Background: Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain. Purpose: The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self-management strategies for people in everyday life after completion of a pain self-management intervention. Data Sources: Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. Study Selection: Study selection included qualitative and mixed-method studies that explored the perceptions of individuals with chronic pain after completion of a self–management intervention. Data Extraction: A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. Data Synthesis: Thirty-three studies with 512 participants were included. Enablers to self-management included self-discovery—the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self-management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self-management included difficulty with sustaining motivation for pain self-management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. Limitations: This review only included interventions that involved at least 4 self–management skills; thus, informative studies may have been missed. The follow-up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low- and middle-income countries could not be located. Conclusions: The sustained effort to self-manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person-centered care via shared decision making and guided problem solving is essential to facilitating ongoing self-management.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Smartphone applications (apps) are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective: To evaluate the contents of smartphone apps for people with persistent pain facilitating self-management support and appraise the app quality. Methods: A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results: Of the 939 apps screened, 19 apps met inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. Three apps (Curable, PainScale-Pain Diary and Coach and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, while few apps had features facilitating social support and communicating with clinicians. No apps provided information tailored to cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). While use of two apps (Headspace and SuperBetter) have been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions: Of the three apps (Curable, PainScale-Pain Diary and Coach and SuperBetter) that met the largest number of items to support skills in self-management of pain, two apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally-tailored information. While two apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians and people with persistent pain in developing apps, and evaluating for clinical efficacy. Clinical Trial: Not applicable

Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app–based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) “at my own pace, space, and place” and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.

Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.