- At-home interactive voice recognition (IVR) therapies may be effective in improving chronic conditions without medication, driving various aspects of patient engagement (i.e. treatment access, feasibility, patient satisfaction), according to a study published in the JAMA Internal Medicine.
IVR is specifically helpful in driving care outcomes for patients with chronic back pain who are seeking treatment through cognitive behavioral therapy (CBT). Chronic pain is an extremely prevalent condition, afflicting more patients than do diabetes, heart disease, and cancer combined, the researchers said.
Clinicians traditionally treat chronic pain with various pain killers, but given the recent opioid crisis, the CDC, HHS, and Institute of Medicine have advocated for non-pharmaceutical methods for chronic pain treatment.
CBT has emerged as a viable chronic pain treatment and helps patients self-manage their pain using psychological, behavioral, and social coping mechanisms. However, patient access is complicated due to CBT’s new emergence in the field.
“Cognitive behavioral therapy (CBT) is an evidence-based treatment that facilitates management of chronic pain and improves outcomes, but access barriers persist,” the researchers said. “Cognitive behavioral therapy delivery assisted by health technology can obviate the need for in-person visits, but the effectiveness of this alternative to standard therapy is unknown.”
Interactive voice recognition, a technology similar to Apple’s Siri or Amazon’s Alexa, helps break down these treatment barriers by allowing patients to undergo CBT in their own homes.
The research team conducted a randomized clinical trial, observing 125 patients with chronic back pain in one department of the Veterans Affairs healthcare system. Intervention group patients used the IVR-CBT tool, consulted a guidebook, and received weekly therapist feedback based on IVR activity, coping skills practice, and pain outcomes.
The control group received weekly in-person CBT.
Researchers also monitored pain, sleep quality, activity levels, and pain coping skill practice for both groups.
Overall, the IVR-CBT and traditional, in-person CBT both improved outcomes for chronic back pain patients at about equal rates. Pain reduction was similar for both groups, with IVR-CBT patients seeing pain reductions of .77 and traditional CBT patients seeing reductions by .84, a difference the researchers say is not statistically significant.
Both treatments also showed equal improvements in physical functioning, sleep quality, and physical quality of life. Treatment persistence was higher for IVR-CBT patients, with those individuals completing 2.3 more treatments than the control group.
“While neither treatment was associated with significant improvements in mood or mental health–related quality of life, mean baseline scores on these measures were near the normal range,” the research team reported. “Overall, both treatments were associated with a statistically and clinically meaningful change for participants with no meaningful differences between treatments.”
Additionally, the researchers found that both CBT delivery methods helped patients, despite the patients’ prior health and pain concerns.
Several of the study participants had multiple pain sites, were unemployed or under-employed, and about one-quarter had a history of substance abuse. Despite these barriers, the patients still managed to benefit from CBT, highlighting the treatment’s promise in reaching multiple patient populations.
Ultimately, these findings suggest the feasibility of IVR-CBT and its effectiveness in expanding chronic pain treatment access. Clinicians also increased treatment adherence by making the treatment more accessible and convenient, the researchers said.
“Consistent with our hypothesis that IVR-CBT would be less burdensome than in-person CBT, participants receiving IVR-CBT completed more treatment weeks than those receiving in-person CBT, were significantly less likely to withdraw prior to treatment, and were more likely to obtain a minimal treatment dose,” the researchers pointed out.
“Our findings speak to the appeal, feasibility, and acceptability of IVR-CBT as an alternative to face-to-face therapy and confirm a primary justification for providing treatment using technology; it promotes convenient, patient-centered treatment,” the researchers continued.
Improved treatment access will help drive better outcomes in patients with chronic pain, the researchers said, ultimately driving a better patient experience.
“This trial suggests that IVR-CBT may address national recommendations to promote pain self-management and reduce barriers to care by providing a scalable, low-burden alternative to standard CBT,” the research team concluded. “Given the large number of Americans living with chronic pain, IVR-CBT and similar approaches are promising strategies for improving the availability of nonpharmacologic care and health outcomes, despite constraints on health system resources.”