SLIDE 4 APNA 30th Annual Conference Session 2044: October 20, 2016 Ellis 4 Veehof et al., 2011
Level of Evidence: 1
Systematic Review & Meta‐analysis
Validity:
Studies included: Acceptance‐based interventions: Acceptance & commitment therapy (ACT) Mindfulness‐based stress reduction therapy (MBSR) 9 Randomized Control Trials (RCT) 5 Clinical Control Trials (CCT) 8 Other Study Designs relevant to study aim (OD) Quality was assessed using criteria recommended by Cochrane Collaboration and Jadad Scale RCTs – Medium to high quality (9) CCT & OD – Low to medium quality (13) Pooled Standardized Mean Differences to determine effect size
Results:
Analysis groups stratified accordingly: All studies Controlled studies (CCTs & RCTs) CCTs RCTs Controlled studies (CCTs & RCTs) Primary Outcomes Pain Intensity: 0.37; CI (0.20 – 0.53) Depression: 0.32; CI (0.13 – 0.50) Secondary Outcomes Anxiety: 0.40; CI (0.07 – 0.73) Physical Wellbeing: 0.35; CI (0.10 – 0.59) Quality of Life: 0.41; CI (0.16 – 0.65) RCTs only Primary Outcomes Pain Intensity: 0.25; CI (0.01 – 0.49) Depression: 0.26; CI (0.05 – 0.47) Secondary Outcomes Anxiety: 0.55; CI (‐0.09 – 1.18) Physical Wellbeing: 0.43; CI (0.04 – 0.82) Quality of Life: 0.25; CI (‐0.10 – 0.59)
Aim:
To assess the effectiveness of ACT‐ based interventions on patients with chronic pain
Method:
Controlled & non‐controlled trials Primary outcomes Pain intensity Depression Secondary Outcomes Anxiety Physical well‐being Quality of Life
Sample:
22 studies ‐1235 patients with chronic pain
Öst, L., 2014
Level of Evidence: 1
Systematic Review & Meta‐analysis
Validity:
Studies included: 3 ACT intervention components Randomly allocate participants to treatment and control or to two or more treatments Quality of studies: Assessed by using self‐developed quality scale Inter‐rater reliability Internal consistency (Cronbach’s alpha = 0.81) Analysis: Multiple levels of analysis to support rigor of meta‐analysis Hedge’s g used to determine effect size Appropriate test for effect size when sample size is relatively small
Results:
Analysis groups stratified accordingly: All studies Somatic studies All studies Psychiatric disorders, somatic disorders, and stress at work Effect size: g = 0.42 Indicating a small effect size Somatic Studies Effect size: g = 0.43 Indicating a small effect size Pain Probably efficacious treatments At least two good experiments showing that the treatment is superior (statistically significant so) to a wait‐ list control group, or One or more good experiments meeting the well‐established treatment criteria with the one exception of having been conducted
Aim:
Update systematic review and meta‐ analysis of Öst, 2008 Compare methodological stringency and effect size of earlier studies (2008) with that of later studies (post 2008) Evaluate the evidence‐based status of ACT for the different disorders for which it has been tried Comparison of ACT vs CBT in a large sample of studies
Method:
Randomized Controlled Trials: Psychiatric Disorders Somatic Disorders Stress at Work Situations
Sample:
60 Randomized control trials 4234 ti t
Advancing treatment. Transforming lives.
PICO Question
In people with chronic pain, is ACT an effective adjunctive treatment? Emerging body of research suggests it is reasonable to use ACT as an adjunctive treatment for pain.
