(194) - Feasibility of 1-day ACT intervention for at-risk veterans undergoing orthopedic surgery: barriers and facilitators

Abstract

Acceptance Commitment Therapy (ACT) is a psychological intervention that has been shown to improve outcomes in patients with chronic pain. United States Military Veterans who report persistent pain and psychological distress prior to surgery, could benefit from receiving ACT. A 1-day ACT workshop has demonstrated efficacy for migraine pain and depression; however, it has not been tested in Veterans prior to surgery for the prevention of persistent post-surgical pain. This mixed methodology study was part of a pilot feasibility study looking at the effect of ACT on Veterans who were at risk for developing persistent post-surgical pain and opioid misuse. We examined barriers and facilitators to attending the workshop, and understanding the content via qualitative interviews with Veterans and workshop trainers. Forty-four Veterans were randomized to receive the ACT intervention and 34 actually received it. Barriers to attending the workshop were health issues, timing of their surgery, work, distance, and travel time. Barriers to understanding the content of the workshop were expectations prior to attending, comfort such as pain or sedation from medication, group format and role-playing. Facilitators to attending the workshop were timing the workshop with other medical or surgical appointments, increasing travel compensation, and inviting family members to attend the workshop with the participant. Facilitators to understanding content of the workshop were aligning their expectations of the workshop with their experience, answering questions, using a white board and repetition of central concepts. They learned from one another and felt safe and comfortable sharing their experiences with the group. In conclusion, Veterans were interested in the 1-day ACT intervention, they felt benefit from the training, felt the group format was beneficial, and they cared enough to share recommendations on how to improve delivery of the workshop. This work is presented with support from NIH NCCIH (R34 AT008349-01).