Home-based person-centered intervention reduces deterioration in chronic pain patients compared to usual careHome-based digital support helps people with chronic pain stay active

BACKGROUND: Chronic pain is a growing global public health challenge and the leading cause of years lived with disability. It significantly impacts various aspects of daily life, including participation in working life, resulting in increased sick leave and substantial burdens at both the personal and societal levels. Person-centered care (PCC) is a practiced ethic that recognizes the patient as a partner in care. Partnership is established through incorporating the person's narrative, shared decision-making, and documentation of jointly agreed goals. Remotely delivered PCC interventions have been shown in other studies to improve self-efficacy and facilitate return to work among persons on sick leave. However, little is known about how self-efficacy and sick leave are affected when a PCC intervention is delivered remotely to persons with chronic pain. OBJECTIVE: This study aimed to evaluate the efficacy of a home-based person-centered intervention consisting of telephone support and an eHealth platform among persons on sick leave due to chronic pain. METHODS: A 2-arm, nonblinded randomized controlled trial was conducted. Participants aged 18 to 65 years on sick leave due to chronic, nonmalignant pain lasting more than 3 months were recruited from 10 primary health care centers in Gothenburg, Sweden. Participants were randomly allocated 1:1 to either the control group or the intervention group. Both groups received usual care; the intervention group additionally participated in a 6-month PCC intervention via telephone and an eHealth platform. The primary outcome was a composite score consisting of change in general self-efficacy and sick leave at the 6-month follow-up. Self-efficacy was assessed using the Swedish version of the 10-item General Self-Efficacy Scale, and sick leave was assessed based on participants' self-reported percentage of sick leave in relation to full-time work. The primary outcome was analyzed according to the intention-to-treat principle using the Mantel-Haenszel chi-square trend test. RESULTS: A total of 654 patients were assessed for eligibility, of whom 59 were included in the final analysis: 29 in the intervention group and 30 in the control group. More participants in the control group (11/30, 36.7%) than in the intervention group (3/29, 10.3%) showed deterioration, resulting in a significant difference in the composite score between the groups at the 6-month follow-up (P=.04), favoring the intervention. This significance also remained in the nonimputed analysis (P=.04). CONCLUSIONS: This study suggests that PCC via telephone and an eHealth platform may influence the level of sick leave and self-efficacy among persons with chronic pain. Since the control group deteriorated while the intervention group largely remained unchanged, PCC may play a protective role in supporting persons with chronic pain in returning to work. Further studies are warranted to confirm these findings.