1 - (IOP 14) Feasibility and Acceptability of an App-based Mindfulness Meditation Intervention for People with Spinal Cord Injury and Chronic Pain: A Pilot Randomized Controlled Trail

Background: Debilitating, persistent pain occurs in 65-85% of persons who sustain spinal cord injury (SCI), one-third of whom categorize their pain as severe. Medication, including opioids, is the frontline treatment, but they are frequently reported as ineffective by persons with SCI and carry many risks which can further reduce QOL. Mindfulness meditation (MM) interventions show promise for managing pain, but often require attending face-to-face sessions, which present barriers for people with SCI. Mobile-supported (i.e., mHealth) interventions are ideally suited to overcome these barriers, but few studies have examined mHealth MM interventions among people with SCI. The purpose of this study was to determine the feasibility and acceptability of an app-guided mindfulness meditation (MM) intervention compared to health education (HE) control in people with spinal cord injury (SCI) and chronic pain.

Methods: 60 individuals with SCI and chronic pain were recruited through local SCI outpatient clinics, national registries, and community outreach and randomized to an app-guided MM intervention (listening to guided meditations on the publicly available Mindfulness Coach app (developed by the National Center for PTSD) 10 minutes/day, 6 days/week, for 6 weeks) or health education (HE) conditions (listening to the TED Talk app for 10 minutes/day, 6 days/week, for 6 weeks). Participants completed assessment of pain, depression, and anxiety at baseline (T1), post-intervention (T2), and follow-up (T3, 6 weeks post-intervention). Feasibility was determined via benchmarks for recruitment (>80% of eligible people consent), adherence (>70% use app >60 minutes/week for 6 weeks), and retention (>70% complete follow-up assessments). Acceptability was determined if >70% of participants endorsed satisfaction on the program evaluation.
Result: Recruitment and retention were feasible; 93% of eligible participants consented and 86% of participants completed T3 assessments. Adherence rates fell below the benchmark for MM (16/24; 67%) and HE (16/26; 62%), but exceeded the benchmark when considering only participants who used the app at least once (MM: 76%; HE: 80%). Most participants were very satisfied with their assigned app (MM: 82%; HE: 81%), would recommend to a friend (MM: 72%; HE: 86%) and planned to continue using it (MM: 73%; HE: 77%). This study was not powered to assess efficacy; however, among participants who used their app, mean (SD) change scores from baseline to post-intervention between MM and HE were promising for pain intensity (MM: -1.00 (1.96) vs. HE: -0.53 (2.03)), depression (MM: -3.93 (5.93) vs. HE: -2.06 (3.45)), and anxiety (MM: -2.50 (6.25) vs. -0.88 (2.47)).

Conclusion: A six-week MM intervention using a no-cost, publicly available app is feasible and acceptable among people with SCI and chronic pain. Revisions to the intervention may be needed to enhance engagement with the app. Future research examining the efficacy of the MM intervention on pain and mood in this population is warranted.