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

1. 1
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
2
• 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
baeling
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
5
"
"
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

2. 2
• 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
8
• 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
9
• 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
11
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)
12
(McCraken & Yang, Pain 2006)

3. 3
Changes in Valued living
13
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)
141=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
16
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
18

4. 4
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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