title: A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial.
abstract: BACKGROUND
  Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited.
  
  
  OBJECTIVE
  The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program.
  
  
  METHODS
  A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels.
  
  
  RESULTS
  Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen's d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen's d=0.74, P=.003), acceptance of pain (Cohen's d=0.54, P=.02), and functioning and symptom levels (Cohen's d=0.75, P=.001).
  
  
  CONCLUSIONS
  The results suggest that 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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209  (Archived by WebCite at http://www.webcitation.org/6DUejLpPY).
authors.affiliation: Institute of Nursing, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. kristjansdottir@gmail.com
authors.forename: Olöf Birna
authors.initials: OB
authors.lastname: Kristjánsdóttir
authors.forename: Egil A
authors.initials: EA
authors.lastname: Fors
authors.forename: Erlend
authors.initials: E
authors.lastname: Eide
authors.forename: Arnstein
authors.initials: A
authors.lastname: Finset
authors.forename: Tonje Lauritzen
authors.initials: TL
authors.lastname: Stensrud
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Sigrid Hørven
authors.initials: SH
authors.lastname: Wigers
authors.forename: Hilde
authors.initials: H
authors.lastname: Eide
mesh_terms: D000328:Adult; D058443:Catastrophization / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D040421:Cell Phone; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D020407:Internet; D008499:Medical Records; D008875:Middle Aged; D008960:Models, Psychological; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*