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Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use

Chris A Anthony^1,2, Edward Octavio Rojas³, Valerie Keffala³

¹Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, United States.

Journal of Medical Internet Research

|July 30, 2020

Summary

This summary is machine-generated.

Mobile messaging delivering Acceptance and Commitment Therapy (ACT) significantly reduced postoperative opioid use and pain intensity in orthopedic trauma patients. This digital intervention offers a promising approach to enhance recovery and pain management following surgery.

Keywords:

acceptance and commitment therapy chatbot conversational agents mHealth opioid crisis orthopedics patient-reported outcome measures postoperative pain text messaging

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Area of Science:

Orthopedic Surgery
Digital Health
Psychological Interventions

Background:

Acceptance and Commitment Therapy (ACT) is a pragmatic approach to mitigate avoidable pain.
Postoperative pain management in orthopedic trauma patients often involves opioid analgesics.
Optimizing non-pharmacological interventions for pain control is crucial in orthopedic care.

Purpose of the Study:

To evaluate the efficacy of an automated mobile messaging robot delivering ACT interventions.
To assess the impact of mobile-delivered ACT on postoperative opioid consumption.
To determine the effect of this intervention on patient-reported outcomes (PROs) in orthopedic trauma patients.

Main Methods:

Adult patients with operative orthopedic trauma fractures receiving mobile messaging were randomized.
The intervention group received twice-daily ACT messages for two weeks post-surgery.
Opioid pill counts and PROs were compared between the ACT intervention and control groups at two weeks.

Main Results:

The ACT intervention group used 36.5% fewer opioid tablets compared to the control group (P=.004).
Patients receiving the ACT intervention reported lower postoperative pain intensity scores (P=.04).
No demographic differences were observed between the 76 study completers (38 per group).

Conclusions:

Mobile-delivered ACT effectively reduced opioid use in orthopedic trauma patients post-surgery.
The intervention also led to decreased self-reported pain intensity, though clinical significance requires further evaluation.
Automated mobile messaging represents a viable strategy for delivering ACT interventions in acute postoperative care.