TY  - JOUR
AU  - Cheng, Abby L
AU  - Agarwal, Mansi
AU  - Armbrecht, Melissa A
AU  - Abraham, Joanna
AU  - Calfee, Ryan P
AU  - Goss, Charles W
PY  - 2023
DA  - 2023/11/17
TI  - Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study
JO  - JMIR Form Res
SP  - e51422
VL  - 7
KW  - digital mental health intervention
KW  - chronic musculoskeletal pain
KW  - anxiety
KW  - depression
KW  - pain interference
KW  - physical function
KW  - behavioral activation
KW  - pain acceptance
KW  - sleep quality
KW  - mediation analysis
KW  - behavioral mechanism
KW  - chronic pain
KW  - digital health intervention
KW  - mobile phone
AB  - Background: Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood. Objective: The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health. Methods: In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants’ engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale–Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P<.20 was considered significant for this pilot study. Results: Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect –0.4, 80% CI –0.7 to –0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well. Conclusions: In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health. Trial Registration: ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722 
SN  - 2561-326X
UR  - https://formative.jmir.org/2023/1/e51422
UR  - https://doi.org/10.2196/51422
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37976097
DO  - 10.2196/51422
ID  - info:doi/10.2196/51422
ER  -