Background & Aims

Chronic Pain (CP) imposes a substantial burden on individuals, including physical discomfort and mental distress (1). While pain management programmes (PMP) are recommended for the management of CP, implementation obstacles remain. Although online interventions may address these obstacles, few studies have investigated their long-term acceptability and feasibility. Exercise is recognised as an effective treatment for CP. In addition, Mindfulness-Based Stress Reduction (MBSR), a group-based third wave mindfulness-based intervention focusing on mind body and behavior, shows extensive evidence base in the treatment of CP. However, there is limited research investigating combining MBSR and exercise online for CP, and the resulting effects of longer follow-ups of this combined intervention. This study investigates the acceptability and feasibility of an online MBSR and exercise programme for patients with CP compared to an online self-management guide at one-year follow-up (2).

Methods

This is a 1 year follow-up study of a parallel-group feasibility randomised controlled trial. 96 participants with CP were randomized to the MOVE or self-management (SM) group interventions. The MOVE group participated in an 8-week online live synchronous intervention combining MBSR and exercise. The SM group received access to an online CP self-management guide. 9 patient-reported outcome measures (PROMs), measuring pain intensity and interference (BPI), pain-related disability (PDI), quality of life (SF-36), perceived global impression of change (PGIC), anxiety (GAD-7), depression (PHQ-9), self-efficacy (PSEQ), pain catastrophizing (PCS), and fear avoidance (FABQ), were collected at baseline, post-intervention, at 12-week and at 1 year follow-up. Data were analyzed using linear mixed models. Baseline characteristics for participants’ demographic and clinical data were reported using descriptive statistics. Effect sizes were interpreted according to the guideline provided by Cohen(3).

Results

67 (70%) of participants completed PROMs at 12-weeks and 48 (50%) completed PROMs at a 1 year follow-up. Small between group differences were observed in the PHQ-9 and the SF-36 Mental Component Score showing improvement in favour of the MOVE group, and a further 9 PROMS showed small improvements in favour of the SM group, all with small (d<0.2) to medium (d=0.64) effect sizes. Within-group changes over time for the MOVE intervention showed improvements in 3 PROMs (GAD-7, PHQ-9, SF-36 PCS) at 1 year follow-up compared to 12-week follow-up. In the SM group, 6 PROMs (PDI, PCS, BPI interference and severity, FABQ physical activity, SF-36, PCS) improved at 1 year compared to 12-week follow-up. In both groups, within-group clinically significant improvements were observed in the SF-36 Physical Component Score.
For the PCIC, 63.3% (n=19) of participants in the MOVE group, and 44.4% (n=8) of participants in the SM group reported an improvement with a noticeable change.

Conclusions

The results of this 1 year follow-up feasibility study suggest that both the online MOVE intervention group and the online SM guide formats explored in this study were feasible and acceptable. There were no missing data reported due to the online format used for collecting the PROMs, which appeared to be a feasible and acceptable method for both data collection and data extraction. The data collection measures for the 1 year follow-up were found to be feasible and the response rates were at an acceptable level. A fully powered RCT examining the effectiveness of MBSR combined with exercise delivered in a live synchronous online format is warranted. The SF-36 is proposed as an appropriate primary outcome measure for a future RCT, capturing both the physical and emotional aspects of quality of life and reflecting both the major components of the MBSR and exercise intervention in the MOVE-Online trial.

References

1.Raftery, M. N., Sarma, K., Murphy, A. W., De la Harpe, D., Normand, C., & McGuire, B. E. (2011). Chronic pain in the Republic of Ireland—community prevalence, psychosocial profile and predictors of pain-related disability: results from the Prevalence, Impact and Cost of Chronic Pain (PRIME) study, part 1. Pain, 152, 1096-1103. https://doi.org/10.1016/j.pain.2011.01.019
2.Deegan, O., Fullen, B. M., Casey, M. B., Segurado, R., Hearty, C., & Doody, C. M. (2022). Combined online interactive mindfulness and exercise programme (MOVE-Online) compared with a self-management guide for adults with chronic pain: protocol for a randomised controlled feasibility trial. BMJ open, 12, e058265. https://doi.org/10.1136/bmjopen-2021-058265
3.Cohen, J. (1988). The effect size index: d. In Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

Presenting Author

Mai Yoshitani

Poster Authors

MAI YOSHITANI

University College Dublin

Lead Author

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Orla Deegan

University College Dublin, Qatar University

Lead Author

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Brona Fullen

University College Dublin

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Maria Gordon

University College Dublin

Lead Author

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Orla McDonagh

University College Dublin

Lead Author

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Orlaith Sheerin

University College Dublin

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Jane Murphy

University College Dublin

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Ore Oyebode

University College Dublin

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Ricard Segurado

University College Dublin

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Conor Hearty

Mater Misericordiae University Hospital

Lead Author

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Máire Casey

Mater Misericordiae University Hospital, Trinity College Dublin, Discipline of Physiotherapy

Lead Author

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Catherine Doody

University College Dublin

Lead Author

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Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science

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