Adherence to Daily Interactive Voice Response Calls for a Chronic Pain Intervention

Abstract

Due to concerns about the safety and efficacy of long-term opioid treatment, non-pharmacological interventions for chronic pain such as cognitive-behavioral therapy for chronic pain (CBT-CP) are being promoted as first-line treatments. Telehealth delivery is designed to increase access and reduce barriers to CBT-CP with comparable effectiveness relative to in-person treatments. Adherence to telehealth treatment protocols is an important consideration in evaluating treatment efficacy. Adherence to 11 weeks of interactive voice response (IVR) phone calls was assessed in this secondary analysis of patients with chronic pain (N = 117) who participated in a clinical trial comparing the effectiveness of an IVR-based CBT-CP program to in-person CBT-CP. Patients in both groups received daily IVR calls to monitor their status. Generalized linear models were used to examine the relationship between baseline characteristics and adherence to IVR calls. Trends in IVR adherence over time and difference in adherence rates between intervention groups were also examined. IVR call adherence was high (90%) and did not differ between intervention groups while participants were enrolled in the program. However, participants in the IVR-only group on average remained engaged in treatment longer and completed more total calls (72 compared to 61 for in-person). Patients with poor baseline cognitive functioning completed fewer IVR calls in the in-person CBT-CP group. Daily IVR calls as part of a CBT-CP intervention were widely accepted by participants. Adherence remained high throughout the intervention across patient subgroups. IVR-delivered CBT-CP may increase access to effective, non-pharmacological management of chronic pain.