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Cited by 38Musculoskeletal pain and rehabilitationDigital Mental Health InterventionsMobile Health and mHealth Applications

Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial

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Nordin, Catharina A, Michaelson, Peter, Gard, Gunvor, Eriksson, Margareta K·2016·Journal of Medical Internet Research
DOI 10.2196/jmir.5634PMC PMC5071618
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Abstract

BACKGROUND: Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). OBJECTIVE: The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. METHODS: A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. RESULTS: Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003). CONCLUSIONS: Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable. CLINICALTRIAL: Clinicaltrials.gov NCT01475591; https://clinicaltrials.gov/ct2/show/NCT01475591 (Archived by WebCite at http://www.webcitation.org/6kUnt7VQh).

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  • GET, exercises with a behavioural approach, CBT, Coping Strategies, Psychological Flexibility, and V.R. had positive effects on pain reduction compared to usual care, while Web-BCPA, EFT, matching therapy to psychological features, and physical cognitive-mindfulness did not affect reducing pain intensity.

    “GET, exercises with a behavioural approach, CBT, Coping Strategies, Psychological Flexibility, and V.R. had positive effects on pain reduction compared to usual care (Table 2) [18, 26, 27, 29, 30, 33]. Web-BCPA, EFT, matching therapy to psychological features, and physical cognitive-mindfulness did not affect reducing pain intensity.”

    From A Scoping Review of the Evidence regarding Assessment and Management of Psychological Features of Shoulder Pain. (2021) · cites this paper as [27]

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  1. [7]The Swedish Council on Health Technology Assessment (SBU) Rehabilitation for Long-Lasting Pain. A Literature Review 2010 Stockholm The Swedish Council on Health Technology Assessment (SBU) 198

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Authors
Nordin, C. A., Michaelson, P., Gard, G., & Eriksson, M. K.
Affiliations
Luleå University of Technology (SE)
Corresponding author
Nordin, Catharina A
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2016-10-05
Volume
18
Issue
10
Pages
e265
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.5634
PMC
PMC5071618
OpenAlex
W2528740775
Cited by
38
References
59
Citations by year
2026: 4 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 7
FWCI
3.50
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
online intervention, behavior change, chronic musculoskeletal pain, pain intensity, self-efficacy, pain catastrophizing, coping, physical activity, self-care, primary care, medication adherence, treatment satisfaction, feasibility, neck and back pain, sleep, stress, self-esteem, communication skills, cognitive skills, maintenance of behavior change
MeSH terms
Adult, Behavior Therapy, Female, Humans, Male, Surveys and Questionnaires, Self Care, Internet, Pain Management

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