query ref pain -009 - keele university › media › keeleuniversity › ri... · mass media,...

Written by Nadia Corp for ©Arthritis Research UK 2011

1

Mass media, internet-delivered and new social media interventions

for improving outcomes of patients with musculoskeletal pain

FEEDBACK FOLLOWING PRELIMINARY SEARCH

QUERY REF: PAIN-009

Received: 19.08.2011 Feedback to CSG: 31.10.2011(due), 11.10.2011 (sent)

SEARCH METHODOLOGY

The content of this feedback report refers only to the most relevant material located under each

of the evidence headings and is drawn predominantly from author abstracts or research

recommendations within Guidelines. The question is posed in the context of controlled trials

exploring the effectiveness of mass media, internet-delivered and ‘new’ social media interventions

for improving outcomes in musculoskeletal pain patients. Studies are restricted to those published

over the last five years (2006-Sept 2011 inclusive). Further details of all the studies included in this

report are shown in the Appendix 2, sorted by report section and author name.

Criteria used (PICO):

Who? (population)

Adults and adolescents with musculoskeletal problems e.g. back-, neck-, joint- and chronic

pain conditions (Except for online social networking interventions well all health conditions

were included).

What? (intervention/exposure/measure)

Any intervention delivered via new media/technologies e.g. mass media (radio-, TV and local

paper campaigns), the internet and new social networking media (Facebook, Twitter etc).

Comparison

Any.

What is measured? What are the outcomes?

Public knowledge, attitudes, beliefs and health behaviours; Pain outcomes; Cost-effectiveness;

Acceptability.

Location and setting

All

Exclusion Criteria

Non-English language guidelines, recommendations, systematic reviews, overviews and clinical

opinions. However, non-English language primary research articles with English abstracts were

included, see Section D: Primary Research.

2

Databases Searched

NHS Evidence: Health Information Resources; Cochrane Database of Systematic Reviews; EMBASE;

MEDLINE; ASSIA; HMIC; ISRCTN Register; Medical Research Council: Clinical Trials Unit; UK Clinical

Research Network Study Portfolio; NIH records on ClinicalTrials.gov; Nederlands Trial Register;

German Clinical Trials Register; Australian New Zealand Clinical Trials Registry.

Citation tracking was also used to locate relevant articles.

Types of Study

Controlled studies with or without randomisation.

Keywords searched

Search protocols were designed around the following terms: Musculoskeletal pain; Mass media;

Internet; New social networking sites e.g. Facebook, Twitter. For example see Appendix 1 for

Medline search protocol

Date limits

2006 to date i.e. previous 5 years.

Summary of available evidence

EVIDENCE TYPE INCLUDED IN FEEDBACK

A Evidence Summaries 0

B Systematic Reviews (and non-systematic reviews) 7 reviews (8 articles)

C Clinical Trial Registries (Current and Closed) 14

D Primary Research 22 studies (30 articles)

E Overviews and expert opinions N/A

F Intellectual Property Office N/A

3

RESULTS

A: Good Quality Evidence Summaries (including guidelines)

No relevant evidence summaries or guidelines were identified.

B: Systematic Reviews

This section includes meta-analyses, systematic reviews and evidence reviews where little specific

detail of the review methodology is given (i.e. non-systematic review).

Seven systematic reviews (reported in 8 publications), of which two included meta-analysis, were

identified as pertinent to this evidence review. Three specifically focus on pain, including reviews

of the internet management of pain (Bender, Radhakrishnan, Diorio, Englesakis, & Jadad, 2011),

the use of web-based cognitive behavioural therapy (CBT) for chronic pain (Macea, Gajos, Calil, &

Fregni, 2010) and computer-based CBT (including via internet) for chronic pain in children and

adolescents (Velleman, Stallard, & Richardson, 2010). Another three reviews have a broader

health focus, which includes pain conditions, and examine any internet intervention (Andersson,

Ljotsson, & Weise, 2011), or more specifically internet CBT (Cuijpers, van Straten, & Andersson,

2008) and behavioural change approaches on ‘new technology’ platforms (Rosser, Vowles, Keogh,

Eccleston, & Mountain, 2009a & b). Lastly, a systematic review specifically focusing online social

networking in the context of sexual health promotion was also included (Gold, Pedrana, Sacks-

Davis, Hellard, Chang, Howard, Keogh, Hocking & Stoove, 2011).

The general consensus across reviews is that web-based interventions, in these cases

predominantly CBT-based, appear to be beneficial for individuals, including adolescents and

children, with (musculoskeletal) pain conditions. However, reviews highlight limited evidence

bases and the need for further high quality research including of long-term outcomes. Notably, the

systematic review focusing on sexual health promotion and online social networking concludes

that these interventions are currently unreported in the scientific press.

C: Clinical Trial Registries

Fourteen, ongoing or recently completed i.e. since 2009, clinical trials were identified for inclusion

in this report, all of which most are RCTs. Whilst the majority of trials focus on adults, three

concern children (C14) and adolescents with chronic pain (C1) or arthritis (C12).

The focus of these trials is broad and covers a range of interventions across a variety of contexts

including:

• Mass media

o Community-wide physical activity promotion for middle/old-aged adults (C4)

• Internet

o Behavioural program for adolescents with chronic pain (C1)

o Web-based CBT for chronic pain in children (C14) and adults (C3)

o Self-management program with telephone support for adolescents with arthritis (C12):

results published in McDonald, Walsh, Vergara, & Gifford (2010), see section D.

4

o Resilience building (Authentic Happiness website) for medically unexplained physical

symptoms including pain (C13)

o Exercise related interventions

� Internet mediated pedometer based intervention to increase walking for people with

chronic back pain (C6): trial protocol also published see Krein, Metreger, Kadri,

Hughes, Kerr, Piette, Kim, & Richardson (2010)

� Online tailored exercise program for chronic low back pain, repetitive strain injury and

whiplash (C10)

� Computer-based telephone counselling to promote strength training adherence of

older adults with knee OA (C2)

o Effectiveness and cost-effectiveness of internet/email, face-to-face versus and standard

management of whiplash associated disorder (C11): protocol also published see

Soderlund, Bring, & Asenlof (2009)

o Cost-effectiveness of

� An individualised online real-life computer tailored physical activity and education

intervention for office workings to prevent (recurrence of) back pain (C7)

� Web-based follow ups for patients undergoing total hip or knee arthroplasty (C8)

• Mobile & Smart-phones

o Web-based situation feedback (using web-enabled mobile phones) for self-management

of patients with fibromyalgia (C5)

o SMS reminders for physiotherapy outpatient attendance (C9)

[Trial end dates were used to order the trials in the following table]

Ref Trial Details Study

Period

C1 Internet Intervention for Adolescents With Chronic Pain

Seattle Children's Hospital

http://ClinicalTrials.gov/show/NCT01316471

2011-2015

C2 Can Computer-based Telephone Counseling Improve Long-term Adherence to

Strength Training in Elders With Knee OA?

Boston University


2011-2014

C3 Online Cognitive Behavioral Therapy (CBT) Workbook

Talaria, Inc


2011-2012

C4 Effectiveness of community-wide promotion of aerobic, flexibility, and muscle-

strengthening activities on musculoskeletal pain and physical activity in middle- and

old- aged people: a cluster RCT

Physical Education and Medicine Research Center UNNAN, Japan

https://upload.umin.ac.jp/cgi-open-

bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R00000327

1&language=E

2009-2012

C5 Stimulating Self Management in Patients With Fibromyalgia Through Web-based

Situational Feedback

Oslo University Collegehttp://ClinicalTrials.gov/show/NCT01236209

2009-2012

C6 Veterans Walk to Beat Back Pain

Department of Veterans Affairs


2009-2012

5

C7 Cost-effectiveness of an individual on line real-life computer-tailored physical activity

and educational intervention at work-site to secondary prevention of non-specific sub

acute or recurrent low back pain on office workers: "Look after your back"

University of Extremadura, Spain

http://www.controlled-trials.com/ISRCTN40949689

2010-2011

C8 Cost-Effectiveness of Web-Based Follow Ups

University of Western Ontario, Canada


2010-2011

C9 Can short message service reminders reduce the do not attend rate in physiotherapy

outpatient clinics?

Angliss Hospital, Victoria (Australia)

http://www.anzctr.org.au/trial_view.aspx?id=320652

2009-2011

C10 Evaluation of the Online Exercise Coach.

Roessingh Research and Development b.v. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1695

2008-2010

C11 Choosing the most efficient and cost-effective treatment for acute whiplash

associated disorders (WAD)

The Swedish Research Council (Sweden)


2006-2011

C12 Internet Self-Management Program With Telephone Support for Adolescents With

Arthritis

The Hospital for Sick Children


2008-2009

C13 A Computer-Based Intervention for Medically Unexplained Physical Symptoms

University of Medicine and Dentistry New Jersey


2007-2009

C14 Web-Based CBT for Children With Chronic Pain

Eunice Kennedy Shriver National Institute of Child Health and Human Development


2007-2009

D: Primary Research

Primary research has been sub-divided according to experimental design (distinguishing large,

medium and small randomized controlled trials) and hence level of evidence provided. See

Appendix 2, Section D for details of studies included in this section.

RCT

Large randomized controlled trials (n≥100)

Internet-based

• Chronic pain

o Interactive website painACTION.com for management of chronic pain (Chiauzzi, Pujol,

Zacharoff, Bond, Yiu, Wood, & Black, 2010; Chiauzzi, Pujol, Wood, Bond, Black, Yiu, &

Zacharoff, 2010; Chiauzzi, Zacharoff, Bond, Yiu, & Wood, 2010).

o Online chronic pain management (Ruehlman, Karoly, & Enders, 2011).

o Health coaching via an internet portal for chronic conditions i.e. chronic pain, depression,

mobility difficulty (Leveille, Huang, Tsai, Allen, Weingart, & Iezzoni, 2009).

• ‘Arthritis Self-Management Program’ – an internet based intervention for individuals with RA,

OA & fibromyalgia (Lorig, Ritter, Laurent, & Plant, 2008).

6

• Web-enhanced self-management (based on cognitive behavioural pain management principles)

for individuals with fibromyalgia (Williams, Kuper, Segar, Mohan, Sheth, & Clauw, 2010).

• Web-based stress management and health promotion program for neck, shoulder and back pain

(Schell, Theorell, Hasson, Arnetz, & Saraste, 2008).

Medium-size randomized controlled trials (n≥50 and n<100)

Internet-based

• Chronic pain

o Internet-based CBT for chronic back pain (Buhrman, Nilsson-Ihrfelt, Jannert, Strom, &

Andersson, 2011)

o Internet-based rehabilitation course for chronic pain and burnout (Brattberg, 2006) with

long-term follow up (Brattberg, 2007).

o Online mind-body self care for older adults with chronic pain (Berman, Iris, Bode, &

Drengenberg, 2009).

• Internet-based telerehabilition following TKA or THA (Russell, Buttrum, Wootton, & Jull, 2011).

Online social-networking

• Non-MSK (non)-pain

o Risk behaviour in adolescents with public MySpace profiles (Moreno, Vanderstoep, Parks,

Zimmerman, Kurth, & Christakis, 2009).

o Intervention for cancer survivors with significant stress (Owen, Bantum, & Stanton, 2011).

Small randomized controlled trials (n<50)

Internet-based

• Virtual practitioner to coach on patient-practitioner communication in pain management in

older adults (McDonald, Gifford, & Walsh, 2009; McDonald, Gifford, & Walsh, 2011; McDonald,

Walsh, Vergara, & Gifford, 2011).

• Web-based CBT for children (11-17 year olds) with chronic pain i.e. headache, abdominal or

MSK pain (Palermo, Wilson, Peters, Lewandowski, & Somhegyi, 2009) and their families i.e.

family-based CBT (Palermo & Long, 2009).

Online social-networking

• Non-MSK (non)-pain

o Use of Skype (online telephone) and Facebook (social networking) to manage care of

adolescents with type I diabetes (Petrovski, Dimirovski, Bogoev, Adamova, Ahmeti, &

Jovanovska, 2011; Petrovski, Dimirovski, Bogoev, & Ahmeti, 2010).

Controlled (before and after) trial

Mass media

• Effect of mass media campaigns regarding (lower) back pain beliefs of GPs (Buchbinder & Jolley,

2007), GPs, physiotherapists and chiropractors (Werner, Gross, Lie, & Ihlebaek, 2008) and public

beliefs (Gross, Russell, Ferrari, Battie, Schopflocher, Hu, Waddell, & Buchbinder, 2010; Werner,

Ihlebaek, Laerum, Wormgoor, & Indahl, 2008)

Internet-based

• Web-based self-management of chronic lower back pain (Schulz, Rubinell, & Hartung, 2007) and

neuropathic pain (painACTION.com) (Venuti, Bromberg, Zacharoff, & Surrette, 2011).

7

Miscellaneous

Internet-based

• Secondary analysis of RCTs to establish website usage patterns of individuals with chronic pain

including back pain, migraine & neuropathic pain (Zacharoff, Wood, Chiauzzi, Bromberg, &

Black, 2011).

• Pilot (pre-trial) study of an internet-based mindfulness-based CBT framework intervention

delivered via mobile phone (Kristjansdottir, Fors, Eide, Finset, van Dulmen, Wigers, & Eide,

2011).

Further studies are identified, which are not detailed in Section D of Appendix 2, which may be

pertinent to the focus of this evidence review: these are listed in Appendix 3 & 4 and include

qualitative studies and non-controlled intervention studies.

E: Overviews and Expert Opinions

These are not detailed in the appendix, as higher-level evidence is available.

F: Intellectual Property Office

Not relevant to this report.

CONCLUSION

Primary research comprises a majority of the studies included in this report (22/29 studies

published in 30/38 articles) with a further 14 clinical trials ongoing or recently completed: of which

only one is apparently published. Six large randomized controlled trials (n>100; 9 articles) are

identified which rate as high-level evidence. Lower level evidence includes 10 randomized control

trials with smaller sample sizes (6 medium sized RCTs; 4 small RCTs), 4 controlled trials, 1

pilot/pre-trial study and 1 secondary analysis of RCTs (not a meta-analysis). Of the seven

systematic reviews (8 articles), two with meta-analyses, reported herein three specifically focus on

pain, three have a broader health focus but include pain conditions, the remaining review focuses

on sexual health promotion but is include as it is specifically concerned with online social-

networking.

The primary research is diverse and covers a range of pain conditions and interventions; however,

the majority of interventions are internet-based including self-management, CBT, (tele)-

rehabilitation and ‘virtual practitioners’. In contrast only two studies (4 papers) explore mass

media interventions and one pre-trial study focuses on the feasibility of using web-enabled mobile

phones/smartphones to deliver interventions. In the context of MSK pain no studies were

identified regarding interventions using online social-networking sites, however, outwith MSK pain

three studies were found focusing on: adolescent risk behaviour, management of type I diabetes

in adolescents and cancer survivors with significant stress. A similar pattern is noted for the

ongoing and recently completed trails.

Overall, the effect of (back pain) mass media interventions on GPs (physiotherapists and

chiropractors) beliefs is equivocal: one study shows a sustained effect and another no significant

impact. However, both studies do concur that public beliefs are positively impacted although no

8

behavioural shifts are observed, and conclude that future campaigns require more extensive

media coverage (and greater investment).

Internet-based interventions, on the whole, appear beneficial in terms of clinical and/or economic

outcomes: although a number of studies identify the need for further high quality research to

confidently evaluate the effectiveness of such interventions. Moreover, many authors suggest

such interventions as adjunct to other treatments rather than as standalone. In addition, one pre-

trial study showed an internet-based intervention could be feasibly delivered via web-enabled

mobile phones/smartphones.

There is a paucity of research regarding health-related interventions delivered via online social-

networking sites. The three studies identified, neither MSK or pain related, reported positive

outcomes of the respective interventions.

In summary, this report identifies the lack of high quality clinical trial evidence as a necessary

research direction in establishing the effectiveness mass media, internet-delivered and, in

particular, ‘new’ social media interventions for improving outcomes in musculoskeletal pain

patients.

ABBREVIATIONS

CBT Cognitive Behavioural Therapy

CI Confidence Interval

EQ5D EuroQol

HADS Hospital Anxiety and Depression Scale

MSK Musculoskeletal

NIH PROMIS National Institutes of Health, Patient Reported Outcomes Measurement

Information System

OA Osteoarthritis

OA-CAT Osteoarthritis computer adaptive test methodology

OR Odds Ratio

QoL Quality of Life

RA Rheumatoid arthritis

RCT Randomized Controlled Trial

sd Standard deviation

SF-12 Medical Outcomes 12-Item Short-Form Health Survey

SF-36 Medical Outcomes 36-Item Short-Form Health Survey

WOMAC Western Ontario and McMaster Universities Osteoarthritis Index

9

REFERENCES

Andersson, G., Ljotsson, B., & Weise, C. (2011). Internet-delivered treatment to promote health.

Current Opinion in Psychiatry, 24(2): 168-172.

Bender, J. L., Radhakrishnan, A., Diorio, C., Englesakis, M., & Jadad, A. R. (2011). Can pain be

managed through the Internet? A systematic review of randomized controlled trials. Pain,

152(8): 1740-1750.

Berman, R. L. H., Iris, M. A., Bode, R., & Drengenberg, C. (2009). The Effectiveness of an Online

Mind-Body Intervention for Older Adults With Chronic Pain. Journal of Pain, 10(1): 68-79.

Brattberg, G. (2006). Internet-based rehabilitation for individuals with chronic pain and burnout: a

randomized trial. International Journal of Rehabilitation Research, 29(3): 221-227.

Brattberg, G. (2007). Internet-based rehabilitation for individuals with chronic pain and burnout II:

a long-term follow-up. International Journal of Rehabilitation Research, 30(3): 231-234.

Buchbinder, R. (2008). Self-management education en masse: effectiveness of the Back Pain: Don't

Take It Lying Down mass media campaign. Medical Journal of Australia, 189(10): S29-S32.

Buchbinder, R., & Jolley, D. (2007). Improvements in general practitioner beliefs and stated

management of back pain persist 4.5 years after the cessation of a public health media

campaign. Spine, 32(5): E156-162.

Buhrman, M., Nilsson-Ihrfelt, E., Jannert, M., Strom, L., & Andersson, G. (2011). Guided Internet-

Based Cognitive Behavioural Treatment For Chronic Back Pain Reduces Pain Catastrophizing: A

Randomized Controlled Trial. Journal of Rehabilitation Medicine, 43(6): 500-505.

Chiauzzi, E., Pujol, L., Zacharoff, K., Bond, K., Yiu, E., Wood, M., & Black, R. (2010a).

PainACTION.com: An interactive self-management website for chronic back pain patients.

Journal of Pain, 11(4): S55.

Chiauzzi, E., Pujol, L. A., Wood, M., Bond, K., Black, R., Yiu, E., & Zacharoff, K. (2010b). painACTION-

Back Pain: A Self-Management Website for People with Chronic Back Pain. Pain Medicine, 11(7):

1044-1058.

Chiauzzi, E., Zacharoff, K. L., Bond, K. S., Yiu, E. C., & Wood, M. E. (2010c). PainACTION.com: An

interactive self-management web site for chronic back pain patients. Pain Medicine, 11(2): 307-

308.

Cuijpers, P., van Straten, A., & Andersson, G. (2008). Internet-administered cognitive behavior

therapy for health problems: a systematic review. Journal of Behavioral Medicine, 31(2): 169-

177.

Garcia-Lizana, F., & Sarria-Santamera, A. (2007). New technologies for chronic disease managment

and control: a systematic review. Journal of Telemedicine and Telecare, 13(2): 62-68.

Gold, J., Pedrana, A. E., Sacks-Davis, R., Hellard, M. E., Chang, S., Howard, S., Keogh, L., Hocking, J.

S., & Stoove, M. A. (2011). A systematic examination of the use of Online social networking sites

for sexual health promotion. BMC Public Health, 11.

Gross, D. P., Russell, A. S., Ferrari, R., Battie, M. C., Schopflocher, D., Hu, R., Waddell, G., &

Buchbinder, R. (2010). Evaluation of a Canadian Back Pain Mass Media Campaign. Spine, 35(8):

906-913.

Krein, S. L., Metreger, T., Kadri, R., Hughes, M., Kerr, E. A., Piette, J. D., Kim, H. M., & Richardson, C.

R. (2010). Veterans walk to beat back pain: study rationale, design and protocol of a randomized

trial of a pedometer-based Internet mediated intervention for patients with chronic low back

pain. BMC Musculoskeletal Disorders, 11.

10

Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., van Dulmen, S., Wigers, S. H., & Eide, H. (2011).

Written online situational feedback via mobile phone to support self-management of chronic

widespread pain: a usability study of a Web-based intervention. BMC Musculoskeletal Disorders,

12.

Leveille, S. G., Huang, A., Tsai, S. B., Allen, M., Weingart, S. N., & Iezzoni, L. T. (2009). Health

Coaching via an Internet Portal for Primary Care Patients With Chronic Conditions A Randomized

Controlled Trial. Medical Care, 47(1): 41-47.

Lorig, K. R., Ritter, P. L., Laurent, D. D., & Plant, K. (2008). The Internet-based Arthritis Self-

Management Program: A one-year randomized trial for patients with arthritis or fibromyalgia.

Arthritis & Rheumatism-Arthritis Care & Research, 59(7): 1009-1017.

Macea, D. D., Gajos, K., Calil, Y. A. D., & Fregni, F. (2010). The Efficacy of Web-Based Cognitive

Behavioral Interventions for Chronic Pain: A Systematic Review and Meta-Analysis. Journal of

Pain, 11(10): 917-929.

McDonald, D., Gifford, T., & Walsh, S. (2009). A virtual practitioner pain communication coach

intervention pilot. Journal of Pain, 10(4): S66.

McDonald, D., Walsh, S., Vergara, C., & Gifford, T. (2010). The effect of a virtual pain coach on

older adults' osteoarthritis pain: A pilot study. Journal of Pain, 11(4): S59.

McDonald, D., Walsh, S., Vergara, C., & Gifford, T. (2011). The effect of a virtual pain coach on pain

management discussions: A pilot study. Journal of Pain, 12(4): P85.

McDonald, D. D., Gifford, T., & Walsh, S. (2011). Effect of a virtual pain coach on older adults' pain

communication: a pilot study. Pain Management Nursing, 12(1): 50-56.

Moreno, M. A., Vanderstoep, A., Parks, M. R., Zimmerman, F. J., Kurth, A., & Christakis, D. A.

(2009). Reducing at-risk adolescents' display of risk behavior on a social networking web site a

randomized controlled pilot intervention trial. Archives of Pediatrics and Adolescent Medicine,

163(1): 35-41.

Owen, J., Bantum, E., & Stanton, A. (2011). Effects of asynchronous professional facilitation on

behavioral engagement in an internet-based intervention for cancer-related distress. Psycho-

Oncology, 20(S1): 4-5.

Palermo, T., & Long, A. (2009). Randomized controlled trial of a web-based psychological

treatment for pediatric chronic pain. Journal of Pain, 10(4): S72.

Palermo, T. M., Wilson, A. C., Peters, M., Lewandowski, A., & Somhegyi, H. (2009). Randomized

controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for

children and adolescents with chronic pain. Pain, 146(1-2): 205-213.

Petrovski, G., Dimirovski, C., Bogoev, M., Adamova, K., Ahmeti, I., & Jovanovska, B. (2011). Internet

visits improve diabetes control in adolescents on pump therapy. Diabetes Technology and

Therapeutics, 13 (2): 261-262.

Petrovski, G., Dimirovski, C., Bogoev, M., & Ahmeti, I. (2010). Carelink, Skype and Facebook

improve diabetes control in adolescents on pump therapy. Diabetologia, 53: S416.

Rosser, B., Vowles, K., Keogh, E., Eccleston, C., & Mountain, G. (2009a). A systematic review of

technology-assisted behaviour change for the management of chronic health conditions

including pain. European Journal of Pain, 13: S266-S267.

Rosser, B. A., Vowles, K. E., Keogh, E., Eccleston, C., & Mountain, G. A. (2009b). Technologically-

assisted behaviour change: a systematic review of studies of novel technologies for the

management of chronic illness. Journal of Telemedicine and Telecare, 15(7): 327-338.

Ruehlman, L., Karoly, P., & Enders, C. (2011). Evaluation of the online chronic pain management

program. Journal of Pain, 12(4): P73.

11

Russell, T. G., Buttrum, P., Wootton, R., & Jull, G. A. (2011). Internet-based outpatient

telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial.

Journal of Bone and Joint Surgery-American Volume, 93A(2): 113-120.

Schell, E., Theorell, T., Hasson, D., Arnetz, B., & Saraste, H. (2008). Impact of a web-based stress

management and health promotion program on neck-shoulder-back pain in knowledge workers?

12 month prospective controlled follow-up. Journal of Occupational & Environmental Medicine,

50(6): 667-676.

Schulz, P. J., Rubinell, S., & Hartung, U. (2007). An internet-based approach to enhance self-

management of chronic low back pain in the Italian-speaking population of Switzerland: results

from a pilot study. International Journal of Public Health, 52(5): 286-294.

Soderlund, A., Bring, A., & Asenlof, P. (2009). A three-group study, internet-based, face-to-face

based and standard-management after acute whiplash associated disorders (WAD) - choosing

the most efficient and cost-effective treatment: study protocol of a randomized controlled trial.

BMC Musculoskeletal Disorders, 10.

Velleman, S., Stallard, P., & Richardson, T. (2010). A review and meta-analysis of computerized

cognitive behaviour therapy for the treatment of pain in children and adolescents. Child Care

Health and Development, 36(4): 465-472.

Venuti, S. W., Bromberg, J., Zacharoff, K., & Surrette, D. (2011). painACTION.com: Web-based

support to self-manage neuropathic pain. Journal of Pain, 12(4): Supplement P1.

Werner, E. L., Gross, D. P., Lie, S. A., & Ihlebaek, C. (2008). Healthcare provider back pain beliefs

unaffected by a media campaign. Scandinavian Journal of Primary Health Care, 26(1): 50-56.

Werner, E. L., Ihlebaek, C., Laerum, E., Wormgoor, M. E. A., & Indahl, A. (2008). Low back pain

media campaign: no effect on sickness behaviour. Patient Education & Counseling, 71(2): 198-

203.

Williams, D. A., Kuper, D., Segar, M., Mohan, N., Sheth, M., & Clauw, D. J. (2010). Internet-

enhanced management of fibromyalgia: a randomized controlled trial. Pain, 151(3): 694-702.

Zacharoff, K., Wood, M., Chiauzzi, E., Bromberg, J., & Black, R. (2011). Distinct chronic pain

diagnoses and website usage patterns: A secondary analysis of clinical trial data. Journal of Pain,

12(4): Supplement P1.

12

APPENDIX 1 1 (systematic adj review).mp.

2 (metaanalys* or meta-analys* or (meta adj analys*)).mp.

3 randomized controlled trial.pt.

4 controlled clinical trial.pt.

5 randomized.ab.

6 placebo.ab.

7 therapy.fs.

8 randomly.ab.

9 trial.ab.

10 groups.ab.

11 or/1-10

12 exp animals/ not humans.sh.

13 11 not 12

14 ((media or advertising or advertizing or radio or television or newspaper* or poster* or flyer*

or (information adj booklet)) adj3 (information or education or campaign* or intervention* or

strateg* or program*)).ti,ab.

15 internet*.ti,ab.

16 web*.ti,ab.

17 exp Computer Communication Networks/

18 exp Mass Media/

19 (mass adj media).ti,ab.

20 (radio or television or tv or campaign).ti,ab.

21 Newspapers/

22 Advertising as Topic/

23 (advertis* or advertiz*).mp.

24 Videotape Recording/

25 exp Telecommunications/

26 Radio/

27 exp Audiovisual Aids/

28 www*.ti,ab.

29 online*.ti,ab.

30 net.ti,ab.

31 (social adj2 media).ti,ab.

32 (facebook or twitter or youtube or myspace or bebo).ti,ab.

33 (technologic* adj assist*).ti,ab.

34 Cellular Phone/

35 ((smartphone or (mobile or cell* or smart)) adj phone*).ti,ab.

36 Telemedicine/

37 telemedicine.ti,ab.

13

38 (text adj messag*).ti,ab.

39 or/14-38

40 exp Pain/

41 pain.ti,ab.

42 40 or 41

43 KNEE/ or knee.ti,ab.

44 SHOULDER/ or shoulder.ti,ab.

45 exp BACK/ or back.ti,ab.

46 neck/ or neck.ti,ab.

47 elbow/ or elbow.ti,ab.

48 exp hand/ or hand.ti,ab.

49 hip/ or hip.ti,ab.

50 exp foot/ or (foot or feet).ti,ab.

51 ankle*.ti,ab.

52 wrist*.ti,ab.

53 joint*.ti,ab.

54 or/43-53

55 42 and 54

56 fibromyalgia.ti,ab.

57 Fibromyalgia/

58 (chronic adj3 pain).ti,ab.

59 (pain adj syndrome*).ti,ab.

60 exp Osteoarthritis/

61 osteoarthritis.ti,ab.

62 or/55-61

63 13 and 39 and 62

64 limit 62 to yr="2001 -Current"

65 (facebook or twitter or myspace or beb).ti,ab.

66 (social adj2 (media or internet)).ti,ab.

67 (social adj2 (site* or website*)).ti,ab.

68 or/65-67

69 13 and 68

70 limit 69 to yr="2001 -Current"

14

FULL TEXT APPENDIX 2 SECTION B – SYSTEMATIC REVIEWS

Title Sample Methodology/ Comments

Summary

Andersson, Ljotsson & Weise (2011). Internet-delivered treatment to promote health.

A review of controlled trials of internet interventions for health conditions.

Not clear from the abstract

Unable to access full article for details

18 studies were included covering a range of health conditions including those with pain. One third of studies targeted adolescents & children. Two cancer trials examined peer support in an online environment: these failed to show any significant improvements.

Overall, several trails found no significant improvements, with the exception of studies into headache, chronic pain and irritable bowel syndrome. However, the majority of studies were small and underpowered.

Concludes internet interventions may have potential in complementing other treatments e.g. CBT, but the benefits of online peer support groups remain unclear. Whilst studies of children and adolescents are emerging there is currently a lack of trials in older adults.

Bender, Radhakrishnan, Diorio, Englesakis & Jadad (2011). Can pain be managed through the Internet? A systematic review of randomized controlled trials.

A systematic review of RCTs evaluating the effects of internet-based interventions on patients with pain (of any kind)

Online search of Medline, CINAHL, PsycINFO and Cochrane Library. Articles published between 1990 and 2010.

6724 citations were identified of which 17 were included in the review. These trials addressed CBT, moderated peer support programs and clinical visit preparation or follow-up support interventions involving 2503 people with pain.

Six studies (35.3%) were rated as high quality. Most CBT trials found improvement in pain (n=7; 77.8%), activity limitation (n=4, 57.1%) and treatment costs (n=2, 50%), however effects on depression (n=2, 28.6%) and anxiety (n=2, 50%) were inconsistent. Evidence was limited, but promising, with regards to the benefits of internet-based peer support programs on pain intensity, activity limitation, health distress and self-efficacy, similarly, social networking programs appear potentially beneficial in children and adolescents. There was insufficient evidence for internet-based clinical support interventions.

Concludes internet-based interventions are potentially beneficial for people with pain, although the types of people benefiting most are unknown. Further, high quality controlled trials with diverse patient groups are recommended to strengthen the evidence-base.

15

Cuijpers, van Straten, & Andersson (2008). Internet-administered cognitive behavior therapy for health problems: a systematic review.

A systematic review of RCTs and comparative studies examining internet-based CBT interventions aimed at behavioural change in patients with existing disorders or health conditions: excluding those focused on mental health or lifestyle change.

Online search of Pubmed, Psycinfo, Embase, the Cochrane Central Register of Controlled Trials and Digital Dissertations. Also, citation tracking

Articles published between 1966 to February 2007.

12 studies met the inclusion criteria: 3 concerned pain, 3 headache and 6 other health conditions. Internet interventions focused on pain and headaches were comparable to face-to-face interventions. Effects were found for other interventions, but these varied with target condition.

Concludes internet-based CBT interventions appear to be a beneficial adjunct to existing treatments. Further, predicts that internet delivery of CBT with play a greater role in future interventions.

Garcia-Lizana & Sarria-Santamera (2007). New technologies for chronic disease management and control: a systematic review.

Systematic review of RCTs assessing the effectiveness of interventions using information and communication technologies (ICT, excluding telephone communication only)

Online search of electronic databases

950 trials were identified, of which 24 met inclusion criteria, these included 5 asthma trials; 3 hypertension trials; 1 home telecare trial; 7 diabetes trials; 6 heart failure trials and 2 trials into prevention of heart disease. Generally, ICT interventions did not show an improvement in clinical outcomes, nor were adverse effects identified. However, in the case of cardiovascular disease detection and follow up, ICT use was associated with better clinical outcomes, reduction in mortality and lower health service utilization. Systems designed to improve education and social support were also shown to be effective. Concludes current evidence for the use of ICTs in the management of chronic disease is limited. Nb: unable to access full article for further details

1Gold, Pedrana, Sacks-Davis, Hellard, Chang, Howard, Keogh, Hocking & Stoove (2011). A systematic examination of the use of Online social networking sites for sexual health promotion.

Systematic review of published scientific literature, electronic sources and social networking sites to examine the extent to which social networking sites are used for sexual health promotion.

Electronic searches using general and scientific search engines, blogs and social networking sites (Facebook, MySpace)

178 sexual health promotion activities were identified which fulfilled the inclusion criteria, however, only 1 of these activities was identified through the traditional systematic search of research articles. Sexual health promotions typically used only one social networking site, were run by not-for-profit organisations, were targeted at young people and included the delivery of information. The most popular social networking site used for health promotion activities was Facebook (71%) followed by MySpace and Twitter. 79% of activities were considered inactive (no online posts within the last month) on MySpace, in contrast to 22% on Facebook and 14% on Twitter. The number of end-users and posts to the site in the last 7 days varied markedly across the different health promotion activities. Concludes social networking sites are being used for sexual health promotion, although the extent to which they are used varies markedly. Furthermore, most activity remains unreported in the scientific literature.

1 Sexual health focus not MSK pain

16

Macea, Gajos, Daglia Calil, & Fregni (2010). The efficacy of web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis.

Systematic review and meta-analysis of prospective RCTs evaluating the effects of web-based CBT intervention for the treatment of chronic pain using specific scales of pain.

Online search of MEDLINE, Cochrane, Psychoinfo, and Scielo databases. Citation tracking was also undertaken.

Restricted to English language articles

164 articles were identified of which 40 were related to the use of the internet for chronic pain. 11 studies met inclusion criteria. The pooled effect size was small (0.285, 95% CI 0.145-0.424) favouring web-based interventions compared to wait-list controls: sensitivity analysis showed result was not the results of any particular study, whilst funnel plots suggest no publication bias. Mean dropout rate was 26.6%. Concludes that findings suggest web-based CBT for chronic pain result in small pain reductions compared to wait-list controls. Therefore, this hold potential as a therapeutic tool for chronic pain, reducing treatment costs and side effects (compared with pharmacological interventions).

Rosser, Vowles, Keogh, Eccleston, & Mountain (2009a) A systematic review of technology-assisted behaviour change for the management of chronic health conditions including pain; and (2009b) Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness.

A systematic review of studies reporting behaviour change approaches considered on a ‘new technology’ platform with particular emphasis on critical features of the designs, methods and technologies that have been used in behaviour change therapies.

Online search of PubMed, EMBase, PsychInfo and MEDLINE, for article published from 1990 to February 2008.

1812 articles identified of which 45 met inclusion criteria: these involved 33 separate interventions. Studies covered a range of chronic health conditions including diabetes, congestive heart disease, depression and stroke, however, none were identified within the arena of chronic pain management.

A majority of studies reported a theoretical basis, usually a cognitive-behavioural framework. A broad range of interventions were identified including mobile palm-pilot devices delivering therapy content, internet therapy modules and home monitoring equipment. 73% of interventions involved professional therapists. High attrition rates were common to most studies.

Conclude that technology-based behavioural change is potentially advantageous in providing more accessible and immediate therapy including self-management systems. However, no studies were identified which examined the long-term behavioural change in individuals with chronic pain.

Velleman, Stallard, & Richardson (2010). A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents.

Systematic review and meta-analysis of studies of computerised, including web-based, CBT interventions for children and adolescents with chronic pain.

Online search of Pubmed (including Medline), Embase and PsychInfo for articles published between 1980 and 2008.

Restricted to English language articles

2730 articles were identified of which four studies met inclusion criteria. All these studies found a beneficial effect of computerised/web-based CBT: with individuals completing computerised CBT more likely to have 50% reduction in symptoms post-treatment than those in a control group.

A medium effect size (-0.41) for reduced pain intensity following computerised/web-based CBT compared to controls was found, with an mean odds ratio of 6.03 for attaining clinically significant reductions in pain.

Concludes computerised/web-based CBT may prove beneficial for treating pain in children and adolescents, however the current evidence base is limited and further research is required.

17

SECTION C – CLINICAL TRIAL REGISTRIES

Title Sponsors and Status Summary

C1 Internet Intervention for Adolescents With Chronic Pain


Seattle Children's Hospital

2011-2015

Not yet recruiting

RCT (active control) to assess the efficacy of a web-based behavioural program to reduce pain and improve functioning in children and adolescents with chronic pain.

Participants: n = 600; age = 11-16 years; chronic pain (not associated with chronic disease) of ≥3 months duration;

Outcomes: Activity limitation; pain; Depression and pain-specific anxiety; Treatment Satisfaction; Parental Response to Pain Behaviour; Sleep Quality; Service Use; Miscarried Helping

Assessed: pre-treatment, immediately post-treatment, 6 and 12 months

C2 Can Computer-based Telephone Counseling Improve Long-term Adherence to Strength Training in Elders With Knee OA?


Boston University

2011-2014

Not yet recruiting

RCT (no intervention control) to determine if computer-based telephone counselling improves adherence to strength training in older adults with knee osteoarthritis.

Participants: n=80; age ≥55 years old; with knee OA

Outcomes: Exercise adherence; WOMAC; NIH PROMIS for physical function; OA-CAT; Quadriceps strength; Timed Physical Function tasks; Exercise quality

Assessed: Baseline, 1 month post-exercise intervention, 12 and 24 months.

C3 Online Cognitive Behavioral Therapy (CBT) Workbook


Talaria, Inc

2011-2012

Not yet recruiting

RCT (active control) to assess the efficacy of an online self-help intervention, The Wellness Workbook, for individuals with chronic low back pain.

Participants: n=198; age ≥18 years old; chronic low back pain (non-cancerous)

Outcomes: pain related disability and interference scores; pain-related disabling beliefs and attitudes

Assessed: Baseline, post-intervention i.e. 10 weeks and 18 week follow-up

C4 Effectiveness of community-wide promotion of aerobic, flexibility, and muscle-strengthening activities on musculoskeletal pain and physical activity in middle- and old- aged people: a cluster RCT

https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000003271&language=E

Physical Education and Medicine Research Center UNNAN, Japan

2009-2012

Active (not recruiting)

RCT (no intervention control) to assess the effectiveness of a community-wide physical activity promotion on MSK pain and physical activity in middle- and old-aged adults.

Participants: n=3000; age >40 and <80 years old

Outcomes: Engagement in regular exercise activity; pain scores of shoulder, low back and knee

Assessed: Baseline and 1 year

18

C5 Stimulating Self Management in Patients With Fibromyalgia Through Web-based Situational Feedback


Oslo University College

2009-2012


RCT (active control) to determine the effectiveness of situational feedback to the self-management of fibromyalgia syndrome using innovative means of patient-provider communication (web-enabled mobile phone).

Participants: n=140; Female; aged ≥18 years old; Fibromyalgia

Outcomes: catastrophizing cognitions; pain acceptance

Assessed: Baseline, post-in house rehabilitation, start of situational feedback; 6 and 12 months

C6 Veterans Walk to Beat Back Pain


Department of Veterans Affairs

2009-2012


RCT (active control) to determine if an Internet-mediated pedometer based intervention increases walking and improves function among individuals with chronic back pain.

Participants: n=229; age ≥18 years old; chronic back pain >3 months

Outcomes: Roland and Morris Disability Index

Assessed: Baseline and 12 months

C7 Cost-effectiveness of an individual on line real-life computer-tailored physical activity and educational intervention at work-site to secondary prevention of non-specific sub acute or recurrent low back pain on office workers: "Look after your back"


University of Extremadura, Spain

2010-2011

Completed

RCT (active control) to assess the cost-effectiveness of an individual online real-life computer tailored physical activity and education intervention at work “Look after your back” to prevent subacute and recurrent low back pain in office workers.

Participants: n=100; age 18-65 years old; office workers with or without Non-specific low back pain

Outcomes: Socio-sanitary costs (direct & indirect); Functional & psychological disability (Roland-Morris Questionnaire, the Oswestry Disability Index and the Start Back Tool); Health related QoL (EQ-5D); fitness & muscular function; Satisfaction with intervention; International Physical Activity Questionnaire; Stage of change

C8 Cost-Effectiveness of Web-Based Follow Ups


University of Western Ontario, Canada

2010-2011

Active (recruiting)

RCT (active control) to determine the cost-effectiveness of web-based follow-up assessments compared to standard in-clinic follow-ups for patients undergoing total hip or total knee arthroplasty.

Participants: n=1000; undergone total hip or total knee arthroplasty

Outcomes: Cost-effectiveness; Harris Hip Score; WOMAC; SF-12; Adverse effects

Assessed: 1 year post-surgery

C9 Can short message service reminders reduce the do not attend rate in physiotherapy outpatient clinics?

http://www.anzctr.org.au/trial_view.aspx?id=320652

Angliss Hospital, Victoria (Australia)

2009-2011

Completed

RCT (active control) to assess the effect of short message service reminders (sent 2 days before their appointment if made >3 days prior, or the day before if the appointment was made 2 days before) on attendance at physiotherapy outpatient clinics

Participants: n=1000; ≥18 years; with physiotherapy appointment in an acute physiotherapy outpatient clinic

Outcomes: Do not attend rate i.e. proportion of all scheduled appointments not attended; cancellation rate; cost

19

C10 Evaluation of the Online Exercise Coach.

http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1695

Roessingh Research and Development b.v.

2008-2010

Completed

RCT (active control) to evaluate the effectiveness of an online tailored exercise program.

Participants: n = 56 ; ≥18 years old; Chronic low back pain, Repetitive Strain Injury, Whiplash

Outcomes: Exercise compliance; preferences; satisfaction; effectiveness

Assessed: (Baseline &) 6 weeks

C11 Choosing the most efficient and cost-effective treatment for acute whiplash associated disorders (WAD) http://www.controlled-trials.com/ISRCTN61531337

The Swedish Research Council (Sweden) 2006-2011 Ongoing

RCT (active control) to determine the most efficient and cost-effective of three treatments for acute whiplash associated disorders: internet-based or face-to-face based approach (both emphases self-monitoring and skills training, with therapist led discussions) or standard-management.

Participants: n =180; age = 18-65 years old; Grade I or II acute whiplash associated disorder

Outcomes: Disability; Cost-effectiveness; Patient Goal Priority Questionnaire; Tampa Scale for Kinesiophopia; Pain Intensity Diary; Self-Efficacy Scale; Copy Strategies Questionnaire; SF-36; Exercise Diary

Assessed: Pre-, post-treatment and 3, 6, 12 and 24 months

C12 Internet Self-Management Program With Telephone Support for Adolescents With Arthritis


The Hospital for Sick Children

2008-2009

Completed

RCT (no intervention control) to evaluate the feasibility of "Teens Taking Charge: Managing Arthritis On-line": an intervention to help adolescents with arthritis to better manage their disease and improve their health-related quality of life.

Participants: n=46; age 12-18 years old; juvenile idiopathic arthritis

Outcomes: Juvenile Arthritis Quality of Life Questionnaire; Disease specific knowledge; Pain coping; Self-efficacy; Adherence to treatment; Stress

Assessed: Baseline & 3 months post-intervention

C13 A Computer-Based Intervention for Medically Unexplained Physical Symptoms


University of Medicine and Dentistry New Jersey

2007-2009

?Completed

RCT (sham control) to assess the effectiveness of a computer-based intervention: 6-sessions of psychological resilience building via “Authentic Happiness” website.

Participants: n=60; aged 18-75 years old; with medically unexplained physical symptoms including persistent fatigue, pain complaints, and gastrointestinal, cardiovascular or musculoskeletal symptoms.

Outcomes: Quick Inventory of Depressive Symptoms; Positive and Negative Affect Scale; Satisfaction with Life Scale; Patient Health Questionnaire; Health Assessment Questionnaire

Assessed: Baseline and 6 weeks

20

C14 Web-Based CBT for Children With Chronic Pain


Eunice Kennedy Shriver National Institute of Child Health and Human Development

2007-2009

?Completed

RCT (no intervention control) to develop and evaluate the feasibility and effectiveness of a web-based treatment approach to provide psychological treatment to reduce pain and improve functioning in children and adolescents with chronic pain.

Participants: n=48; age 12-18 years old; chronic headache, abdominal, and/or MSK pain ≥3 months

Outcomes: activity limitations; parental response to pain behaviours; depressive symptoms; pain intensity

Assessed: Immediately post-treatment and 3-month follow up

SECTION D – PRIMARY RESEARCH

Square brackets around the title of an article indicate that whilst the article’s abstract is available in English, the main body of the article is NOT in English.

Title Sample Methodology/ Comments Summary

Berman, Iris, Bode & Drengenberg (2009). The Effectiveness of an Online Mind-Body Intervention for Older Adults With Chronic Pain.

RCT

78 adults ≥55 years old with chronic pain randomized to receive online mind-body self-care techniques (n=41) or wait-list (n=37).

To assess the feasibility and efficacy of delivering an online mind-body self-care intervention.

Assessed: Baseline & 6 weeks.

Outcomes: pain intensity, limitations due to pain, pain self-efficacy, anxiety, depression and awareness of pain responses.

Both intervention and control groups showed improvement in pain intensity and pain interference at follow up, whilst a significant between-group difference in awareness of pain responses was identified. In addition, the intervention group showed increased confidence in using non-medical self-care techniques for pain management at follow up, and showed a marked reduction in mean pain scores between log-on and log-off suggesting an immediate benefit in reducing pain.

Concludes that a short-term online mind-body pain intervention is both feasible and efficacious. Therefore, suggesting the internet can be an efficient means of delivering self-care education to older adults with chronic pain to complement clinical care.

21

Brattberg (2006). Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial.

RCT

55 people, aged 18-65 years old, with chronic pain and burnout on sick leave for ≥ 6 months, randomly assigned to participate in a 20-week online/internet-based rehabilitation course (n=27) or wait-list control (n=28).

To investigate whether existential discussions, with a CBT emphasis (Socratic dialogue) in a group over the Internet, has rehabilitative effects for people on long-term sick leave, who suffer from chronic pain and burnout. Assessed: Baseline & 23 weeks Outcomes: SF-36; HADS & stress barometer.

The intervention group showed significant improvement in depression, pain, vitality, social function, presence of stress symptoms and performance problems involving work or other activities due to physical illness, compared to controls.

For the 23 individuals not on permanent disability pensions, 13 (57%) also increase work capacity.

The number needed to treat with regard anxiety and depression was 2; and for increased work capacity was 3.

Concludes internet-based rehabilitation of individuals on long-term sick leave is a good complement to other rehabilitation programs.

Brattberg (2007). Internet-based rehabilitation for individuals with chronic pain and burnout II: a long-term follow-up.

RCT

50 people, aged 18-65 years old, with chronic pain and burnout on sick leave for ≥ 6 months, previously randomized to participate in a 20-week online/internet-based rehabilitation course (n=25) or wait-list control (n=25).

To investigate the long-term outcomes of an internet based group rehabilitation course (existential discussions, with a CBT emphasis and Socratic dialogue) for people on long-term sick leave, who suffer from chronic pain and burnout. Assessed:12-month follow up Outcomes: SF-36; HADS & stress barometer.

At 12-months follow up no significant differences in stress or health were identified between the intervention and control groups. However, individuals in the treatment group reported significantly greater improvement in work capacity compared to controls (50% vs 13% of participants had increased work capacity respectively, p=0.005).

Concludes internet-based rehabilitation for people on long-term sick leave appears to complement other rehabilitation programs.

Buchbinder & Jolley (2007). Improvements in general practitioner beliefs and stated management of back pain persist 4.5 years after the cessation of a public health media campaign.

Quasi-experimental, nonrandomised, parallel group-controlled study. Mailed survey of general practitioners in Victoria (exposed to mass-media campaign) and New South Wales (NSW; controls)

To assess the impact of a media campaign on general practitioner beliefs and state behaviour about back pain 4.5 years after its cessation.

Assessed: Before, immediately after and 4.5 years later.

Outcomes: knowledge and attitudes to back pain; management of back pain

635 GPs in Victoria and 511 GPs in NSW completed the 4.5 year follow up.

At the last follow up Victorian GPs showed sustained improvement in beliefs and behaviour compared to baseline. Compared to their NSW counterparts they were 2.0 (95% CI 1.3-3.0) times as likely to know patients with low back pain need not wait to be almost pain free to return to work; 1.78 (95% CI 1.27-2.49) times as likely not to order acute low back pain tests and 0.47 (95% CI 0.33-0.69) times as likely to order lumbosacral radiographs; 0.49 (95% CI 0.34-0.73) times as likely to prescribe bed rest and 1.62 (95% CI 1.19-2.22) times as likely to advise work modification.

Concludes population-based strategy to shift society views regarding back pain has a sustained effect on GP beliefs and behaviour 4.5 years following cessation.

22

Buhrman, Nilsson-Ihrfelt, Jannert, Strom & Andersson (2011). Guided Internet-Based Cognitive Behavioural Treatment For Chronic Back Pain Reduces Pain Catastrophizing: A Randomized Controlled Trial.

Controlled trial

54 people with chronic back pain receiving a 12 week program including education, cognitive skills acquisition, behavioural rehearsal, generalisation and maintenance (n=26) or control group (n=28).

To evaluate the effects of an internet-based CBT intervention on symptoms of chronic back pain.

Assessed: Baseline, 12 weeks

Outcomes: Catastrophizing subscale of the Coping Strategies Questionnaire.

The treatment group showed a significant decrease in catastrophizing at 12-week follow-up and an improvement in QoL, although the majority of outcomes showed no positive benefit of the treatment. 58% (15/26) of individuals in the treatment group compared to 18% (5/28) of controls showed reliable improvement in catastrophizing.

Concludes internet-based CBT may complement other treatment for individuals with chronic pain and have difficulty accessing specialist treatment facilities.

Chiauzzi, Pujol, Zacharoff, Bond, Yiu, Wood, & Black (2010). PainACTION.com: An interactive self-management website for chronic back pain patients. and Chiauzzi, Zacharoff, Bond, Yiu, & Wood (2010). PainACTION.com: An interactive self-management web site for chronic back pain patients.

RCT (Posters)

Experimental group used painACTION.com (8 site visits a month & 5 monthly boosters) or control group (treatment as usual). Experiment group participants were also classified as either high dose or low dose based on a median split.

To describe the development and testing of painACTION.com, an interactive website.

Assessed: Baseline, post-intervention, 3 & 6 month follow up.

Outcomes: pain, physical & emotional functioning, self-efficacy, catastrophizing, pain beliefs and work productivity.

Experimental participants exhibited decreased stress across all time points. Those with high baseline pain increased relaxation, and decreased guarding and helplessness. Those experimental participants recruited online showed decreased average pain ratings and worst pain levels, and increased coping self-statements. High dose participants reported increased coping self-statements and decreased stress.

Concludes the internet has the potential to provide an effective mode for enhancing self-management in back pain patients. Better outcomes are suggested in less severe online groups i.e. with lower disability compared to clinical groups. Furthermore, better responses appear associated with higher baseline pain levels and those at higher website doses.

23

Chiauzzi, Pujol, Wood, Bond, Black, Yiu, & Zacharoff (2010). painACTION-Back Pain: A Self-Management Website for People with Chronic Back Pain.

RCT 299 people with chronic back pain recruited online and via a pain clinic, randomized to painACTION-Back Pain website or control (text-based material) conditions.

To determine the effect of an interactive self-management website for people with chronic back pain on emotional and physical levels.

Assessed: Baseline, 1, 3 and 6- month follow up.

Outcomes: pain intensity, physical functioning, emotional functioning, copy, self-efficacy, fear-avoidance, perceived improvement with treatment and catastrophizing.

Follow up rates at 6 months were 73% and 84% for Website and control groups respectively.

Website participants report significantly lower stress increased coping self-statements and greater social support use, with clinically significant differences in pain intensity, depression, anxiety, stress and global ratings of improvement.

Participants recruited online and using the Website intervention reported significantly lower “worst” pain, lower ‘average’ pain and increased coping self-statements compared to controls, whereas no differences were noted in participants recruited at the pain clinic.

Concludes online self-management programs for people with chronic back pain can effect improvements in stress, coping and social support and clinically significant improvements in pain, depression, anxiety and global rates of improvement.

Gross, Russell, Ferrari, Battie, Schopflocher, Hu, Waddell, & Buchbinder (2010). Evaluation of a Canadian Back Pain Mass Media Campaign.

Controlled trial.

Telephone survey of random sample from intervention (mass media campaign: Don’t Take it Lying Down) and control provinces in Canada, before and after campaign.

To evaluate a back pain mass media campaign’s effect on back pain beliefs, work disability and health utilization outcomes.

Assessed: Pre- and post-campaign

Outcomes: Back Beliefs Questionnaire, importance of staying active. Also number of visits to healthcare providers, use of diagnostic imaging and compensation claim incidence and duration.

Over the 4-year period 8566 participants completed the beliefs survey. No significant changes in the Back Beliefs Questionnaire were found pre- and post-campaign, however those participants agreeing with the statement “if you have back pain you should try to stay active” significantly increased from 56% to 63% (p=0.008) with no change in the control group (c. 60%). No significant changes were noted with regards to behavioural outcomes.

Concludes a mass media campaign appears to have a small impact on public beliefs specifically related to the campaign’s message to stay active, in contrast no effect on health utilization or work disability outcomes were found. Moderate levels of awareness of the campaign suggest that future campaigns require more extensive media coverage.

Kristjansdottir, Fors, Eide, Finset, van Dulmen, Wigers, & Eide (2011). Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention.

Pilot (Pre-trial) study

6 women trialling an internet intervention delivered via mobile phone grounded in a mindfulness-based CBT framework: activities, emotions and pain cognitions were registered via mobile phone 3 times a day and participants received individualised written feedback.

To develop and test the usability of a 4-week internet intervention delivered by web-enabled mobile phone to support self-management of chronic widespread pain.

The majority of women rated the intervention as supportive, meaningful and user-friendly. Response rates to the daily registration entries were high and there were few technical problems.

Concludes the intervention appears feasible. With web applications now become available on mobile phones there is increase availability of this type of application.

24

Leveille, Huang, Tsai, Allen, Weingart, & Iezzoni (2009). Health Coaching via an Internet Portal for Primary Care Patients With Chronic Conditions A Randomized Controlled Trial.

RCT

241 patients registered as portal users and due primary care physician appointments were screened for depression, chronic pain and mobility difficulty and randomized to intervention or control groups.

To assess the effectiveness of an internet portal-based coaching intervention to promote patient-primary care physician discussion about chronic conditions.

Assessed: One-week and 3-month

Outcomes: visit experience, target conditions, QoL, diagnosis and management.

A high percentage of both intervention and control groups discussed their screened condition during their primary care appointment (85% and 80% respectively). A significantly greater percentage of intervention compared to control participants reported receiving specific health advice (94% vs 84%, p=0.03) and were referred to specialists (51% vs 28%, p=0.002), they were also more satisfied than controls (p=0.07). In addition, no difference in detection or management of screened conditions, symptom ratings and QoL across the two groups.

Concludes an internet portal-based coaching intervention identified some possible benefits in care for chronic conditions, although no significant changes in patient outcomes were found. Further research is required to examine potential benefits of internet portal interventions

Lorig, Ritter, Laurent, & Plant (2008). The Internet-based Arthritis Self-Management Program: A one-year randomized trial for patients with arthritis or fibromyalgia.

RCT

855 patients with RA, OA or fibromyalgia with internet access randomized to an internet-based Arthritis Self-Management Program (n=433) or usual care (n=422).

The internet-base program was interactive and included Web-based instruction; Web-based bulletin board discussion; tools e.g. exercise logs, medication diaries, and tailored exercise programs; and the Arthritis Helpbook which contains all of the program content.

To assess the efficacy of an internet-based Arthritis Self-Management Program.

Assessed: 6 months & 1 year

Outcomes: 6 health status (pain, fatigue, activity limitation, health distress, disability and global health), 4 health behaviour (aerobic exercise, stretching & strengthening exercise, practice of stress management and communication with physicians) and 5 utilization (physician visits, emergency room visits, chiropractic visits, physical therapist visits and nights in hospital) variables and self-efficacy.

At 1 year follow up the intervention group showed significant improvement in 4 of 6 health status variables and self-efficacy. No significant differences in health behaviours of utilization were identified.

Concludes an internet-based Arthritis Self-Management Program is effective at improving health status of individuals at 1 year and is a feasible alternative to small group Arthritis Self-Management Programs.

25

McDonald, Gifford, & Walsh (2009). A virtual practitioner pain communication coach intervention pilot.

RCT. Pilot study.

30 community dwelling older adults with osteoarthritic pain watched a video of a practitioner describing important OA pain information then randomized to either a computer generated virtual practitioner pain communication coach; a video displayed pain communication coach and no coach.

To assess a pain communication coaching intervention (incorporating interpretability & discourse management strategies from Communication Accommodation Theory) on communication of osteoarthritic pain.

Assessed: Baseline & Post-test

Outcomes: Brief Pain Inventory Short Form, pain description

Older adults in the virtual coach group described a mean of 6.4 (±3.29[sd]) items of important pain information, in the video coach group 3.0 (±2.08) and no coach condition 5.0 (±2.37): these differences did not attain statistical significance (F2,25=2.06, p=0.15, eta2=0.02). Further, those who practiced with a virtual coach described >1 addition item of important pain information.

Concludes the clinically significant group difference and small effect size supports the need for a larger RCT. The virtual coach intervention may potentially enable older adults to more effectively communicate their pain management requirements.

Nb: Unable to access full article to clarify study details & results

McDonald, Walsh, Vergara, & Gifford (2011). The effect of a virtual pain coach on pain management discussions: A pilot study.

RCT. Pilot study.

23 older adults with osteoarthritic pain randomized to pain communication plus virtual pain coach or the pain communication-only group

To assess a pain communication coaching intervention on communication of osteoarthritic pain, practitioners’ pain management changes and older adults’ pain and depressive symptoms.

Assessed: Pre & Post-intervention

Outcomes: Brief Pain Inventory Short Form, pain description, Beck Depression Inventory II.

Adults in the pain communication + virtual coach group described significantly more pain source information (p=0.009) and were prescribed 4.1 times more pain management changes (95% CI = 1.5-11.1, p=0.005) compared to the communication only group. Only the pain communication + virtual coach group reported significant reductions in pain intensity (mean=3.8±1.50[sd] vs 3.2±2.36 and 12.5±5.39 vs 9.9±5.80, respectively).

Concludes the virtual pain coach is a innovative way of improving pain management discussions between older adults with pain and practitioners.

McDonald, Gifford, & Walsh (2011). Effect of a virtual pain coach on older adults' pain communication: a pilot study.

RCT. Pilot study.

30 community dwelling older adults, ≥60 years, with self-reported pain from osteoarthritis watched a video of a practitioner describing important OA pain information then randomized to either a computer generated virtual practitioner pain communication coach (n=12); a video displayed pain communication coach (n=7) and no coach (n=11).

To assess a pain communication coaching intervention on communication of osteoarthritic pain.

Assessed: Baseline & Post-test

Outcomes: Brief Pain Inventory Short Form, pain description

Older adults in the virtual coach group described a mean of 6.3 (±3.17[sd]) items of important pain information, in the video coach group 3.0 (±2.08) and no coach condition 5.2 (±2.40): these differences did not attain statistical significance (F2,25=3.17, p=0.06, η2=0.01). Further, those who practiced with a virtual coach described >1 addition item of important pain information. Concludes the clinically significant group difference and small effect size supports the need for a larger RCT. The virtual coach intervention may potentially enable older adults to more effectively communicate their pain management requirements.

26

2Moreno, Vanderstoep, Parks, Zimmerman, Kurth & Christakis (2009). Reducing at-risk adolescents' display of risk behavior on a social networking web site a randomized controlled pilot intervention trial.

RCT (non-MSK)

190 adolescents, self-described 18- to 20 year olds, with public MySpace profiles. 58.4% male.

To examine if an online intervention (by email) reduces sex and substance abuse referencing by at-risk adolescents on social networking sites.

Assessed: baseline & 3-months

Outcomes: references to sex and substance abuse, and security settings.

At baseline, 54.2% reference sex and 85.3% referenced substance abuse, in their social networking site profile.

At follow up the proportion of profiles in which reference dropped to 0 for sex were 13.7% in the intervention group vs 5.3% in the control group (p=0.05) and for substance use 26.0% vs 22% (p=0.61). The proportion of profiles set to private at follow up were 10.5% in the intervention group and 7.4% in the control group (p=0.45). Profiles in which any of these changes occurred was 42.1% in the intervention group and 29.5% in controls (p=0.07).

Concludes a brief email intervention using social networking sites shows potential in reducing sexual references in at-risk adolescents’ public online profiles. Further studies are required to determine how adolescents view disclosure of different risk behaviours to promote safe internet use.

3Owen, Bantum & Stanton (2011). Effects of asynchronous professional facilitation on behavioral engagement in an internet-based intervention for cancer-related distress.

RCT (non-MSK)

76 cancer survivors with significant stress given access to www.health-space.net (an internet-based social-networking intervention, randomized to treatment (n=49) or wait-list control (n=27).

To explore behavioural engagement in the intervention, its correlates and evaluate the effects of facilitation.

Outcomes: behavioural engagement (discussion board and blog posts, and replies, use of weekly chat, private messaging) and facilitators interventions (i.e. replies, private messages).

38 participants (50%) actively utilized the health-space.net intervention. A significant positive association was demonstrated between behavioural engagement and distress (OR = 1.24, p=0.008), but few other associations were identified with demographic or psychosocial characteristics.

Mean use of the interventions was 4.8 hours across all participants and 7.9 hours among participants who posted at least once.

Facilitation activities were significantly correlated with time spent using the intervention (r = 0.83, p < 0.001). For each participant periods of active facilitation were compared with random periods without facilitation: effects of active facilitation effort were small and non-significant (OR = 1.06, 95% CI = 0.45-1.7) with facilitation resulting in participant engagement 17.8% of the time compared wth 14.5% of time periods without facilitation.

Concludes facilitation of asynchronous interventions may reinforce active users without strongly influencing subsequent use.

2 Risk behaviour focus, not MSK pain 3 Cancer survivors not MSK pain

27

Palermo, & Long (2009). Randomized controlled trial of a web-based psychological treatment for pediatric chronic pain.

RCT (small scale)

30 (of 45 enrolled) adolescents (11-17 years) with chronic headache, abdominal or MSK pain, randomized to web-based family CBT comprising 8-10 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions (n=14) or usual care (n=16).

77% females, mean age 14.9 years

To assess the effectiveness of a web-based psychological treatment for adolescents with chronic pain.

Assessed: daily (online diary)

Outcomes: pain intensity, activity limitations, depressive symptoms, parental solicitousness and QoL.

Repeated measures ANOVAs showed significant decreases in pain intensity scores with time (p=0.004) and a significant time x group effect (p=0.008) highlighting a greater reduction in pain for the web-based CBT intervention. A similar pattern was observed for activity limitation: reduction with time (p=0.05) and a time x group effect (p=0.04) showing a greater reduction for the web-based intervention group.

The rate of clinically significant improvement in pain (i.e.≥50% reduction) was greater in the web-based intervention compared to usual care group (43% vs 13%, χ2=3.52, p=0.06).

Concludes initial findings suggest the web-based family CBT intervention has potential. Further analysis of data to be conducted.

Palermo, Wilson, Peters, Lewandowski, & Somhegyi (2009). Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain.

RCT

48 children (11-17 years) with chronic headache, abdominal or MSK pain and associated functional disability and their parents, randomly assigned to an internet treatment group (8 weeks of online modules) or waitlist control undergoing usual care.

To evaluate the effectiveness of a web-based psychological treatment for adolescents with chronic pain.

Assessed: Pre-, post-treatment and 3 months

Outcomes: pain intensity, activity limitations, parental protectiveness, depressive symptoms.

The internet treatment group showed a significantly greater reduction in pain intensity and activity limitation post-treatment compared to the control group: this was maintained at 3-month follow up. Furthermore, the intervention group also showed significantly greater rate of clinically significant improvement compared to controls. However, no group differences were found for parental protectiveness or child depressive symptoms post treatment.

Children and parents both rated the internet intervention as acceptable.

Concludes internet delivery of family CBT for reducing pain and improving function in children with chronic pain appears efficacious and acceptable.

28

4Petrovski, Dimirovski, Bogoev, Adamova, Ahmeti & Jovanovska (2011). Internet visits improve diabetes control in adolescents on pump therapy.

RCT (non-MSK)

42 adolescents, aged 14-23 years old, with type I diabetes and Medtronic PRT (insulin pump with glucose sensor) randomized to standard care with regular clinic visits for intervention (pump-settings-basal bolus insulin, education) and internet group managed online (data downloaded via Carelink software [Medtronic] and intervention given via Skype or Facebook)

To evaluate Carelink, Skype & Facebook as tools for improving diabetes control in adolescents on Medtronic PRT.

Assessed: Before, 3 & 6 months after study

Outcomes: A1C

The regular number of visits to clinic was 12.2±1.4 per patient in the usual care group and internet visits were 13.6±2.1 per patient in the intervention group. There was significant improvement in diabetes control for both groups at the end of the study. Internet visits were more preferable by patients

Concludes that young diabetic patients prefer to make contact with their health care providers via internet, where new technologies using software like Careline and Skype/Facebook can improve diabetes control in line with usual care.

4Petrovski, Dimirovski, Bogoev & Ahmeti (2010). Carelink, Skype and Facebook improve diabetes control in adolescents on pump therapy. [conference abstract]

RCT (non-MSK)

38 adolescents, aged 13-22 years old, with type I diabetes and Medtronic PRT (insulin pump with glucose sensor) randomized to standard care with regular clinic visits for intervention (pump-settings-basal bolus insulin, education) and internet group managed online (data downloaded via Carelink software [Medtronic] and intervention given via Skype or Facebook)

To evaluate Carelink, Skype & Facebook as tools for improving diabetes control in adolescents on Medtronic PRT.

Assessed: Before, 3 & 6 months after study

Outcomes: A1C

The regular number of visits to clinic was 11.2±1.2 per patient in the usual care group and internet visits were 12.8±2.4 per patient in the intervention group. There was significant improvement in diabetes control for both groups at the end of the study. Internet visits were more preferable by patients

Concludes that young diabetic patients prefer to make contact with their health care providers via internet, where new technologies using software like Careline and Skype/Facebook can improve diabetes control in line with usual care.

Ruehlman, Karoly, & Enders (2011). Evaluation of the online chronic pain management program.

RCT

305 individuals with chronic pain (male=109; female=196) randomly assigned to the Chronic Pain Management Program (content & functionality derived from cognitive, behavioural, interpersonal and self-management approaches to chronic pain, n=162) or to waitlist control (n=143).

To assess the efficacy of the Chronic Pain Management Program.

Assessed: Baseline, 7 and 14 weeks

Outcomes: pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing, pain induced fear, stress, anxiety, depression, knowledge about principles of chronic pain and its management.

The Chronic Pain Management Program was associated with significant decreases in pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing and pain induced fear, along with significant reductions in stress, anxiety and depression. Furthermore, the intervention group showed an increased knowledge regarding principles of chronic pain and its management.

4 Diabetes focus, not MSK pain

29

Russell, Buttrum, Wootton, & Jull (2011). Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial.

RCT

65 individuals randomized to receive a 6-week outpatient physical therapy program or 6-week internet-based telerehabilitation program

To assess the equivalence of an internet-based telerehabilitation program compared to conventional outpatient physical therapy for patients following total knee arthroplasty.

Assessed: Baseline & 6 weeks

Outcomes: WOMAC, Patient Specific Functional Scale, timed up-and-go test, pain intensity, knee flexion & extension, quadriceps muscle strength, limb girth measurements, gait assessment and QoL.

At baseline the characteristics of both groups were similar and all participants showed significant improvements in all outcomes measures at follow up (p<0.01, all cases). At 6-week follow up the telerehabilitation group showed comparable improvements to the outpatient physical therapy group with regards to knee flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, QoL and clinic gait and WOMAC scores. Furthermore, telerehabilitation was associated with improved outcomes for Patient-Specific Functional Scale and the stiffness subscale of WOMAC (p<0.05). Patients also reported a high level of satisfaction with the internet-based program.

Concludes the outcomes achieved by an internet-based telerehabilitation program at 6-weeks post-total knee arthroplasty are comparable to conventional outpatient physical therapy programs.

Schell, Theorell, Hasson, Arnetz, & Saraste (2008). Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up.

Prospective controlled trial.

226 news media employees in two study groups and one control group.

Nb: unable to access full article to clarify details

To assess the effect of a web-based stress management program on neck-shoulder-back pain and perceived pain-relatedness to stress.

Assessed: Baseline, after 6 months intervention & 12 months follow up

Outcomes: pain, stress

No significant differences across groups were noted at any time point.

Between baseline and post-intervention the more intensive program group showed decreased back pain and the controls less pain–relatedness to stress. Furthermore intragroup variation was associated with pain localization and was inconsistent.

Concludes the web-based stress management program did not affect neck-shoulder-back pain or perceived pain-relatedness to stress in stress intense occupations.

Schulz, Rubinell, & Hartung (2007). An internet-based approach to enhance self-management of chronic low back pain in the Italian-speaking population of Switzerland: results from a pilot study.

Controlled, pilot study

20 patients with chronic low back pain using a website for 5 months. 15 patients acted as controls.

To outline the development and evaluate a website designed to enhance self-management of chronic low back pain.

Assessed: Baseline, 4 months and post-intervention

Outcomes including back pain, physical activity, medical consultation, and painkiller use.

Compared to the control group, the intervention group showed a reduction in back pain intensity, increased physical activity, reduced use of painkillers and medical consultations, and gains in declarative and procedural knowledge. Further, a positive assessment of the website was made.

Concludes further research is needed to test the approach on a broader scale.

30

Venuti, Bromberg, Zacharoff, & Surrette (2011). painACTION.com: Web-based support to self-manage neuropathic pain.

Controlled study.

Participants assigned to receive a tailored interactive website or given access to a non-tailored, information only website (control). Participants completed a minimum number of sessions during a four week intervention period

To assess the efficacy of a website designed to aid people with neuropathic pain.

Assessed: Baseline, 1-, 3- and 6-month post-baseline.

Outcomes: pain rating, pain frequency, pain severity, management behaviours and psychosocial distress.

Concludes the internet is an excellent tool for aiding patients with chronic neuropathic pain manage their conditions. However, current websites are non-tailored/non-interactive and thus do not help patients attain improved outcomes in headache management and symptom reduction. The proposed painACTION intervention is a significant innovative advance in effective behavioural and lifestyle change support for neuropathic pain care. Nb: unable to access full article to clarify study details and results

Werner, Gross, Lie, & Ihlebaek (2008). Healthcare provider back pain beliefs unaffected by a media campaign.

Controlled study. Quasi-experiment before & after survey.

243 doctors, physiotherapists and chiropractors in primary care in two Norwegian counties exposed to a media campaign, and a neighbouring county serving as controls.

To assess the impact of a mass media campaign on healthcare provider back pain beliefs.

Assessed: pre- (2002) and post-campaign (2005).

Outcomes: beliefs about lower back pain

There was a general tendency for all providers to hold beliefs more in line with guidelines in 2005 compared with 2002 irrespective of whether they were exposed to the media campaign or not. Some baseline differences in beliefs between professional groups remained and seems to further increase between 2002 and 2005: particularly regarding low back pain as a self-limiting condition.

Concludes a low back pain mass media campaign aimed at healthcare professionals did not results in important improvements in belief. Furthermore, important differences in beliefs were identified across provider groups.

Werner, Ihlebaek, Laerum, Wormgoor, & Indahl (2008). Low back pain media campaign: no effect on sickness behaviour.

Controlled study. Quasi-experiment before & after survey.

1500 randomly chosen people before, during and after a media campaign in two Norwegian counties and from a neighbouring county acting as controls.

To assess the effect of a mass media campaign on popular beliefs regarding lower back pain.

Assessed: before, during and after the media campaign

Outcomes: lower back pain beliefs, sickness absence, surgery rates for disc herniation and imaging examinations for lower back pain.

There was a small but statistically significant shift in popular beliefs about lower back pain: beliefs about the use of X-rays and the importance of remaining active and at work appeared changed. However, this change was not associated with any noticeable change in sickness behaviour.

Concludes mass media campaigns appear to improve popular beliefs about lower back pain, but this was too small to produce a significant shift in behaviour. A mass media campaign with larger investment is needed to affect population change in sickness behaviour related to lower back pain.

Williams, Kuper, Segar, Mohan, Sheth, & Clauw (2010). Internet-enhanced management of fibromyalgia: a randomized controlled trial.

RCT

118 patients with fibromyalgia randomly assigned to standard care with access to a Web-Enhanced Behavioural Self-management program (grounded in cognitive and behavioural pain management principles) or standard care alone.

To examine the effectiveness of an internet-based exercise and behavioural self-management program for fibromyalgia.

Assessed: Baseline & 6 months

Outcomes: pain, physical functioning, fatigue, sleep, anxiety and depressive symptoms, and global impression of improvement.

Individuals in the web-enhanced group showed significantly greater improvements in pain, physical functioning and overall global improvement compared to controls. Exercise and relaxation techniques were the most commonly utilized skills over the 6 months.

Concludes a no-contact, internet-based self management intervention showed efficacy on key outcomes in patients with fibromyalgia. Whilst not everyone would be expected to find the approach beneficial, this study emphasises non-pharmacological interventions can be successfully integrated into routine clinical practice and enhance outcomes.

31

Zacharoff, Wood, Chiauzzi, Bromberg, & Black (2011). Distinct chronic pain diagnoses and website usage patterns: A secondary analysis of clinical trial data.

Secondary analysis of RCTs

218 participants with back pain (n=89), migraine (n=88) and neuropathic pain (n=41) randomized to experimental intervention in their respective clinical trials.

To quantify differences in participant usage patterns, according to chronic pain type, of structurally similar online health sites

Outcomes: total minutes spent on site, number of page views, ratio of active to passive content.

Preliminary analysis reveals significant differences between usage of the three pain types studies. Significantly migraine sufferers showed lower overall site usage but a high active: passive ratio; those with back pain and neuropathic pain showed a more similar usage pattern.

Concludes patients with different types of chronic pain utilize online health resources differently and this has implications for the future development online interventions.

32

APPENDIX 3 Other references concerning musculoskeletal pain

Observational studies

Baker, J.F., Devitt, B.M., Kiely, P.D., Green, J., Mulhall, K.J., Synnott, K.A. and Poynton, A.R. (2010)

Prevalence of Internet use amongst an elective spinal surgery outpatient population. European Spine

Journal, 19(10): 1776-1779.

Barker, K.K. (2008) Electronic support groups, patient-consumers, and medicalization: the case of contested

illness. Journal of Health & Social Behavior, 49(1): 20-36.

Cascade, E. and Bharmal, M. (2010) Use of patient-reported outcomes in on-line communities to conduct

observational comparative effectiveness research: A pilot study in rheumatoid arthritis. Value in Health,

13 (7): A318.

Cella, D., Gershon, R., Shen, J., Morales, S. and Riley, W. (2010) Representativeness of the patient-reported

outcomes measurement information system internet panel. Journal of Clinical Epidemiology, 63(11):

1169-1178.

Rosser, B.A. and Eccleston, C. (2011) Smartphone applications for pain management. Journal of

Telemedicine & Telecare, 17(6): 308-312.

Sharma, A., Agarwal, S., Broatch, J., & Raja, S. N. (2009). A Web-Based Cross-Sectional Epidemiological

Survey of Complex Regional Pain Syndrome. Regional Anesthesia and Pain Medicine, 34(2): 110-115.

Theiler, R., Alon, E., Brugger, S., Ljutow, A., Mietzsch, T., Muller, D., Ott, A., Rimle, M., Zemp, A., & Urwyler,

A. (2007). Evaluation of a standardized internet-based and telephone-based patient monitoring system

for pain therapy with transdermal fentanyl. Clinical Journal of Pain, 23(9): 804-811.

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Seydel, E. R., & van de Laar, M. A. F. J. (2008). Self-

reported differences in empowerment between lurkers and posters in online patient support groups.

Journal of Medical Internet Research, 10(2): e18.

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Seydel, E. R., & van de Laar, M. A. F. J. (2009).

Participation in online patient support groups endorses patients' empowerment. Patient Education &

Counseling, 74(1): 61-69.

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Smit, W. M., Moens, H. J. B., Siesling, S., Seydel, E. R., &

van de Laar, M. A. F. J. (2009). Health-related Internet use by patients with somatic diseases: frequency of

use and characteristics of users. Informatics for health & social care, 34(1): 18-29.

Wicks, P., Massagli, M., Frost, J., Brownstein, C., Okun, S., Vaughan, T., Bradley, R., & Heywood, J. (2010).

Sharing health data for better outcomes on PatientsLikeMe. Journal of Medical Internet Research, 12(2):

e19.

Qualitative studies

Barker, K.L., Minns Lowe, C.J. and Reid, M. (2007) The development and use of mass media interventions

for health-care messages about back pain: what do members of the public think? Manual Therapy, 12(4):

335-341.

Glenton, C., Nilsen, E. S., & Carlsen, B. (2006). Lay perceptions of evidence-based information - a qualitative

evaluation of a website for back pain sufferers. BMC Health Services Research, 6 (34).

Rosser, B. A., McCullagh, P., Davies, R., Mountain, G. A., McCracken, L., & Eccleston, C. (2011). Technology-

mediated therapy for chronic pain management: the challenges of adapting behavior change

interventions for delivery with pervasive communication technology. Telemedicine Journal & E-Health,

17(3): 211-216.

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Lebrun, C. E. I., Drossaers-Bakker, K. W., Smit, W. M.,

Seydel, E. R., & de Laar, M. (2008). Coping with somatic illnesses in online support groups: Do the feared

disadvantages actually occur? Computers in Human Behavior, 24(2): 309-324.

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Seydel, E. R., & van de Laar, M. A. F. J. (2010). Patient-

initiated online support groups: motives for initiation, extent of success and success factors. Journal of

Telemedicine & Telecare, 16(1): 30-34.

33

van Uden-Kraan, C. F., Drossaert, C. H. C., Taal, E., Shaw, B. R., Seydel, E. R., & van de Laar, M. A. F. J. (2008).

Empowering processes and outcomes of participation in online support groups for patients with breast

cancer, arthritis, or fibromyalgia. Qualitative Health Research, 18(3): 405-417.

Miscellaneous

Buchbinder, R. (2008). Self-management education en masse: effectiveness of the Back Pain: Don't Take It

Lying Down mass media campaign. Medical Journal of Australia, 189(10): S29-S32.

Chiauzzi, E., Wing Venuti, S. and Zacharoff, K. (2009) PainAction.com: An interactive self-management

website for chronic pain patients. Journal of Pain, 10(4): S5.

Corcoran, T. B., Haigh, F., Seabrook, A., & Schug, S. A. (2009). The quality of internet-sourced information

for patients with chronic pain is poor. Clinical Journal of Pain, 25(7), 617-623.

Gross, D. P., Field, J., Shanski, K., & Ferrari, R. (2008). An evaluation of low back-pain-related content in

Canadian newspaper media. Journal of Spinal Disorders & Techniques, 21(1): 1-3.

Katz, R. S., Kwan, L., & Polyak, J. L. (2009). Best websites for fibromyalgia. Arthritis and Rheumatism, 60, 90.

Keogh, E., Rosser, B. A., & Eccleston, C. (2010). e-Health and chronic pain management: current status and

developments. Pain, 151(1): 18-21.

Morlion, B., Walch, H., Yihune, G., Vielvoye-Kerkmeer, A., de Jong, Z., Castro-Lopes, J., Stanton-Hicks, M.

(2008). The Pain Associates' International Network Initiative: a novel practical approach to the challenge

of chronic pain management in Europe. Pain Practice, 8(6): 473-480.

Polomano, R. C., Droog, N., Purinton, M. C. P., & Cohen, A. S. (2007). Social support web-based resources

for patients with chronic pain. Journal of Pain & Palliative Care Pharmacotherapy, 21(3): 49-55.

Rolfson, O., Salomonsson, R., Dahlberg, L. E., & Garellick, G. (2011). Internet-based follow-up questionnaire

for measuring patient-reported outcome after total hip replacement surgery-reliability and response rate.

Value in Health, 14(2): 316-321.

Shinchuk, L. M., Chiou, P., Czarnowski, V., & Meleger, A. L. (2010). Demographics and attitudes of chronic-

pain patients who seek online pain-related medical information: implications for healthcare providers.

American Journal of Physical Medicine & Rehabilitation, 89(2): 141-146.

Smarr, K. L., Musser, D. R., Shigaki, C. L., Johnson, R., Hanson, K. D., & Siva, C. (2011). Online Self-

Management in Rheumatoid Arthritis: A Patient-Centered Model Application. Telemedicine and E-Health,

17(2): 104-110.

Washington, T. A., Fanciullo, G. J., Sorensen, J. A., & Baird, J. C. (2008). Quality of chronic pain websites.

Pain Medicine, 9(8): 994-1000.

Yanni, L. M., Priestley, J. W., Schlesinger, J. B., Ketchum, J. M., Johnson, B. A., & Harrington, S. E. (2009).

Development of a comprehensive e-learning resource in pain management. Pain Medicine, 10(1): 95-105.

34

APPENDIX 4 References regarding social networking sites and not MSK pain

Systematic Review

Gold, J., Pedrana, A.E., Sacks-Davis, R., Hellard, M.E., Chang, S., Howard, S., Keogh, L., Hocking, J.S. and

Stoove, M.A. (2011) A systematic examination of the use of Online social networking sites for sexual

health promotion. BMC Public Health, 11.

Observational studies

Chou, W.-y.S., Hunt, Y.M., Beckjord, E.B., Moser, R.P. and Hesse, B.W. (2009) Social media use in the United

States: implications for health communication. Journal of Medical Internet Research, 11(4): e48.

Farmer, A.D., Bruckner Holt, C.E.M., Cook, M.J. and Hearing, S.D. (2009) Social networking sites: a novel

portal for communication. Postgraduate Medical Journal, 85(1007): 455-459.

Kalpidou, M., Costin, D. and Morris, J. (2011) The relationship between Facebook and the well-being of

undergraduate college students. Cyberpsychology, behavior and social networking, 14(4): 183-189.

Rice, E., Monro, W., Barman-Adhikari, A. and Young, S.D. (2010) Internet Use, Social Networking, and

HIV/AIDS Risk for Homeless Adolescents. Journal of Adolescent Health, 47(6): 610-613.

Young, S.D. and Rice, E. (2011) Online Social Networking Technologies, HIV Knowledge, and Sexual Risk and

Testing Behaviors Among Homeless Youth. Aids and Behavior, 15(2): 253-260.

Qualitative studies

Ahmed, O.H., Sullivan, S.J., Schneiders, A.G. and McCrory, P. (2010) iSupport: do social networking sites

have a role to play in concussion awareness? Disability & Rehabilitation, 32(22): 1877-1883.

Bender, J.L., Jimenez-Marroquin, M.-C. and Jadad, A.R. (2011) Seeking support on facebook: a content

analysis of breast cancer groups. Journal of Medical Internet Research, 13(1): e16.

Chapple, A. and Ziebland, S. (2011) How the Internet is changing the experience of bereavement by suicide:

A qualitative study in the UK. Health: an Interdisciplinary Journal for the Social Study of Health, 15(2).

Chew, C. and Eysenbach, G. (2010) Pandemics in the age of Twitter: content analysis of Tweets during the

2009 H1N1 outbreak. PLoS ONE [Electronic Resource], 5(11): e14118.

Egan, K.E. and Moreno, M.A. (2009) Prevelance of stress references on college freshmen's facebook

profiles. Pediatric Research, 66 (4): 476.

Heaivilin, N., Gerbert, B., Page, J.E. and Gibbs, J.L. (2011) Public Health Surveillance of Dental Pain via

Twitter. Journal of Dental Research, 90(9): 1047-1051.

Juarascio, A.S., Shoaib, A. and Timko, C.A. (2010) Pro-eating disorder communities on social networking

sites: a content analysis. Brunner-Mazel Eating Disorders Monograph Series, 18 (5): 393-407.

Killackey, E., Anda, A.L., Gibbs, M., Alvarez-Jimenez, M., Thompson, A., Sun, P. and Baksheev, G.N. (2011)

Using internet enabled mobile devices and social networking technologies to promote exercise as an

intervention for young first episode psychosis patients. BMC Psychiatry, 11.

Kitta, A. (2010) Using web 2.0 technologies to understand public concerns and provide information.

Canadian Journal of Infectious Diseases and Medical Microbiology, 21 (4): 196.

Kolpa, E. and Moreno, M. (2011) Relationship of weight references to mental health and stress references

on college freshman Facebook profiles. Journal of Adolescent Health, 48 (2): S92-S93.

Moreno, M.A., Parks, M.R., Zimmerman, F.J., Brito, T.E. and Christakis, D.A. (2009) Display of health risk

behaviors on mySpace by adolescents prevalence and associations. Archives of Pediatrics and Adolescent

Medicine, 163(1): 27-34.

35

Scanfeld, D., Scanfeld, V. and Larson, E.L. (2010) Dissemination of health information through social

networks: twitter and antibiotics. American Journal of Infection Control, 38(3): 182-188.

Recruitment via social networking sites

Ahmed, N., Jayasinghe, Y., Moore, E.E., Fenner, Y., Fletcher, A., Tabrizi, S.N., Wark, J.D. and Garland, S.

(2011) Knowledge, barriers and facilitating factors for chlamydia screening in Victorian women aged 16-

25 using social networking sites. Journal of Pediatric and Adolescent Gynecology, 24 (2): e63.

Brady, J.E., Ball, P.L. and Meena-Leist, C.E. (2010) Investment in education and our youth bridges academic

restrictions to blood donation. Transfusion, 50: 108A.

Frawley, H., Whitburn, L., Daly, J.O. and Galea, M. (2011) E-recruitment: The future for clinical trials in a

digital world? Neurourology and Urodynamics, 30 (6): 811-812.

Gunasekaran, B., Jayasinghe, Y., Moore, E., Fenner, Y., Fletcher, A., Tabrizi, S., Wark, J.D. and Garland, S.M.

(2011) Knowledge of human papillomavirus (HPV) and the HPV vaccine among young women in victoria,

australia who have been randomly recruited via facebook. Journal of Pediatric and Adolescent

Gynecology, 24 (2): e66-e67.

Rogers, V.L., Griffin, M.Q., Wykle, M.L. and Fitzpatrick, J.J. (2009) Internet versus face-to-face therapy:

emotional self-disclosure issues for young adults. Issues in Mental Health Nursing, 30(10): 596-602.

Miscellaneous

Boulos, M.N., Wheeler, S., Tavares, C. and Jones, R. (2011) How smartphones are changing the face of

mobile and participatory healthcare: an overview, with example from eCAALYX. Biomed Eng Online, 10:

24.

Brownstein, C.A. and Wicks, P. (2010) The potential research impact of patient reported outcomes on

osteogenesis imperfecta. Clinical Orthopaedics & Related Research, 468(10): 2581-2585.

Chilvers, J. (2011) Implementation of a Facebook page by school nurses. Community Practitioner, 84(4): 33-

35.

Cobb, N.K., Graham, A.L. and Abrams, D.B. (2010) Social Network Structure of a Large Online Community

for Smoking Cessation. American Journal of Public Health, 100(7): 1282-1289.

Filipkowski, K.B. and Smyth, J.M. (2011) Living our social lives online: Virtual ostracism. Psychosomatic

Medicine, 73 (3): A25.

Geoghegan, T. and Monseau, M. (2011) Moving from 2.No : building strategic consensus to create

communities for attention-deficit hyperactivity disorder awareness on Facebook. Journal of

Communication In Healthcare, 4(1): 4-12.

Hedge, K.C. and Donald, C.P. (2011) Evaluation of the use of a social networking site in sexual health care.

International Journal of STD & AIDS, 22(3): 171-172.

Kind, T. (2009) The Internet as an adjunct for pediatric primary care. Current Opinion in Pediatrics, 21(6):

805-810.

Krall, J. (2009) Using social metrics to evaluate the impact of online healthcare communications. Journal of

Communication In Healthcare, 2(4): 387-394.

Lefebvre, C. (2009) Integrating Cell Phones and Mobile Technologies Into Public Health Practice: A Social

Marketing Perspective. Health Promotion Practice, 10(4): 490-494.

Levine, D., Madsen, A., Wright, E., Barar, R.E., Santelli, J. and Bull, S. (2011) Formative research on

MySpace: online methods to engage hard-to-reach populations. Journal of Health Communication, 16(4):

448-454.

Seeman, N. (2008) Web 2.0 and Chronic Illness: New Horizons, New Opportunities. Healthcare Quarterly,

11(1): 104-110.

Spriggs, M. (2009) Consent in cyberspace: Internet-based research involving young people. Monash

Bioethics Review, 28(4): 32.31-15.

36

Tan, L. (2008) Psychotherapy 2.0: MySpace Blogging as Self-Therapy. American Journal of Psychotherapy,

62(2): 143-163.

Williams, I.I.I.D. (2010) The PatientsLikeMe®; Multiple Sclerosis Community : using online marketing to shift

the health data privacy paradigm. Journal of Communication In Healthcare, 3(1): 48-61.

query ref pain -009 - keele university › media › keeleuniversity › ri... · mass media,...

Documents