Development and pilot evaluation of an online relapse-prevention program based on acceptance and commitment therapy for chronic pain patients
Open accessAbstract
BACKGROUND: A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed. OBJECTIVE: In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)-both as a website and as a mobile app-was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs. METHODS: In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors. RESULTS: The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users. CONCLUSIONS: This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors. TRIAL REGISTRATION: Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D).
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Studies testing online ACT interventions for chronic pain generally appear to have resulted in improvements in pain and mental health outcomes.
“which generally appear to have resulted in improvements in pain and mental health outcomes.”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [17]
The Introduction (page not available) reports a positive effect on catastrophizing among participants who completed one mobile ACT intervention for chronic pain. It also describes improvements from web-based CBT and multidisciplinary rehabilitation, but those are not evidence that online ACT studies generally improved both pain and mental health outcomes. This paper’s pilot evaluation assessed program use and perceived support, not those outcomes. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe possible incubation effect contrasts with previously found meta-analytical evidence on the follow-up effects of ACT interventions for chronic pain (Hughes et al, 2016).
“which would contrast with previously found meta-analytical evidence on the follow-up effects of ACT interventions for chronic pain (Hughes et al, 2016) 17”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [17]
The Introduction (page unavailable) cites a meta-analysis of acceptance-based interventions for chronic pain and says some patients’ therapeutic gains decrease one year after CBT- or ACT-based rehabilitation. It does not report meta-analytical findings specifically about follow-up effects of ACT interventions or assess an incubation effect. The cited 2015 paper also does not discuss Hughes et al. (2016). (LLM, conf=0.82)
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- Authors
- Fledderus, M., Schreurs, K. M., Bohlmeijer, E. T., & Vollenbroek-Hutten, M. M.
- Affiliations
- Roessingh Research and Development (NL)
- University of Twente (NL)
- Corresponding author
- Fledderus, Martine
- Venue
- JMIR Human Factors
- Publisher
- JMIR Publications Inc.
- Published
- 2015-01-05
- Volume
- 2
- Issue
- 1
- Pages
- e1
- ISSN
- 2292-9495 (ISSN-L)
- PMC
- PMC4797667
- OpenAlex
- W2140177682
- Cited by
- 30
- References
- 32
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 1
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Human Factors (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Twente Research Information (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- acceptance and commitment therapy, chronic pain, relapse prevention, online intervention, mobile application, user-centered design, usability evaluation, contextual inquiry, multidisciplinary rehabilitation, behavior maintenance, avoidance behavior, pain management, fatigue, social interaction
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