title: Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial.
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).
  
  
  
  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.
authors.affiliation: Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California; VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Matthew Scott
authors.initials: MS
authors.lastname: Herbert
authors.affiliation: Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California; VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California. Electronic address: nafari@ucsd.edu.
authors.forename: Niloofar
authors.initials: N
authors.lastname: Afari
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, California.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Pia
authors.initials: P
authors.lastname: Heppner
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Williams
authors.affiliation: Biogen, Neurology Clinical Development, Cambridge, Massachusetts.
authors.forename: Satish
authors.initials: S
authors.lastname: Eraly
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California.
authors.forename: Katie
authors.initials: K
authors.lastname: VanBuskirk
authors.affiliation: Durham VA Medical Center, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Cathy
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Bondi
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
authors.affiliation: Department of Psychiatry, University of California, San Diego, California.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Golshan
authors.affiliation: VA San Diego Healthcare System, University of California, San Diego, California; Department of Psychiatry, University of California, San Diego, California.
authors.forename: Julie Loebach
authors.initials: JL
authors.lastname: Wetherell
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D049269:Videoconferencing
keywords: Chronic pain; acceptance and commitment therapy; noninferiority; pain interference; telehealth