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. 2015 Jan 5;2(1):e1.
doi: 10.2196/humanfactors.3302.

Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients

Martine Fledderus  1 , Karlein Mg Schreurs, Ernst T Bohlmeijer, Miriam Mr Vollenbroek-Hutten
Affiliations

Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients

Martine Fledderus et al. JMIR Hum Factors. .

Abstract

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).

Keywords: acceptance and commitment therapy; aftercare; chronic pain; eHealth; relapse prevention.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Example of a website prototype (Values and actions).
Figure 2
Figure 2
Example of a mobile app prototype (Exercises).
Figure 3
Figure 3
Screenshot of a page of the website (Values and actions).
Figure 4
Figure 4
Screenshot of the mobile app homepage.
See this image and copyright information in PMC

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References

    1. Smout MF, Hayes L, Atkins PWB, Klausen J, Duguid JE. The empirically supported status of acceptance and commitment therapy: An update. Clin Psychol. 2012 Nov 04;16(3):97–109. doi: 10.1111/j.1742-9552.2012.00051.x. http://dx.doi.org/10.1111/j.2040-1124.2010.00046.x - DOI - DOI
    1. Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain. 2011 Mar;152(3):533–542. doi: 10.1016/j.pain.2010.11.002. http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(10)00687-1 - DOI - PubMed
    1. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;14(11) - PMC - PubMed
    1. Morley S. Relapse prevention: Still neglected after all these years. Pain. 2008 Feb;134(3):239–240. doi: 10.1016/j.pain.2007.12.004. - DOI - PubMed
    1. Maruta T, Malinchoc M, Offord KP, Colligan RC. Status of patients with chronic pain 13 years after treatment in a pain management center. Pain. 1998 Feb;74(2-3):199–204. - PubMed