title: Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients.
abstract: BACKGROUND
  A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed.
  
  
  OBJECTIVE
  In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)-both as a website and as a mobile app-was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs.
  
  
  METHODS
  In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors.
  
  
  RESULTS
  The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users.
  
  
  CONCLUSIONS
  This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors.
  
  
  BACKGROUND
  Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D).
authors.affiliation: Roessingh Research and Development, Enschede, Netherlands. martinefledderus@gmail.com.
authors.forename: Martine
authors.identifier: http://orcid.org/0000-0001-7303-1682
authors.initials: M
authors.lastname: Fledderus
authors.forename: Karlein Mg
authors.identifier: http://orcid.org/0000-0002-1229-0151
authors.initials: KM
authors.lastname: Schreurs
authors.forename: Ernst T
authors.identifier: http://orcid.org/0000-0002-7861-1245
authors.initials: ET
authors.lastname: Bohlmeijer
authors.forename: Miriam Mr
authors.identifier: http://orcid.org/0000-0002-8372-3022
authors.initials: MM
authors.lastname: Vollenbroek-Hutten
keywords: acceptance and commitment therapy; aftercare; chronic pain; eHealth; relapse prevention