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Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study
Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.ORCID-id: 0000-0003-1833-5506
Vise andre og tillknytning
2020 (engelsk)Inngår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, BMC MUSCULOSKELETAL DISORDERS, Vol. 21, nr 1, artikkel-id 212Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions: Adjusting treatment content and format based on participants characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

sted, utgiver, år, opplag, sider
BioMed Central, 2020. Vol. 21, nr 1, artikkel-id 212
Emneord [en]
ICBT; ACT; Person-based approach; Motivation; Change; Engagement; Attrition; Constructivist grounded theory
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-165330DOI: 10.1186/s12891-020-03198-1ISI: 000525521300001PubMedID: 32252707Scopus ID: 2-s2.0-85083071771OAI: oai:DiVA.org:liu-165330DiVA, id: diva2:1426790
Merknad

Funding Agencies|County Council of Ostergotland

Tilgjengelig fra: 2020-04-27 Laget: 2020-04-27 Sist oppdatert: 2024-01-17bibliografisk kontrollert
Inngår i avhandling
1. Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain: Feasibility, patients’ experiences and implementation process
Åpne denne publikasjonen i ny fane eller vindu >>Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain: Feasibility, patients’ experiences and implementation process
2023 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Chronic pain represents a major burden for individuals and society. Internet-delivered psychological interventions are evidence-based treatments that enable patients to access qualified care at a time and place convenient for them. Internet-delivered Acceptance and commitment therapy (IACT) has shown promising treatment effects for chronic pain patients on pain-related outcomes such as disability, pain intensity, and interference, and on psychological outcomes such as catastrophizing, fear-avoidance and acceptance. Interdisciplinary pain rehabilitation programs (IPRP) are multimodal interventions given by synchronized teams of health care professionals from different disciplines. With moderate treatment effects on many outcomes, IPRP is the best evidence treatment for chronic pain to date.   

IACT may add to IPRP’s effectiveness by providing individual psychological treatment via the internet. However, IACT has not yet been implemented in routine care in a larger scale. In this thesis, the aim was to study if IACT may be acceptable for chronic pain patients and if it is feasible and effective as an addition to IPRP. Three methodological approaches were used: qualitative analysis, implementation science and a controlled trial of effectiveness in a clinical context.   

Study I showed that an internet-delivered aftercare intervention enabled chronic pain patients to change their perception of their body and pain and their attitude about their future and self. Furthermore, self-motivating goals and acceptance strategies appeared to influence autonomy. The results gave promise to the feasibility of IACT as aftercare following IPRP. Study II showed that chronic pain patients’ experiences of IACT vary, with respect to being in treatment and the consequences of treatment. Specifically, e-therapist feedback and deadlines for homework may have an impact on autonomy and change. Patients’ expectations, motivations, and restraints could explain treatment engagement and experiences. In Study III, IACT added during IPRP enhanced the treatment effects on pain acceptance and affective distress. Furthermore, IACT added as aftercare strengthened the long-term effect of IPRP on psychological flexibility and self-efficacy. However, unsatisfactory completion rates complicated the interpretation of the findings. Study IV showed that implementing IACT in an IPRP setting may be facilitated by contextual alinement and modifications based on patients’ needs. Thorough testing of the application and matching the intervention’s aim with the host’s needs are important not to challenge the process. An implementation framework may ease planning and evaluation of implementation processes.   

In conclusion, IACT could be feasible as an addition to IPRP. IACT can help chronic pain patients self-manage their pain and improve pain acceptance and self-efficacy. However, chronic pain patients’ varying experiences may need to be considered to improve treatment engagement and help patients benefit from treatment. In addition, implementation of IACT in IPRP settings is likely to depend on both flexibility to changing host needs and continuity of known pivotal components in IACT.   

Abstract [sv]

Långvarig smärta medför ett lidande för den drabbade individen och konsekvenser för samhället. Internetbaserade psykologiska behandlingar är evidensbaserade in-satser som ger patienter tillgång till kvalificerad vård vid den tid och på den plats som passar dem. Internetbaserad Acceptance and commitment therapy (IACT) kan påverka smärtintensitet samt hur mycket smärtan hindrar individen. IACT påverkar också psykologiska faktorer som katastrofiering, rädsla/undvikande och smärtacceptans. Multimodala smärtrehabiliteringsprogram (MMR) består av flera behandlingsinsatser som ges parallellt av ett team där vårdpersonal från olika professioner samarbetar. MMR har medelstor påverkan på flera faktorer och är den rekommenderade behandlingen för personer med långvarig smärta.  

IACT skulle kunna vara hjälpsamt för smärtpatienter som komplement till MMR, genom att ge individuell psykologisk behandling via internet. IACT har ännu inte implementerats rutinmässigt i sjukvården. I denna avhandling är syftet att studera om IACT uppskattas av smärtpatienter och om IACT är tillämpbart och effektivt som tillägg till MMR. Tre olika metoder används, nämligen kvalitativ analys, implementeringskunskap och en kontrollerad studie av effektivitet på en smärtrehabiliteringsklinik.   

Studie I visade att internetbaserad eftervård hjälpte smärtpatienter att förändra sin uppfattning om sin kropp och sin smärta samt sin attityd till sin framtid och sig själva. Därtill tycktes patienternas autonomi påverkas av motiverande mål och acceptansstrategier. Resultatet talar för att IACT är tillämpbart som eftervård efter MMR. Studie II visade att smärtpatienters upplevelser av IACT varierar, både avseende att vara i behandling och behandlingens konsekvenser. Kontakten med en terapeut via internet (e-terapeut) och deadlines för hemuppgifter tycktes på-verka patienternas förändring och autonomi. Patienternas förväntningar, motivation och begränsningar kan förklara deras upplevelser och hur de deltar i behandling. Studie III visade att IACT som tillägg kan förbättra den effekt som MMR har på patienters smärtacceptans och hur påverkade de är av känslor. IACT som tillägg efter MMR kan förstärka den långsiktiga effekten av MMRP på psykologisk flexibilitet och self-efficacy. Studie IV visade att implementering av IACT på en smärtrehabiliteringsklinik kan underlättas av likriktning med kontextfaktorer och anpassningar utifrån patienters behov. Noggrann testning av tekniken bakom IACT och att matcha syftet med IACT med klinikens behov är viktigt för att inte försvåra implementeringen. Ett ramverk för implementering kan underlätta såväl planering som utvärdering av processen.   

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2023. s. 76
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1836
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-193047 (URN)10.3384/9789180750288 (DOI)9789180750271 (ISBN)9789180750288 (ISBN)
Disputas
2023-05-12, Berzeliussalen, Building 463, Campus US, Linköping, 09:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2023-04-11 Laget: 2023-04-11 Sist oppdatert: 2023-04-11bibliografisk kontrollert

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