Elsevier

The Journal of Pain

Volume 18, Issue 2, February 2017, Pages 200-211
The Journal of Pain

Original Report
Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial

https://doi.org/10.1016/j.jpain.2016.10.014Get rights and content
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Highlights

  • Video teleconferencing was noninferior to in-person delivery on pain interference.

  • The in-person group exhibited greater improvements in activity levels at follow-up.

  • Significantly greater attrition was observed in the video teleconferencing group.

Abstract

The purpose of this randomized noninferiority trial was to compare video teleconferencing (VTC) versus in-person (IP) delivery of an 8-week acceptance and commitment therapy (ACT) intervention among veterans with chronic pain (N = 128) at post-treatment and at 6-month follow-up. The primary outcome was the pain interference subscale of the Brief Pain Inventory. Secondary outcomes included measures of pain severity, mental and physical health-related quality of life, pain acceptance, activity level, depression, pain-related anxiety, and sleep quality. In intent to treat analyses using mixed linear effects modeling, both groups exhibited significant improvements on primary and secondary outcomes, with the exception of sleep quality. Further, improvements in activity level at 6-month follow-up were significantly greater in the IP group. The noninferiority hypothesis was supported for the primary outcome and several secondary outcomes. Treatment satisfaction was similar between groups; however, significantly more participants withdrew during treatment in the VTC group compared with the IP group, which was moderated by activity level at baseline. These findings generally suggest that ACT delivered via VTC can be as effective and acceptable as IP delivery for chronic pain. Future studies should examine the optimal delivery of ACT for patients with chronic pain who report low levels of activity. This trial was registered at ClinicalTrials.gov (NCT01055639).

Perspective

This study suggests that ACT for chronic pain can be implemented via VTC with reductions in pain interference comparable with IP delivery. This article contains potentially important information for clinicians using telehealth technology to deliver psychosocial interventions to individuals with chronic pain.

Key words

Chronic pain
telehealth
noninferiority
acceptance and commitment therapy
pain interference

Cited by (0)

This study was supported by Veterans Affairs Rehabilitation R&D grant F6891R and the Office of Academic Affiliations, Department of Veterans Affairs. This study also is the result of work supported with resources of the VA San Diego Healthcare System. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs or any of the institutions with which the authors are affiliated.

The authors have no conflicts of interest to declare.