Berube M, Gelinas C, Feeley N, et al. Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial. Pain Med. 2019 Mar 6. pii: 5370334. doi: 10.1093/pm/pnz008. (Original study)

OBJECTIVE: 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design. A pilot randomized controlled trial (RCT) with two parallel groups.

SETTING: A supraregional level 1 trauma center.

METHODS: Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities.

RESULTS: More than 80% of eligible patients agreed to participate, and an attrition rate of =18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (=4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores = 10) were obtained through the end of the study.

CONCLUSIONS: Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.

Discipline Area Score
Psychologist 6 / 7
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
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Comments from MORE raters

Physician rater

Although this is an interesting issue, it's small sample. It would be necessary to enlarge it in order to understand the real relevance of intervention.

Psychologist rater

As a clinical psychologist with pain management as one of my specialties, I would expect these results. The benefit of this article is that it provides evidence for additional replicated research in pain management. The results of the article also will be useful in public presentations with a clarification that the results are from a pilot research project.
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