Clinical utility of a mHealth assisted intervention for activity modulation in chronic pain: The pilot implementation of pain ROADMAP

Thank you to APS members Nicole Andrews and Michael Deen and their colleagues David Ireland and Marlien Varnfield for sharing the following recent publication.

Article first published online: 10 March 2023

Journal Reference: Andrews, N. E., Ireland, D., Deen, M., and Varnfield, M. (2023). Clinical Utility of a mHealth Assisted Intervention for Activity Modulation in Chronic Pain: The Pilot Implementation of Pain ROADMAP. European Journal of Pain. https://doi.org/10.1002/ejp.2104

DOI: https://doi.org/10.1002/ejp.2104

Abstract

Background

According to the World Health Organization, mobile health (mHealth) technologies can transform the face of health care service delivery across the globe. The evaluation of mHealth interventions for pain management is an emerging field that has been identified as a research priority. The aim of current study was to explore the clinical utility of a mobile health platform (Pain ROADMAP) for assisting with the delivery of a tailored activity modulation intervention through remote monitoring and the identification of activities that cause severe pain exacerbations (i.e., overactivity periods).

Design Pilot implementation.

Setting

Outpatient clinic at a multidisciplinary pain centre located in a large tertiary public hospital in Australia.

Subjects Twenty adults with chronic pain.

Methods

The twenty adult participants undertook a one-week Pain ROADMAP monitoring intervals in their own homes which involved wearing an Actigraph activity monitor and entering pain, opioid use, and activities carried out throughout the day into a custommade phone app. The Pain ROADMAP online portal integrated and analysed the data to detect activities that caused a severe pain exacerbation (i.e., a pain flare up) and provided information about progress overtime through summary statistics pertaining the data collected. As part of a 15-week treatment protocol, participants received feedback from three dispersed Pain ROADMAP monitoring periods. Treatment focused on adapting pain-provoking activities, gradually increasing goal-related activity, and optimising routine.

Results

1 For the most part, participants were able to tolerate and adhere to the monitoring procedures.

2 All participants who filled in the evaluation questionnaire at the end of the study indicated that Pain ROADMAP feedback was valuable and that it was worth undergoing the monitoring to receive the feedback that was provided by the clinician.

3 Participants who completed the 15-week treatment protocol had a significant reduction in activity related pain flare ups and experienced a stabilisation in their pain levels.

4 Clinically meaningful decreases in opioid use, depression, and activity avoidance along with increases in productivity were also observed.

5 A few participants commented that the Actigraph activity monitor was bulky and that the ability to wear the monitor on other parts of the body would improve Pain ROADMAP monitoring.

6 Participants recommended a number of minor changes to the app such as customisable notification tones and the ability to edit data once it has been entered.

7 Two participants under the age of 25 dropped out of the study early. Hence, strategies may be needed to ensure mHealth assisted treatments are engaging for young people such as the use of gamification to increase motivation.

Conclusions

This is the first study to demonstrate how mHealth innovations that utilise ecological momentary assessment can be successfully integrated with wearable technologies to provide a tailored activity modulation intervention that is both highly valued by people with chronic pain and assists individuals to make constructive behavioural changes. Overall, the results of the pilot implementation provide evidence for the clinical utility of mHealth assisted activity modulation interventions within the pain field. Adaptions such as low costs sensors, increased app customisability and gamification may be important for enhanced uptake, adherence, and scalability.

Declaration

This work was supported by a Metro North Hospital and Health Service LINK project grant and the Motor Accident Insurance Commission (MAIC), Australia. Dr Andrews was supported by a Patricia Dukes Fellowship administered by the Royal Brisbane and Women’s Hospital Foundation.