Automated Self-management (ASM) vs. ASM-Enhanced Collaborative Care for Chronic Pain and Mood Symptoms

the CAMMPS Randomized Clinical Trial

Kurt Kroenke, Fitsum Baye, Spencer G. Lourens, Erica Evans, Sharon Weitlauf, Stephanie McCalley, Brian Porter, Marianne Matthias, Matthew Bair

Research output: Contribution to journalArticle

Abstract

Background: Chronic musculoskeletal pain is often accompanied by depression or anxiety wherein co-occurring pain and mood symptoms can be more difficult to treat than either alone. However, few clinical trials have examined interventions that simultaneously target both pain and mood conditions. Objective: To determine the comparative effectiveness of automated self-management (ASM) vs. ASM-enhanced collaborative care. Design: Randomized clinical trial conducted in six primary care clinics in a VA medical center. Participants: Two hundred ninety-four patients with chronic musculoskeletal pain of at least moderate intensity and clinically significant depressive and/or anxiety symptoms. Intervention: ASM consisted of automated monitoring and 9 web-based self-management modules. Comprehensive symptom management (CSM) combined ASM with collaborative care management by a nurse-physician team. Both interventions were delivered for 12 months. Main Measures: Primary outcome was a composite pain-anxiety-depression (PAD) z-score consisting of the mean of the BPI, PHQ-9, and GAD-7 z-scores: 0.2, 0.5, and 0.8 represent potentially small, moderate, and large clinical differences. Secondary outcomes included global improvement, health-related quality of life, treatment satisfaction, and health services use. Key Results: Both CSM and ASM groups had moderate PAD score improvement at 12 months (z = − 0.65 and − 0.52, respectively). Compared to the ASM group, the CSM group had a − 0.23 (95% CI, − 0.38 to − 0.08; overall P =.003) greater decline in composite PAD z-score over 12 months. CSM patients were also more likely to report global improvement and less likely to report worsening at 6 (P =.004) and 12 months (P =.013). Conclusions: Two intervention models relying heavily on telecare delivery but differing in resource intensity both produced moderate improvements in pain and mood symptoms. However, the model combining collaborative care led by a nurse-physician team with web-based self-management was superior to self-management alone. Trial Registration: ClinicalTrials.gov: NCT0175730.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StatePublished - Jan 1 2019

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Self Care
Chronic Pain
Randomized Controlled Trials
Anxiety
Pain
Depression
Musculoskeletal Pain
Nurses
Physicians
Health Services
Primary Health Care
Quality of Life
Outcome Assessment (Health Care)
Clinical Trials

Keywords

  • anxiety
  • clinical trial
  • collaborative care
  • depression
  • pain
  • telemedicine

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Automated Self-management (ASM) vs. ASM-Enhanced Collaborative Care for Chronic Pain and Mood Symptoms : the CAMMPS Randomized Clinical Trial. / Kroenke, Kurt; Baye, Fitsum; Lourens, Spencer G.; Evans, Erica; Weitlauf, Sharon; McCalley, Stephanie; Porter, Brian; Matthias, Marianne; Bair, Matthew.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Chronic musculoskeletal pain is often accompanied by depression or anxiety wherein co-occurring pain and mood symptoms can be more difficult to treat than either alone. However, few clinical trials have examined interventions that simultaneously target both pain and mood conditions. Objective: To determine the comparative effectiveness of automated self-management (ASM) vs. ASM-enhanced collaborative care. Design: Randomized clinical trial conducted in six primary care clinics in a VA medical center. Participants: Two hundred ninety-four patients with chronic musculoskeletal pain of at least moderate intensity and clinically significant depressive and/or anxiety symptoms. Intervention: ASM consisted of automated monitoring and 9 web-based self-management modules. Comprehensive symptom management (CSM) combined ASM with collaborative care management by a nurse-physician team. Both interventions were delivered for 12 months. Main Measures: Primary outcome was a composite pain-anxiety-depression (PAD) z-score consisting of the mean of the BPI, PHQ-9, and GAD-7 z-scores: 0.2, 0.5, and 0.8 represent potentially small, moderate, and large clinical differences. Secondary outcomes included global improvement, health-related quality of life, treatment satisfaction, and health services use. Key Results: Both CSM and ASM groups had moderate PAD score improvement at 12 months (z = − 0.65 and − 0.52, respectively). Compared to the ASM group, the CSM group had a − 0.23 (95{\%} CI, − 0.38 to − 0.08; overall P =.003) greater decline in composite PAD z-score over 12 months. CSM patients were also more likely to report global improvement and less likely to report worsening at 6 (P =.004) and 12 months (P =.013). Conclusions: Two intervention models relying heavily on telecare delivery but differing in resource intensity both produced moderate improvements in pain and mood symptoms. However, the model combining collaborative care led by a nurse-physician team with web-based self-management was superior to self-management alone. Trial Registration: ClinicalTrials.gov: NCT0175730.",
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AU - Lourens, Spencer G.

AU - Evans, Erica

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