Mobile Health Care and Health Behavior Change : Development of a System for Virtual Counseling based on Written Diary Questionnaires and Situational Feedback

In the future virtual e-health counseling through the mobile phones will be an important feature of health care. Patients are shortly in face to face contact with health care personal. Many patients face challenges living with chronic diseases and the patients have to change health behavior and life style to life as healthy as possible with a high degree of quality of life. Development of new ways of health counseling should also apply principles of universal design as accessibility for all and ease of use. We have designed a system for virtual counseling through written questionnaire diaries and situational feedback – the www.wsf.hio.no that is delivered to the patient through an internet enabled mobile phone. The system is applied in a pilot study with patients with widespread chronic musculoskeletal pain and is currently running in a randomized controlled study within the same patient group. The system ensures safe contact with the patients and has been running successfully for 30 month. The patients are able to use the cell phone with a short f2f instruction. The therapists can easy follow patients’ responses independent of place. The researcher can easily extract data from the system. At the present moment the 2nd generation of the system will be redesigned in order to improve the functionality further and to be tested out in other patient samples – contributing to increase the universal accessibility of new methods in health counseling

Smartphone intervention with diaries and situational feedback for women with fibromyalgia – Randomized controlled trial of a smartphone intervention with therapist feedback to reduce pain-related catastrophizing using elements from Acceptance and Commitment Therapy following inpatient chronic pain rehabilitation

E-health involves the use of technology-based communication methods to provide health care. It is a rapidly expanding field. In this thesis, a four-week smartphone intervention given as after-care to women with fibromyalgia who had completed an inpatient chronic pain rehabilitation program is investigated. The aim was to support constructive self-management by the means of daily electronic diaries and written situational therapist-feedback focusing on thoughts, feelings and behavior related to self-management. The therapeutic framework was based on cognitive behavioral therapeutic principles from Acceptance and Commitment Therapy. The pilot testing of the intervention is described in Paper I. In Papers II and III, the short- and long-term (5- and 11-month) effects of the intervention were investigated in a randomized controlled trial, with pain-related catastrophizing - maladaptive cognitions - as the primary outcome. The participants’ experience of the intervention was assessed with self-report questionnaires (Papers I and II). Both the intervention group and the control group received access to a website with self-management information. The smartphone intervention was generally well accepted and experienced as supportive and meaningful. 140 women were included in the trial and 112 completed the study; 48 in the intervention group and 64 in the control group. The effect on catastrophizing (measured with Pain Catastrophizing Scale) was large (Cohen’s d = .87, P The lack of between-group effects at the 11-month follow-up may indicate a need for more continuity in interventions to support self-management in persons with fibromyalgia. However, the positive short- and midterm effects and the feasibility results suggest a promising intervention

Mobile Health Care and Health Behavior Change : Development of a System for Virtual Counseling based on Written Diary Questionnaires and Situational Feedback

In the future virtual e-health counseling through the mobile phones will be an important feature of health care. Patients are shortly in face to face contact with health care personal. Many patients face challenges living with chronic diseases and the patients have to change health behavior and life style to life as healthy as possible with a high degree of quality of life. Development of new ways of health counseling should also apply principles of universal design as accessibility for all and ease of use. We have designed a system for virtual counseling through written questionnaire diaries and situational feedback – the www.wsf.hio.no that is delivered to the patient through an internet enabled mobile phone. The system is applied in a pilot study with patients with widespread chronic musculoskeletal pain and is currently running in a randomized controlled study within the same patient group. The system ensures safe contact with the patients and has been running successfully for 30 month. The patients are able to use the cell phone with a short f2f instruction. The therapists can easy follow patients’ responses independent of place. The researcher can easily extract data from the system. At the present moment the 2nd generation of the system will be redesigned in order to improve the functionality further and to be tested out in other patient samples – contributing to increase the universal accessibility of new methods in health counseling

Web-based, self-management enhancing interventions with e-diaries and personalized feedback for persons with chronic illness: A tale of three studies

AbstractObjectiveChronic illness places high demands on patients. Interventions supporting self-management and providing personalized feedback might help patients to gain new perspectives and enhance use of constructive self-management strategies. We developed three comparable web-based CBT-grounded interventions including e-diaries and feedback delivered through PDAs/smartphones. The feasibility and efficacy of these interventions have been investigated for patients with irritable bowel syndrome (in an RCT), chronic widespread pain (RCT) and type 2 diabetes (feasibility study).MethodsThis is a descriptive study that summarizes the content, feasibility and efficacy of the interventions and discusses issues relevant for implementing this type of web-based therapeutic interventions in clinical practice.ResultsThe web-based interventions appear feasible, acceptable and supportive. In a short and midterm time frame, the interventions promote self-management.ConclusionBooster sessions may be needed for prolonged effects. Given the physical and mental symptoms of the patients under study and the nature of the intervention, providers who deliver the feedback need a health care background and training in this specific way of counseling.Practice implicationsThe results of the three studies suggest that personalized web-based interventions are effective and have the potential to support self-management in daily healthcare. Studies concerning clinical significance and implementation are needed

Mobile Health Care and Health Behavior Change : Development of a System for Virtual Counseling based on Written Diary Questionnaires and Situational Feedback

In the future virtual e-health counseling through the mobile phones will be an important feature of health care. Patients are shortly in face to face contact with health care personal. Many patients face challenges living with chronic diseases and the patients have to change health behavior and life style to life as healthy as possible with a high degree of quality of life. Development of new ways of health counseling should also apply principles of universal design as accessibility for all and ease of use. We have designed a system for virtual counseling through written questionnaire diaries and situational feedback – the www.wsf.hio.no that is delivered to the patient through an internet enabled mobile phone. The system is applied in a pilot study with patients with widespread chronic musculoskeletal pain and is currently running in a randomized controlled study within the same patient group. The system ensures safe contact with the patients and has been running successfully for 30 month. The patients are able to use the cell phone with a short f2f instruction. The therapists can easy follow patients’ responses independent of place. The researcher can easily extract data from the system. At the present moment the 2nd generation of the system will be redesigned in order to improve the functionality further and to be tested out in other patient samples – contributing to increase the universal accessibility of new methods in health counseling

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

Contains fulltext : 117955.pdf (publisher's version ) (Open Access)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)

Examining Fidelity of Web-based Acceptance and Commitment Interventions for Women with Chronic Widespread Pain

Objectives. To examine the protocol adherence to the theoretical background of Acceptance and Commitment Therapy (ACT) in a RCT of a web-based intervention including e-diaries and written personalized feedback delivered via smartphone for persons with chronic widespread pain.Methods. The data consisted of 790 written feedback. A qualitative descriptive design on how ACT and other therapeutic processes were used in the feedback which was applied. The analysis was done with a feedback coding scheme developed employing a combination of an inductive and deductive approach.Results. The coded feedback messages reflected five of the six main ACT processes in addition to communication and motivation strategies. The degree of inter-rater reliability between the researchers coding the feedback, measured by Cohen’s kappa, was 0.790.Conclusions. Based on the level of adherence to ACT-principles the treatment integrity can be judged as high. The developed coding scheme can serve as a basis for coding written therapeutic feedback and thereby serve as a tool for a reliable assessment of the treatment fidelity in ACT based interventions delivered by internet.Practice Implications. Internet-delivered psychological interventions to support people with chronic conditions are increasingly common. Such interventions can be seen as person-centered therapeutic approaches. This study indicates that ACT can reliably be delivered in a written web-based format.   </jats:p

A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial

Contains fulltext : 118536.pdf (publisher's version ) (Open Access)BACKGROUND: Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited. OBJECTIVE: The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program. METHODS: A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels. RESULTS: Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen's d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen's d=0.74, P=.003), acceptance of pain (Cohen's d=0.54, P=.02), and functioning and symptom levels (Cohen's d=0.75, P=.001). CONCLUSIONS: The results suggest that 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. TRIAL REGISTRATION: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY)

Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention

Background This pretrial study aimed to develop and test the usability of a four-week Internet intervention delivered by a Web-enabled mobile phone to support self-management of chronic widespread pain. Methods The intervention included daily online entries and individualized written feedback, grounded in a mindfulness-based cognitive behavioral approach. The participants registered activities, emotions and pain cognitions three times daily using the mobile device. The therapist had immediate access to this information through a secure Web site. The situational information was used to formulate and send a personalized text message to the participant with the aim of stimulating effective self-management of the current situation. Six women participated and evaluated the experience. Results The intervention was rated as supportive, meaningful and user-friendly by the majority of the women. The response rate to the daily registration entries was high and technical problems were few. Conclusion The results indicate a feasible intervention. Web-applications are fast becoming standard features of mobile phones and interventions of this kind can therefore be more available than before