Smartphone-based exercise intervention for chronic pain: PainReApp randomized clinical trial protocol, 2021, Moral-Munoz et al

[Andy]

Abstract
Aim
To evaluate the effectiveness of PainReApp, an mHealth system, based on physical exercise recommendations for patients with chronic pain (low back pain, fibromyalgia and diabetic neuropathic pain) based on pain intensity, quality of life, anxiety and/or depression, and sleep quality.

Design
Single-blinded randomized controlled trial.

Methods
One hundred patients from three different chronic conditions (low back pain, fibromyalgia and neuropathic diabetic pain) will be recruited and randomized into two groups to receive the intervention with a physical activity program guided by the PainReApp system (experimental group) or with the program information in paper format (control group). All patients will attend a first face-to-face session in which the smartphone application usage (experimental group) and exercise execution will be explained (both groups). Data will be collected at baseline, 4, 12 and 24 weeks. Nevertheless, the users of the application will have a daily registry of the exercise performed and the self-perceived difficulty. The primary outcomes of the trial will be the intensity of pain and quality of life. Anxiety and/or depression and sleep quality will be also assessed to evaluate the influence of the physical activity at multiple levels.

Discussion
Physical exercise is becoming one of the leading evidence-based interventions to treat chronic pain. It needs to be adapted to the necessities of each pain condition. One of the major problems is the low adherence to the proposed program. New strategies that empower the patients, such as the m-Health, are reliable and useful tools to ease this end.

Impact
To the best of our knowledge, this is the first long-term randomized controlled trial researching the impact of an m-health system on chronic pain from different origin. The intervention is based on international physical exercise recommendations and can be performed without specific material, allowing the home-based practice.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/jan.15095

 

[Sean]

Data will be collected at baseline, 4, 12 and 24 weeks.

Strongly prefer a minimum of 52 weeks for chronic conditions.

Nevertheless, the users of the application will have a daily registry of the exercise performed and the self-perceived difficulty. The primary outcomes of the trial will be the intensity of pain and quality of life.

Subjective self-report.

Physical exercise is becoming one of the leading evidence-based interventions to treat chronic pain. It needs to be adapted to the necessities of each pain condition. One of the major problems is the low adherence to the proposed program.

No possibility that this suggests it might be the intervention itself that is the problem, not the way in which it is delivered?

 

[NelliePledge]

People who like Apps think they are the solution for all issues.

 

[Argos]

One of the major problems is the low adherence to the proposed program

People who are in constant pain want nothing more than to be free of pain. Why would they stop an excercise program if it genuinly helped them? Patients don't need "Empowerment" ,they need real treatments.

 

[Midnattsol]

People who are in constant pain want nothing more than to be free of pain. Why would they stop an excercise program if it genuinly helped them? Patients don't need "Empowerment" ,they need real treatments.

I wonder how this will play out in the long run, I have seen a researcher say that subjects fail lifestyle interventions, they feel guilty and this can fuel ill health (this was a lifestyle intervention for depression, where the goal was to lose weight). So maybe we shouldn't provide these treatments...

Then again, I was extremely annoyed by the study design. If people feel guilty during a weight loss/healthier diet intervention, something has gone wrong and it is not at the participant's side of the equation.

 

[rvallee]

Physical exercise is becoming one of the leading evidence-based interventions to treat chronic pain. It needs to be adapted to the necessities of each pain condition. One of the major problems is the low adherence to the proposed program.

Totally consistent. It's the latest craze and also no one's buying it. How does it make it sense for something to be effective yet people stop using it? It doesn't. At all. It's essentially an appeal to authority: authorities are using it, therefore it must be good, otherwise they wouldn't be pushing it so far. It's a "leading intervention" not because it's useful, but because it's pushed relentlessly despite admissions that most people stop using it quickly because it's simply useless.

Those "studies" about acceptability are super weird, I legit don't understand their purpose other than allowing for psychosomatic pseudoscience through. Anything can be acceptable with the right conditions. Astrology, homeopathy, you name it. It says nothing at all about usefulness, or even applicability. Eating chocolate every day would be more acceptable than this, does it make it a better treatment for chronic pain? Of course not.

To the best of our knowledge, this is the first long-term randomized controlled trial researching the impact of an m-health system

As far as I can tell m-Health is the company. So this is the first trial of one of the company's products. I don't know why they felt the need to mention this. I guess because if people don't look carefully they don't get that it means nothing, sounds like a first at something, so it means "novel", which usually means a bunch of made-up stuff. Because everything is both novel and bespoke but also evidence-based and standardized (because otherwise none of the evidence would make any sense).

This is simply not serious. As usual.