Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy (PACT-A)

Lina Braun (), Yannik Terhorst, Ingrid Titzler, Johanna Freund, Janika Thielecke, David Daniel Ebert and Harald Baumeister
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Lina Braun: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
Yannik Terhorst: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
Ingrid Titzler: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
Johanna Freund: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
Janika Thielecke: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
David Daniel Ebert: Faculty TUM Department of Sport and Health Sciences, TU Munich, 80992 Munich, Germany
Harald Baumeister: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany

IJERPH, 2022, vol. 19, issue 21, 1-24

Abstract: Musculoskeletal symptoms are increased in farmers, whereas the prevalence of chronified pain is unknown. Online interventions based on acceptance and commitment therapy (ACT) have shown encouraging results in the general population, representing a promising approach for reducing pain interference in green professions (i.e., farmers, foresters, gardeners). We conducted a pragmatic RCT comparing a guided ACT-based online intervention to enhanced treatment-as-usual in entrepreneurs, contributing spouses, family members and pensioners in green professions with chronic pain (CPG: ≥grade II, ≥6 months). Recruitment was terminated prematurely after 2.5 years at N = 89 (of planned N = 286). Assessments were conducted at 9 weeks (T1), 6 months (T2) and 12 months (T3) post-randomization. The primary outcome was pain interference (T1). The secondary outcomes encompassed pain-, health- and intervention-related variables. No treatment effect for reduction of pain interference was found at T1 (β = −0.16, 95%CI: −0.64–0.32, p = 0.256). Improvements in cognitive fusion, pain acceptance, anxiety, perceived stress and quality of life were found only at T3. Intervention satisfaction as well as therapeutic and technological alliances were moderate, and uptake and adherence were low. Results are restricted by low statistical power due to recruitment issues, high study attrition and low intervention adherence, standing in contrast to previous studies. Further research is warranted regarding the use of ACT-based online interventions for chronic pain in this occupational group. Trial registration: German Clinical Trial Registration: DRKS00014619. Registered: 16 April 2018.

Keywords: internet intervention; acceptance and commitment therapy; ACT; chronic pain; farmers; gardeners; foresters; 6-month follow-up; 12-month follow-up; randomized controlled trial (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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