Effectiveness of online pain managementprograms on improving pain self-efficacy andkinesiophobia: a systematic review and metaanalysis

Abstract

Objective: Online pain management programs (OPMP) provide an alternative for providing pain management. Pain self-efficacy and kinesiophobia have been shown to be mediators and predictors for disability in chronic pain. The efficacy of OPMPs has mostly been evaluated via improvements in pain intensity or psychological constructs such as depression, anxiety or pain catastrophising, with less evaluating pain self-efficacy and kinesiophobia. This systematic review and meta-analysis investigated the effectiveness of OPMPs on improving pain self-efficacy and kinesiophobia in the chronic pain population.   Methods: Five databases were searched and studies included if they were randomised controlled trials that evaluated the effectiveness of OPMPs compared to usual care or face-to-face pain management programs on improving pain self-efficacy or kinesiophobia in adults with the musculoskeletal chronic pain. Risk of bias was assessed using Cochrane Collaboration‚Äôs tool for assessing risk of bias. Random-effects models were used in the meta-analyses. Standard mean difference (SMD) (Hedges‚Äô g) and mean difference (MD) were used as effect measures. Certainty of evidence was assessed using the GRADE approach.   Results: 14 studies were eligible for inclusion, 12 studies and 7 studies with pain self-efficacy and kinesiophobia as their primary outcome respectively. Significant improvements were found post-treatment in pain self-efficacy (N=792, SMD=0.46, 95%CI=0.24 to 0.68, I2=76.1%) and kinesiophobia (N=603, SMD=-0.66, 95%CI=-1.05 to -0.26, I2= 80.1%). Effect sizes were small to moderate and did not meet their measurement tools' minimal clinically important difference.   Conclusions: OPMPs appear to be effective in improving pain self-efficacy and kinesiophobia, however their effect may not be clinically meaningful.