This project will evaluate the feasibility of a new fully self-guided online Acceptance and Commitment Therapy (ACT) program entitled Advancing Online Psychology Tools for the Transitional Pain Service (ADOPT-TPS), developed on an online health application platform called Manage My Pain (MMP). The ACT program is designed to teach mindfulness skills and provide psychoeducation about post-surgical pain. The feasibility of the self-guided online program will be compared to a pre-existing psychologist-guided workshop that delivers the same program. It is anticipated that the self-guided online ACT program will be deemed feasible by participants.
The Transitional Pain Service (TPS) at Toronto General Hospital is a multidisciplinary treatment program that aims to prevent chronic post-surgical pain (CPSP) and persistent opioid use after surgery. CPSP is a major public health concern impacting from 10% up to 70% of patients, depending on the type of surgery. Those experiencing CPSP are at higher risk for prolonged opioid use, which introduces challenges like addiction, misuse, and overdose. Acceptance and Commitment Therapy (ACT) is an evidence-based psychology intervention that is effective in reducing patients' risk of CPSP and opioid use. However, access to this intervention is currently limited to predominantly in-person, specialized hospital-based clinic settings like the TPS, which prioritize patients at highest risk for CPSP and often require physician referrals for quick access. There is a need for such treatment approaches to spread to other institutions and to be available for lower-risk post-surgery patients, yet the shortage of specialized pain psychologists creates a barrier to widespread dissemination. The current project will evaluate the feasibility of a novel fully self-guided online ACT intervention entitled Advancing Online Psychology Tools for the Transitional Pain Service (ADOPT-TPS), developed on a mobile health application platform called Manage My Pain (MMP). A randomized, controlled pilot feasibility trial will evaluate the efficacy of ADOPT-TPS by comparing it to a pre-existing psychologist-guided workshop. Once tested, this scalable, evidence-based online intervention can be easily implemented at institutions across Canada and beyond to address CPSP and opioid use without the need for specialized pain psychologists on staff.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Participants will be invited to access the ACT program on the Manage My Pain (MMP) app. Participants will follow the instructions in the app to complete the program in a self-paced manner. The program includes psychoeducational materials, guided mindfulness meditations, and self-reflection activities.
Participants will be invited to join a one-session ACT group workshop guided by a psychologist. The session will take place virtually using video call software. The psychologist will guide participants through the workshop agenda, which will include psychoeducational material, guided mindfulness meditations, and partaking in voluntary discussions with other group members.
Toronto General Hospital- The Department of Anesthesia and Pain Management
Toronto, Ontario, Canada
RECRUITINGUniversity Health Network- Toronto General Hospital
Toronto, Ontario, Canada
RECRUITINGFeasibility of the online ACT program as assessed by the Feasibility Survey
A 10-item Likert scale (min possible score = 10, max possible score = 70). Higher scores indicate greater feasibility.
Time frame: Participants will be sent a link to fill out the measure within 1 week of completing their respective program.
Acceptability of the online ACT program as assessed by the Treatment Evaluation Inventory - Short Form
A 9-item Likert scale (min possible score = 9, max possible score = 45). Higher scores indicate greater acceptability.
Time frame: Participants will be sent a link to fill out the measure within 1 week of completing their respective program.
Retrospective Semi-structured Interview
A brief interview with a randomized subset of participants
Time frame: Participants will be sent an invitation for an interview within 1 month after completing their respective program
Treatment Adherence as assessed by the Integration of ACT Skills Survey
A 5-item Likert scale (min possible score = 5, max possible score = 35). Higher scores indicate greater treatment adherence
Time frame: Participants will be sent a link to complete the measure within 1 month after completing their respective program.
Pain Intensity as assessed by the Pain Numerical Rating Scale
A 4-item Likert scale (min possible score = 0, max possible score = 40). Higher scores indicate greater pain intensity.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Pain Interference as assessed by the PROMIS Pain Interference Scale - Short Form 8a
A 8-item Likert scale (min possible score = 8, max possible score = 40). Higher scores indicate greater pain interference.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Pain Medication Misuse as assessed by the PROMIS Prescription Pain Medication Misuse Scale - Short Form 7a
A 7-item Likert scale (min possible score = 7, max possible score = 5). Higher scores indicate greater pain medication misuse.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Pain Catastrophizing as assessed by the Pain Catastrophizing Scale
A 13-item Likert scale (min possible score = 0, max possible score = 52). Higher scores indicate greater pain catastrophizing.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Depressive symptoms as assessed by PROMIS Emotional Distress - Depression - Short Form 8b
A 8-item Likert scale (min possible score = 8, max possible score = 40). Higher scores indicate greater depressive symptoms.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Anxiety symptoms as assessed by the PROMIS Emotional Distress - Anxiety - Short Form 8A
A 8-item Likert scale (min possible score = 8, max possible score = 40). Higher scores indicate greater anxiety symptoms.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Psychological Inflexibility in Pain as measured by the Psychological Inflexibility in Pain Scale
A 16-item Likert scale (min possible score = 16, max possible score = 112). Higher scores indicate greater psychological inflexibility in pain.
Time frame: Participants will be sent a link to fill out the measure prior to starting their respective program, within 1 week of completing their respective program, and 1 month after completing their respective program.
Use of Study Platform as assessed by the Use of Manage My Pain Platform Survey
A 5-item Likert scale (min possible score = 4, max possible score = 20). Higher scores indicate more frequent use of the platform.
Time frame: Participants will be sent a link to fill out the measure within 1 week of completing the respective program, and 1 month after completing their respective program.
Maxwell P Lead Clinical Health Psychologist, PhD, C Psych
CONTACT
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