title: Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study.
abstract: BACKGROUND
  Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective.
  
  
  OBJECTIVE
  The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain.
  
  
  METHODS
  A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire.
  
  
  RESULTS
  Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients completed questionnaires. Low specificity of the resources to one's condition and time poorness may have been barriers to engagement.
  
  
  CONCLUSIONS
  Results suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.
authors.affiliation: Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia. mmerolli@student.unimelb.edu.au.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0003-4273-1816
authors.initials: M
authors.lastname: Merolli
authors.forename: Kathleen
authors.identifier: http://orcid.org/0000-0003-1616-2170
authors.initials: K
authors.lastname: Gray
authors.forename: Fernando
authors.identifier: http://orcid.org/0000-0002-7312-5707
authors.initials: F
authors.lastname: Martin-Sanchez
authors.forename: Steven
authors.identifier: http://orcid.org/0000-0002-1260-1853
authors.initials: S
authors.lastname: Mantopoulos
authors.forename: Malcolm
authors.identifier: http://orcid.org/0000-0003-2598-1397
authors.initials: M
authors.lastname: Hogg
keywords: chronic disease; chronic pain; participatory health; patient-reported outcomes; pilot study; self-management; social media; therapeutic affordances