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Cited by 78Digital Mental Health InterventionsMusculoskeletal pain and rehabilitationMobile Health and mHealth Applications

A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial

Open access
Kristjánsdóttir, Ólöf Birna, Fors, Egil A, Eide, Erlend, Finset, Arnstein, Stensrud, Tonje Lauritzen, van Dulmen, Sandra, Wigers, Sigrid Hørven, Eide, Hilde·2013·Journal of Medical Internet Research
DOI 10.2196/jmir.2442PMC PMC3636011
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Abstract

BACKGROUND: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. OBJECTIVE: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. METHODS: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress. RESULTS: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen's d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen's d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. CONCLUSION: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0).

AI snapshot

Written from the paper’s full text.

TL;DR

At 11-month follow-up, this randomized trial found no significant between-group differences on catastrophizing or secondary outcomes, so the earlier short-term benefits were not maintained between groups. However, within-group and change-score analyses suggested modest continued improvement in catastrophizing and acceptance in the smartphone intervention group, while the control group showed some worsening on functioning, symptoms, distress, and fatigue.

Key findings

  • No significant between-group differences remained at 11 months on catastrophizing or secondary outcomes (P>.10); for catastrophizing, ITT analyses were LOCF P=.22 and MI P=.31, and per-protocol complete-case P=.18 and MI P=.23.
  • Catastrophizing improved more from discharge (T2) to 11-month follow-up (T5) in the intervention group (M=−2.36, SD 8.41) than the control group (M=.40, SD 7.20), P=.045, using ITT LOCF change scores.
  • Per-protocol within-group analysis showed a small positive effect on catastrophizing in the intervention group (Cohen’s d=.33, P=.04) and no change in the control group; acceptance improved within the intervention group (Cohen’s d=.73, P<.001) but not the control group.
  • From T2 to T5, small-to-large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05), but not within the intervention group.

Methods

  • Parallel-group randomized controlled trial: 140 women with chronic widespread pain were randomized after a 4-week inpatient multidimensional rehabilitation program to a smartphone intervention or control; both groups received access to an informational self-management website.
  • The smartphone intervention consisted of one face-to-face session plus 4 weeks of three daily smartphone diaries and daily personalized written therapist feedback based on cognitive behavioral and acceptance and commitment therapy principles.
  • Outcomes were self-reported paper questionnaires at admission, discharge, 4 weeks after discharge, 5 months, and 11 months; the primary outcome was the Pain Catastrophizing Scale, with secondary measures including CPAQ, FIQ, SF-8, GHQ-12, CPVI, and VAS symptom ratings. Analyses used t-tests, nonparametric tests, Cohen’s d, ITT complete-case/LOCF/multiple imputation, and per-protocol analyses.

Limitations

  • Stated: the 11-month response rate was below 70%; non-returners reported more symptoms at admission, which may have influenced results. Withdrawal was 30.4% in the intervention group versus 3.0% in the control group, and many who withdrew found the combination of smartphone intervention and inpatient participation stressful.
  • Stated: the authors lacked login information for website use and did not include a question assessing participants’ evaluation of the smartphone intervention; within-group catastrophizing results were significant in complete-case analysis (P=.04) but only borderline with multiple imputation (P=.09), so those results should be interpreted cautiously.
  • Evident from the text: despite randomization, groups differed at baseline in mean pain level (P=.02) and SF-8 physical functioning (P=.03); the control group unexpectedly improved on several variables between 5- and 11-month follow-up, which the authors could not explain with available data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.2442

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Between T4 and T5, paired samples t-tests did not show changes in the intervention group (M=.06, SD 5.05, n=31), P=.94 for catastrophizing.

    “Between 5-month follow-up (T4) and 11-month follow-up (T5), paired samples t-tests did not show changes in the intervention group (M=.06, SD 5.05, n=31), P=.94 for catastrophizing.”
    Quote in the paperNot a substantial claim
  • Findingown data

    When all intended-to-treat were analyzed (LOCF), catastrophizing improved more during the follow-up period (T2-T5) in the intervention group (M=-2.36, SD 8.41) than the control group (M=.40, SD 7.20), P=.045.

    “When all intended-to-treat were analyzed (LOCF), catastrophizing seemed to improve more during the follow-up period (T2-T5) in the intervention group (M=-2.36, SD 8.41) than the control group (M=.40, SD 7.20), P=.045, using t-test of change scores.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Reduction in disease impact (measured by FIQ) was found for the intervention group only (Cohen's d=.42, P=.03).

    “Reduction in disease impact (measured by FIQ) was found for the intervention group only (Cohen’s d=.42, P=.03).”
    Quote in the paperSubstantial claim
  • Findingown data

    In the T4-T5 period, there was a reduction in catastrophizing in the control group (M=-3.25, SD 7.09, n=34), P=.01.

    “However, in this period (T4-T5), there was a reduction in catastrophizing in the control group (M=-3.25, SD 7.09, n=34), P=.01.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the analysis where missing variables were imputed, there was a tendency towards a small positive within-group effect during T2-T5.

    “In the analysis, where missing variables were imputed, there was a tendency towards a small positive within-group effect during this period (T2-T5).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 41
  • Classified as probably not a substantial claim. 36
  • The quote only partly states this claim. 5

  • May combine two claims.

    Findingown data

    13.1% (n=5) in the intervention group and 11.1% (n=5) in the control group reported feeling worse now compared to before the inpatient program.

    “13.1% (n=5) in the intervention group and 11.1% (n=5) in the control group reported feeling worse now compared to before the inpatient program.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No between-group differences were found at the 11-month follow-up; P-values ranged from .13 (SF-8, physical) and .17 (CPAQ) to .98 (sleep disturbance).

    “No between-group differences were found at the 11-month follow-up; P-values ranged from .13 (SF-8, physical) and .17 (CPAQ) to .98 (sleep disturbance).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At the 11-month follow-up, there was no difference between the groups on the measure of catastrophizing (PCS) in ITT (LOCF P=.22 and MI P=.31) or per protocol analyses (complete case P=.18 and MI .23).

    “At the 11-month follow-up (T5), there was no difference between the groups on the measure of catastrophizing (PCS); neither according to the ITT-analysis (LOCF P=.22 and MI P=.31) nor the per protocol analysis (complete case analysis, P=.18 and analysis with MI .23).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    No change was reported by 39.5% (n=15) in the intervention group and by 48.9% (n=22) in the control group.

    “No change was reported by 39.5% (n=15) in the intervention group and by 48.9% (n=22) in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a moderate negative effect on fatigue (VAS), and a tendency towards a small negative effect on sleep (VAS) and pain (VAS) in the control group.

    “There was a moderate negative effect on fatigue (VAS), and a tendency towards a small negative effect on sleep (VAS) and pain (VAS) in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When the 5-month follow-up results (T4) were compared to the 11-month follow-up (T5), no changes were found for acceptance, pain level, functioning, and symptom level (measured by FIQ), sleep disturbance, fatigue, and mental health (all P values > 0.10).

    “When the 5-month follow-up results (T4) were compared to the 11-month follow-up (T5), no changes were found for acceptance, pain level, functioning, and symptom level (measured by FIQ), sleep disturbance, fatigue, and mental health (all P values > 0.10).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The control group also showed improvement in depression (measured by a VAS, M=8.29, SD 20.13, n=35, P=.02), whereas no significant change was found in the intervention group during this (T4-T5) period.

    “The control group also showed improvement in depression (measured by a VAS, M=8.29, SD 20.13, n=35, P=.02), whereas no significant change was found in the intervention group during this (T4-T5) period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When comparing the smartphone intervention's baseline data (T2) to the 11-month follow-up (T5), there was a moderate positive effect on acceptance (CPAQ) in the intervention group, but not in the control group.

    “When comparing the smartphone intervention’s baseline data (T2) to the 11-month follow-up (T5), there was a moderate positive effect on acceptance (CPAQ) in the intervention group, but not in the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a tendency towards improvement in values-based living in the intervention group but not in the control group.

    “There was a tendency towards improvement in values-based living in the intervention group but not in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a small negative effect on functioning and symptom levels measured by the FIQ in the control group, but not in the intervention group.

    “There was a small negative effect on functioning and symptom levels measured by the FIQ in the control group, but not in the intervention group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a significant reduction in pain level in the intervention group between T1 and T5, mostly due to changes during the inpatient program.

    “There was a significant reduction in pain level in the intervention group between T1 and T5, mostly due to changes during the inpatient program (see Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For GHQ, there was a large negative effect for emotional distress but only in the control group.

    “For GHQ, there was a large negative effect for emotional distress but only in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During T4-T5, the control group showed improvement in values-based living (M=.25, SD .70, n=33, P=.046), whereas the intervention group did not.

    “During this period (T4-T5), the control group showed improvement in values-based living (M=.25, SD .70, n=33, P=.046), whereas the intervention group did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the physical component of SF-8, there was a small negative effect for the intervention group (P=.046), but not the control group.

    “For the physical component of SF-8, there was a small negative effect for the intervention group (P=.046), but not the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Reduction in physical functioning (measured by SF8) was found in the intervention group (M=3.45, SD 7.76, n=31, P=.02) and a trend towards improvement in the control group (M=2.30, SD 7.10, n=34, P=.07).

    “Reduction in physical functioning (measured by SF8) was found in the intervention group (M=3.45, SD 7.76, n=31, P=.02) and a trend towards improvement in the control group (M=2.30, SD 7.10, n=34, P=.07).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Within-group analyses comparing the baseline for the smartphone intervention to the 11-month data indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.

    “However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In within-group analyses comparing the baseline for the smartphone intervention (T2) to the 11-month data (T5), the intervention group showed changes in the desired direction in catastrophizing, whereas the control group did not.

    “the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, revealed changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.”
    • Also stated in: § Discussion · hedged
      “the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the control group, emotional distress (GHQ-12) increased from T2 to T5, whereas it did not increase in the intervention group.

    “increase in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    • Also stated in: § Discussion · plain
      “increases in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Between the two follow-ups (T2 and T5), the control group reported some improvement in catastrophizing, whereas the intervention group did not.

    “between the two follow-ups, the control group reported some improvement in several variables (catastrophizing, values-based living, and depression) whereas the intervention group did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the control group, disease impact (FIQ) increased from T2 to T5, whereas it did not increase in the intervention group.

    “increase in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    • Also stated in: § Discussion · plain
      “increases in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A positive effect (Cohen's d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group.

    “A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In within-group analyses comparing T2 to T5, the intervention group showed changes in the desired direction in acceptance, whereas the control group did not.

    “the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, revealed changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.”
    • Also stated in: § Discussion · hedged
      “the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Per protocol within-group analysis showed a small positive effect (Cohen's d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up.

    “Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the control group, fatigue (VAS) increased from T2 to T5, whereas it did not increase in the intervention group.

    “increase in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    • Also stated in: § Discussion · plain
      “increases in disease impact, emotional distress, and fatigue were seen in the control group but not within the intervention group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Between T2 and T5, the control group reported some improvement in values-based living, whereas the intervention group did not.

    “between the two follow-ups, the control group reported some improvement in several variables (catastrophizing, values-based living, and depression) whereas the intervention group did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the within-group analysis, the difference between the intervention baseline (T2) and 11-month follow-up (T5) in the intervention group was significant applying complete case analysis (P=.04) but only borderline significant in the analysis with MI (P=.09).

    “in the within-group analysis, the difference between the intervention baseline (T2) and 11-month follow-up (T5) in the intervention group was significant applying complete case analysis (P=.04) but only borderline significant in the analysis with MI (P=.09)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Between T2 and T5, the control group reported some improvement in depression, whereas the intervention group did not.

    “between the two follow-ups, the control group reported some improvement in several variables (catastrophizing, values-based living, and depression) whereas the intervention group did not.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study testing a no-therapist contact online intervention found positive effects on pain, catastrophizing, and disability for the intervention group.

    “Another study, testing the effect of a no-therapist contact online intervention found positive effects on pain, catastrophizing, and disability for the intervention group [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Short-term effects of multidimensional rehabilitation are well established, but concerns about long-term effects have been raised.

    “The short-term effects are well established, but concerns about the long-term effects have been raised [7-11].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [7] source

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    • cites [8] source

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    • cites [9] source

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    • cites [10] Turk, DC, 1991, Pain source

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    • cites [11] source

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Multidimensional rehabilitation is the recommended treatment for chronic widespread pain, including interventions based on cognitive behavioral therapy.

    “Multidimensional rehabilitation is the recommended treatment, including interventions based on cognitive behavioral therapy (CBT) where patients learn how thoughts, beliefs, and feelings can influence the pain experience and functioning [6,7].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Flor, H, 2011, Chronic Pain: An Integrated Biobehavioral Approach

      Not checked in the free run.

    • cites [7] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A few studies have investigated a different approach to iCBT with daily communication with a therapist over a few weeks, using a personal digital assistant or smartphone.

    “A few studies have investigated a different approach to iCBT with daily communication with a therapist over a few weeks, using a personal digital assistant (PDA) or smartphone [20-24].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [20] source

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    • cites [21] source

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    • cites [22] source

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    • cites [23] source

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    • cites [24] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An increasing number of studies on Internet-based interventions, many based on CBT (iCBT), indicate their efficacy in supporting use of constructive self-management strategies in individuals living with chronic illness.

    “An increasing number of studies on Internet-based interventions, many based on CBT (iCBT), indicate their efficacy in supporting use of constructive self-management strategies in individuals living with chronic illness [12-15].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [12] source

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    • cites [13] source

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    • cites [14] source

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    • cites [15] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Most iCBT interventions for chronic pain are based on weekly modules with self-help material and involve weekly written communication with a therapist.

    “Most iCBT interventions for chronic pain are based on weekly modules with self-help material and involve weekly written communication with a therapist [16,19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] source

      Not checked in the free run.

    • cites [19] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Results of research on iCBT for individuals with chronic pain are not entirely consistent, but a recent systematic review concluded that Internet-based interventions seem promising.

    “The results of research on iCBT for individuals with chronic pain are not entirely consistent, but in a recent systematic review, it was concluded that Internet-based interventions seem promising [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of persons with persistent symptoms after multidisciplinary pain management rehabilitation who received 8 weeks of guided iCBT, there was a medium between-group effect between intervention and active control, but a small within-group effect on catastrophizing after the intervention, and improvements were maintained after 6 months.

    “In the third study, persons with persistent symptoms after multidisciplinary pain management rehabilitation received 8 weeks of guided iCBT. There was a medium between-group effect between the intervention group and the active control group, but a small within-group effect on catastrophizing after the intervention, and the improvements were maintained after 6 months [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A randomized trial of a website with self-management information based on CBT and no therapist contact reduced pain and increased physical functioning in individuals with fibromyalgia compared with standard care at 6-month follow-up.

    “A randomized trial of an intervention consisting of a website with self-management information based on CBT and no therapist contact was found to reduce pain and increase physical functioning in individuals with fibromyalgia, compared with a control group receiving standard care alone, at a 6-month follow-up [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In the current study, the Cronbach alpha coefficients for the General Health Questionnaire were .72-.88.

    “In the current study, the Cronbach alpha coefficients were .72-.88.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Cronbach alpha coefficients for the Fibromyalgia Impact Questionnaire were .78-.87.

    “The Cronbach alpha coefficients were .78-.87 (two questions related to work were excluded because of high missing rates).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study is registered at ClinicalTrial.gov (NCT01236209).

    “The study is registered at ClinicalTrial.gov (NCT01236209).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The use of a smartphone instead of a desktop or laptop computer gives the participant the flexibility to register and receive information in different situations of daily life.

    “The use of a smartphone instead of a desktop or laptop computer gives the participant the flexibility to register and receive information in different situations of daily life.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In our sample, the internal consistency of the Pain Catastrophizing Scale was high on all assessments (Cronbach alpha = .89-.94).

    “In our sample, the internal consistency was high on all assessments (Cronbach alpha = .89-.94).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Instead of weekly feedback from a therapist, the participants receive a daily written message personalized according to the recently registered information.

    “Instead of weekly feedback from a therapist, the participants receive a daily written message personalized according to the recently registered information.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    21 withdrew from the intervention group (30.4%) and 2 withdrew from the control group (3.0%).

    “21 withdrew from the intervention group (30.4%) and 2 withdrew from the control group (3.0%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present study, the Cronbach alpha coefficients for the Chronic Pain Values Inventory success scale were .75-.88.

    “In the present study, the Cronbach alpha coefficients for the success scale were .75-.88.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was a trend toward the completers being younger (M=43.33, SD 11.18) than the ones who withdrew (M=48.43, SD 10.06), P=.07.

    “There was a trend toward the completers being younger (M=43.33, SD 11.18) than the ones who withdrew (M=48.43, SD 10.06), P=.07.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Despite randomization, the groups differed in mean pain level (P=.02) and physical functioning measured by SF-8 (P=.03) at admission to the rehabilitation center.

    “Despite randomization, the groups differed in mean pain level (P=.02) and physical functioning measured by SF-8 (P=.03) at admission to the rehabilitation center.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the intervention group, 14 patients did not complete the intervention.

    “In the intervention group, 14 patients did not complete the intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    8 discontinued participation before receiving the allocated intervention.

    “8 discontinued participation before receiving the allocated intervention.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The design is a parallel-group randomized controlled trial.

    “The design is a parallel-group randomized controlled trial.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was a trend towards a higher level of depression (measured by a single VAS) in the group who withdrew (M=43.62, SD 28.57) compared to the completers (M=31.81, 28.92), at admission to the inpatient program, P=.06.

    “Additionally, there was a trend towards a higher level of depression (measured by a single VAS) in the group who withdrew (M=43.62, SD 28.57) compared to the completers (M=31.81, 28.92), at admission to the inpatient program, P=.06.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In our study, the Cronbach alpha coefficients for the Chronic Pain Acceptance Questionnaire were .81-.92.

    “In our study, the Cronbach alpha coefficients were .81-.92.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    At 5-month follow-up, the effects remained moderate for catastrophizing, acceptance of pain, and functioning and symptom level.

    “At 5-month follow-up, the effects remained moderate for catastrophizing, acceptance of pain, and functioning and symptom level [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    140 were randomized to one of the two study arms.

    “140 were randomized to one of the two study arms (Figure 1).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    In the fourth week of the program, participants were randomly assigned to one of the two study groups.

    “In the fourth week of the program, participants were randomly assigned to one of the two study groups.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    In these studies, diaries with questions aiming to support awareness of disability-related thoughts and feelings have been made available to patients on a Web-enabled mobile phone or a smartphone.

    “In these studies, diaries with questions aiming to support awareness of disability-related thoughts (eg, catastrophizing) and feelings have been made available to patients on a Web-enabled mobile phone or a smartphone.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The Cronbach alpha for the SF-8 mental component were .65-.74 and .79-.85 for the physical component.

    “The Cronbach alpha for the mental component were .65-.74 and .79-.85 for the physical component.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    When only completers (n=112) were included, the response rate at T5 was 81.3% (n=39) in the intervention group and 70.3% (n=45) in the control group.

    “When only completers (n=112) were included, the response rate at T5 was 81.3% (n=39) in the intervention group and 70.3% (n=45) in the control group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The effects on catastrophizing in that iCBT trial remained at 6-month follow-up, but more long-term effects are not reported.

    “The effects on catastrophizing were remained at 6-month follow-up, but more long-term effects are not reported [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An 8-week, guided iCBT intervention following multidisciplinary treatment was found to reduce catastrophizing in a randomized trial with 72 persons with residual symptoms post treatment.

    “An 8-week, guided iCBT intervention following multidisciplinary treatment was found to reduce catastrophizing in a randomized trial with 72 persons with residual symptoms post treatment [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Those not returning the follow-up questionnaires reported generally more symptoms at admission to the inpatient program than those who returned them, which could have influenced the results.

    “Those not returning the follow-up questionnaires reported generally more symptoms at admission to the inpatient program than those who returned them, thus having the possibility to influence the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Those who returned the questionnaires at T5 reported also less disease impact (M=56.45, SD 16.82) on FIQ at admission to the inpatient program compared to those who did not return them (M=64.22, SD 14.59), P=.03.

    “Those who returned the questionnaires at T5 reported also less disease impact (M=56.45, SD 16.82) on FIQ at admission to the inpatient program compared to those who did not return them (M=64.22, SD 14.59), P=.03.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Multiple imputations have been recommended to improve the validity of results in trials with incomplete datasets.

    “Multiple imputations have been recommended to improve the validity of results in trials with incomplete datasets [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    This kind of smartphone intervention may therefore be suited for providing self-management support following inpatient pain management program.

    “This kind of smartphone intervention may therefore be suited for providing self-management support following inpatient pain management program.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Improvement in those variables indicates that the participants cope better with their situation.

    “Improvement in those variables indicates that the participants cope better with their situation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Medications, education, CBT, and physical exercises are among the recommended treatment options for individuals with CWP and fibromyalgia.

    “Medications, education, CBT, and physical exercises are among the recommended treatment options for individuals with CWP and fibromyalgia [7,9].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] source

      Not checked in the free run.

    • cites [9] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A smartphone application based on ACT to support values-based living was found feasible in an exploratory study including 11 healthy volunteers.

    “A smartphone application based on ACT to support values-based living was found feasible in an exploratory study including 11 healthy volunteers [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Ly, KH, 2012, SpringerPlus source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Those who returned the T5 assessments reported more success in living according to values (M=2.13, SD .81) than those who did not return them (M=1.74, SD .85), P=.04.

    “Those who returned the T5 assessments reported more success in living according to values (M=2.13, SD .81) than those who did not return them (M=1.74, SD .85), P=.04.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Only about one fourth of the sample showed meaningful improvement, including 10% with substantial improvement in symptom severity.

    “Only about one fourth of the sample showed meaningful improvement, including 10% with substantial improvement in symptom severity [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The patients who withdrew tended to score higher on depression and were older than the completers, which could have influenced their interest and capacity to participate.

    “The patients who withdrew tended to score higher on depression and were older than the completers, which could have influenced their interest and capacity to participate.”
    Quote in the paperNot a substantial claim
69 of 69

  • The paper relies on this without support.

    Research on the effects of iCBT for persons with pain beyond 6-month follow-up is limited.

    “To date, research on the effects of iCBT for persons with pain beyond 6-month follow-up is limited.”

  • The paper relies on this without support.

    The informational website given to both groups does not itself produce changes in the outcomes.

    “Both groups were given access to an informational website to promote constructive self-management.”

  • The authors state this as an assumption.

    The control group's limited use of the website did not cause any changes seen in the control group.

    “Based on the limited use of the website, it is not assumed to have caused any changes seen in the control group.”

  • The paper relies on this without support.

    Positive effects from inpatient rehabilitation fade over time without additional support.

    “in order to prevent the fading of positive effects from the given rehabilitation.”

  • The paper relies on this without support.

    Short-term effects of recommended treatments are well established, but concerns about long-term effects have been raised.

    “The short-term effects are well established, but concerns about the long-term effects have been raised.”

  • The paper relies on this without support.

    Adherence to recommended self-management strategies after treatment is important for long-term effect.

    “Adherence to recommended self-management strategies after treatment seems important for long-term effect.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The dosage of interventions was very diverse.

    “The dosage of interventions was also very diverse, ranging from 2 sessions per week for 3 weeks [51] or 5 sessions per week for 4 weeks [46,47] to 12 to 15 weekly sessions [39] or even weekly reminders for 12 months [55].”

    From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [47]

  • Kristjánsdóttir et al. showed a favorable effect on pain management at 4-week follow-up (catastrophizing score lower for intervention, M = 9.20, SD = 5.85, compared to control, M = 15.71, SD = 9.22, P < 0.01, Cohen's d = 0.87).

    “In Norway, Kristjánsdóttir et al. [22, 23] showed a favorable effect on pain management in a 4-week follow-up (catastrophizing score lower for Intervention, M = 9.20, SD = 5.85, compared to Control, M = 15.71, SD = 9.22, P < 0.01, with a large effect size, Cohen’s d = 0.87) but not in the 5-month and 11-month follow-ups (outcome variables including catastrophizing, acceptance, functioning, and”

    From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [23]

  • Kristjánsdóttir et al. found no favorable effect at 5-month and 11-month follow-ups on outcome variables including catastrophizing, acceptance, functioning, and symptom level (all P > 0.1).

    “but not in the 5-month and 11-month follow-ups (outcome variables including catastrophizing, acceptance, functioning, and symptom level, all P > 0.1).”

    From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [23]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting score ranges for the Chronic Pain Values Inventory

    Minor

    The assessment description says the CPVI success rating ranges from 0 to 5, but the note to Table 1 gives its range as 0 to 6.

1 of 1

Cites

Flagged first, then by citations

1 of the 49 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Croft, P, 1993, J Rheumatol, 20, 710
  2. Wigers, SH, 2007, Tidsskr Nor Laegeforen, 127, 604
  3. Burckhardt, CS, 1991, J Rheumatol, 18, 728
  4. Saris-Baglama, RN, 2011, Quality Metric Outcomes Scoring Software 4.5. User's Guide

Cited by

Sorted by citations

Related

Authors
Kristjánsdóttir, Ó. B., Fors, E. A., Eide, E., Finset, A., Stensrud, T. L., van Dulmen, S., Wigers, S. H., & Eide, H.
Affiliations
  • OsloMet – Oslo Metropolitan University (NO)
  • Norwegian University of Science and Technology (NO)
  • University of Oslo (NO)
  • Buskerud University College (NO)
Corresponding author
Kristjánsdóttir, Ólöf Birna
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2013-03-28
Volume
15
Issue
3
Pages
e72
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.2442
PMC
PMC3636011
OpenAlex
W2105877869
Semantic Scholar
10f1f5120c8028a65cdfffe4e3ec5ac9933d0b2f
Cited by
78
References
49
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 6 · 2022: 7 · 2021: 11 · 2020: 10 · 2019: 6 · 2018: 8 · 2017: 8 · 2016: 10 · 2015: 2 · 2014: 5
FWCI
8.73
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Funders
Norges Forskningsråd (182014)
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
smartphone-based intervention, chronic widespread pain, pain catastrophizing, cognitive behavioral therapy, therapist feedback, pain diary, self-management, pain acceptance, long-term follow-up, women, emotional distress, fatigue, chronic pain rehabilitation, online intervention, mobile health, daily functioning, symptom levels
MeSH terms
Female, Follow-Up Studies, Humans, Microcomputers, Pain, Cell Phone, Pain Management

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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