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      • Record: found
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      A Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) in Older Adults With Obesity: Protocol for the MORPH Trial

      research-article
      Author(s): , PhD 1 , 2 , , , MD 3 , , PhD 4 , , PhD 2 , , PhD 1
      Editor(s):
      Other contributor(s): (Reviewer), (Reviewer)
      Publication date (Electronic):
      Journal: JMIR Research Protocols
      Publisher: JMIR Publications
      Keywords: technology, weight loss, sedentary lifestyle, chronic pain, mindfulness

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          Abstract

          Background

          Chronic pain is a complex, age-related health issue that affects both physical functioning and quality of life. Because the impact of chronic pain is worsened by obesity and inactivity, nonpharmacological interventions that promote movement, reduce sitting, and aid in weight loss are needed to help manage pain symptoms among older adults with chronic pain.

          Objective

          The Mobile Intervention to Reduce Pain and Improve Health (MORPH) pilot trial aims to develop and test the feasibility and acceptability of a novel, patient-centered intervention to reduce chronic pain and improve physical functioning in older adults, leveraging the combination of telecoaching and individually adaptive mHealth tools to decrease both body mass and sedentary behavior.

          Methods

          MORPH comprises 2 phases, including a 1-year iterative development phase, and a 1-year pilot randomized controlled trial (RCT). During the development phase, representative participants will engage in one-on-one structured interviews and a 1-week field test. The resulting feedback will be used to guide the development of the finalized MORPH intervention package. During the second phase, the finalized intervention will be tested in a pilot RCT (N=30) in which older adult participants with chronic pain and obesity will be assigned to receive the 12-week MORPH intervention or to a waitlist control. Primary outcomes include self-reported pain symptoms and physical function.

          Results

          Phase 1 recruitment is ongoing as of December 2017.

          Conclusions

          The MORPH intervention brings together a strong body of evidence using group-based behavioral intervention designs with contemporary mHealth principles, allowing for intervention when and where it matters the most. Given the ubiquity of smartphone devices and the popularity of consumer activity and weight monitors, the results of this study may serve to inform the development of scalable, socially driven behavioral pain management interventions.

          Trial Registration

          ClinicalTrials.gov NCT03377634; https://clinicaltrials.gov/ct2/show/NCT03377634 (Archived by WebCite at http://www.webcitation.org/6yj0J5Pan)

          Registered Report Identifier

          RR1-10.2196/9712

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          Most cited references32

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          The clinical use of mindfulness meditation for the self-regulation of chronic pain.

          Jon Kabat-Zinn, Leslie Lipworth, Robert G. Burney (1985)
          Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
          Article 0 comments Cited 330 times – based on 0 reviews     Review now
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            Ecological momentary assessment.

            Saul Shiffman, Arthur Stone, Michael R. Hufford (2008)
            Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.
            Article 0 comments Cited 291 times – based on 0 reviews     Review now
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              A behavior change model for internet interventions.

              Lee Ritterband, Frances Thorndike, Daniel Cox … (2009)
              The Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published. The purpose of this article is to propose a model to help guide future Internet intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions. The model purports that effective Internet interventions produce (and maintain) behavior change and symptom improvement via nine nonlinear steps: the user, influenced by environmental factors, affects website use and adherence, which is influenced by support and website characteristics. Website use leads to behavior change and symptom improvement through various mechanisms of change. The improvements are sustained via treatment maintenance. By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established.
              Article 0 comments Cited 208 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jason Fanning:
                Department of Health and Exercise ScienceWake Forest UniversityPO Box 7868Winston-Salem, NC, 27106United States1 3367585042fanninjt@wfu.edu
                ORCID: http://orcid.org/0000-0002-5527-1698
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: May 2018
                Publication date (Electronic): 14 May 2018
                Volume: 7
                Issue: 5
                Electronic Location Identifier: e128
                Affiliations
                [1] 1 Department of Health and Exercise Science Wake Forest University Winston-Salem, NC United States
                [2] 2 Section on Geriatric Medicine Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NC United States
                [3] 3 Department of Anesthesiology Wake Forest School of Medicine Winston-Salem, NC United States
                [4] 4 Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem, NC United States
                Author notes
                Corresponding Author: Jason Fanning fanninjt@ 123456wfu.edu
                Author information
                https://orcid.org/http://orcid.org/0000-0002-5527-1698
                https://orcid.org/http://orcid.org/0000-0001-9568-1336
                https://orcid.org/http://orcid.org/0000-0002-4811-4205
                https://orcid.org/http://orcid.org/0000-0002-7726-6670
                https://orcid.org/http://orcid.org/0000-0003-2281-4649
                Article
                Publisher ID: v7i5e128
                DOI: 10.2196/resprot.9712
                PMC ID: 5972205
                PubMed ID: 29759957
                SO-VID: e2e5d262-72f9-4a57-a190-494a9e17cdc2
                Copyright statement: ©Jason Fanning, Amber K Brooks, Edward Ip, Barbara J Nicklas, W Jack Rejeski. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.05.2018.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 21 December 2017
                Date revision requested : 31 January 2018
                Date revision received : 26 February 2018
                Date accepted : 26 February 2018
                Product
                Self URI: http://www.researchprotocols.org/2018/5/e128/
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: technology,weight loss,sedentary lifestyle,chronic pain,mindfulness
                Data availability:
                Keywords: technology, weight loss, sedentary lifestyle, chronic pain, mindfulness

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