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Supporting women with widespread pain to live according to own values – web based counseling in the home setting Hilde Eide

Professor, Study Director Buskerud University College, Norway

7th Nordic Health Promotion Research Conference - Vestfold University College

19th June 2013 1

•  Chronic widespread pain and fibromyalgia are complex disorders

•  Multidimentional rehabilitation is recommended •  Need for self-management support •  Internet-based interventions may be effective

Introduction

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•  Regelmessig  aerobic  trening  predikerer  posi3v  effekt  på  pasientenes  symptomer  

(Hørven  Wigers  &  Finset  2007,    Haüser  et  al  DÄI  2009)  

•  Kontekstuell  CBT  som  ”Acceptance  og  commitment  terapi”  og  ”mindfullness  based  CBT”  ser  også  lovende  ut  

(Dahl  Ja  et  al,  Beh  Ther  2004,  Mc  Cracken  et  al,  J  Beh  Med  2007,  

McCracken  &  Vowles,  Health  Psychology  2008,  Wicksell,  Karolinska  Ins3tute  2009)      

AWerdsendring  og  akseptering  

Work  towards   Work  away  from  Consciousness  of  own  values  

Unclear  values  

Commited  ac3ons  based  on  own  values  

Ac3on  (Not  in  line  with  own  values)  determined  by  pain,  ”error  of  thought”  or  avoidance  of  painful  feelings  

Preseance  here  and  now   Focus  on  past  or  future  Acceptance  (of  what  is  -­‐    and  is  not  possible  to  change)  

Avoidant  behaviour  of  nega3ve  thoughts  and  feeling  (stop  ba\eling  the  wrong  things)  

Less  influence  of  content  of  thoughts  on  emo3ons  and  behaviour  

Strong  influence  of  nega3ve  thoughts  

Acceptance  and  Commitment  therapy    -­‐  ACT  (Hayes  et  al,  Beh  Res  Ther  2006)  

•  One individual start-up meeting"•  Diaries: Three daily web-based registrations

for 4 weeks"•  Feedback: One written feedback from

counselor daily for 4 weeks"•  Website: Written exercises and audio

mindfulness exercises"

The smartphone intervention

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""

Design

4 weeks of inpatient

rehabilitaion for widespread chronic

pain Randomized n = 140

Intervention

group: smartphone &

website n= 70

Control group:

website only N= 70

1. Pilot 2. RCT 3. Qualitative research

T0: Before rehabilitation program T1: After rehabilitation program T2: Post-smartphone intervention T3: 5-month follow up T4: 11-month follow up

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•  Female 100% •  83% had fibromyalgia •  Mean age: 43 (18-61) •  Average pain: 62 (0-100 VAS) •  Mean duration of pain: 12 years (2-37)

Patient characteristics at T1

•  a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation."

(Kristjansdottir, Fors, Eide et al. "Journal of Medical Internet Research 2013a)"

Resultater RCT I

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•  The results of this randomized trial are ambiguous. "•  No significant between-group effect was found at 11-

month follow-up. "•  Within-group analyses indicated changes in the

desired direction in catastrophizing and acceptance in the intervention group but not in the control group. "

•  The study provides modest evidence supporting the long-term effect of the intervention."

"(Kristjansdottir, Fors, Eide et al. "

Journal of Medical Internet Research 2013b)"

Resultater RCT II

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•  Oppfølgingen “utvider bevisstheten”, oppleves som motiverende, støttende

•  Ambivalens: Utfordring med teknologi, Utfordrende- kan gi dårlig samvittighet, relasjonen

(ElmaJelin, Granum V, Eide H. Experiences of a web-based nursing intervention—interviews with women with chronic musculoskeletal pain. Pain Management Nursing, 2012)

Hva sier deltakerne?

•  Psychological flexibility"–  Catastrophizing (primary outcome)"–  Acceptance"–  Values-based living"

•  Functioning and symptoms"

Outcomes

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1. Family Participation in your relationships with your parents, children, other close relatives, people you live with, or whoever is your ‘‘family’’

2. Intimate relations

Being the kind of partner you want to be for your husband/wife or closest partner in life

3. Friends Spending time with friends, doing what you need to maintain friendships, or providing help and support for others as a friend

4. Work Engaging in whatever is your occupation, your job, volunteer work, community service, education, or your work around your own home

5. Health Keeping yourself fit, physically able, and healthy just as you would most want to do

6. Growth and learning

Learning new skills or gaining knowledge, or improving yourself as a person as you would most want

Chronic pain values inventory (CPVI)

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Changes in Valued living

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Value T1 (125)

T2 (120)

T3 (N= 88)

T4 (N = 84)

T5 (N= 88)

Family 2.9 (1.1) 3.1 (1.1) 3.3 (1.0) 3.1 (1.1) 3.3 (1.0)

Relation-ship

2.1 (1.2) 2.4 (1.2) 2.6 (1.4) 2.3 (1.4) 2.6 (1.3)

Friends 2.1 (1.1) 2.4 (1.0) 2.8 (1.1) 2.6 (1.1) 2.7 (1.2)

Work 1.8 (1.3) 1.9 (1.4) 2.3 (1.4) 2.3 (1.4) 2.6 (1.4)

Health 1.6 (1.1) 3.0 (1.2) 2.9 (1.2) 2.5 (1.3) 2.5 (1.1)

Growth 1,8 (1.2) 2.7 (1.3) 2.4(1.3) 2.3 (1.3) 2.3 (1.2)

Success in valued living (mean / sd)

14 1=do not agree – 6= agree completely

Value T1 (125)

T3 (N= 88)

T4 (N = 84)

T5 (N= 88)

Valued living T1 (CPVI)

** ** **

Acceptance (CPAQ)

** NS ** **

Physical functioning (SF-8)

* ** * NS

Mental functioning (SF-(8)

** * / NS ** *

Catastrophizing (PCS)

** * / NS * NS

Age NS NS NS NS

Predictors of valued living

•  Valued living seems dependent on valued living as an intrinsic attitude

•  Valued living is associated with acceptance and willingness to be active as well as mental and physical functioning

•  Valued living is supported by webbased counseling in the home and daily life setting

Discussion

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Hilde Eide, BUC (Project leader) Olof Kristjansdottir; PhD-student OAUC/UIO Andrèa Nes OAUC/UIO (Phd- student) Sandra van Dulmen, NIVEL/St. Radboud University, BUC) Espen Brembo, MA Arnstein Finset, UIO Egil A Fors NTNU/St. Olavs Hospital Erlend Eide, E-design Sigrid Wigers, Jeløy Kurbad Norwegian Research Council grant no. 182014

Research Group 1  Kristjansdottir O, Fors EA, Eide E, Finset A, van Dulmen S.,

Stensrud TL, Wigers S, H Eide H. 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 results of a randomized controlled trial. J Med Internet Res 2013 | vol. 15 | iss. 3 | e72

2  Nes A, Eide H, Kristjansdottir O, van Dulmen S. Web-based, self-management enhancing interventions with e-diaries and personalized feedback for persons with chronic illness; a tale of three studies. In Press. Patient education and Counseling

3  Kristjansdottir O, Fors EA, Eide E, Finset A, van Dulmen S., Stensrud TL, Wigers S, H Eide H A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial. J Med Internet Res. 2013 Jan 7;15(1):e5. doi: 10.2196/jmir.2249.

PapersI

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4  Jelin E, Granum V, Eide H (2012). Experiences of a web-based nursing intervention—interviews with women with chronic musculoskeletal pain. Pain Mangement Nursing, 2012 Mar;13(1):2-10

5  Kristjansdottir O, Fors EA, Eide E, Finset A, van Dulmen S, Hørven Wigers S, Eide H. Written situational feedback via mobile phone to support self-management of chronic widespread pain: a usability pilot study. BMC – Musculoskeletal disorders 2011, 12:51. doi:10.1186/1471-2474-12-51

6  Eide H, Kristjánsdoóttir ÓB, Nes A. Kommunikasjon-steknologisk helseveiledning - kognisjon, emosjonalitet og betydningen av situasjonsfeedback. I Lerdal A og Fagermoen MS (red). Læring og mestring - et helsefremmende perspektiv i praksis og forskning. 2011, Gyldendal Akademisk; Oslo

Papers II

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