, University of Otago, Dunedin, New Zealand
Lead Author
Topics
- Patient Engagement and Co-Creation in Research and Education