Hilde Eide NHPRC 2013
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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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