Abstract
BackgroundAcceptance and commitment therapy (ACT) can be effective in treating chronic pain. Despite evidence supporting the effectiveness of ACT, uncertainties remain regarding which subgroups in the chronic pain population are likely to benefit most and least. This protocol describes the application for two meta-analytic approaches, one at the level of individual participant data and the other at the level of aggregated data, from randomized controlled trials of ACT for chronic pain (ACT-CP-MA).MethodsWe will systematically conduct literature searches in CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registers. Two reviewers will independently select studies for inclusion and data extraction. ACT-CP-MA will include randomized controlled trials with ACT for chronic pain compared to control conditions for adults (≥ 18 years) with chronic pain (> 3 months). We will invite the authors of all eligible trials to share individual participant data. Outcomes will include standardized measures of pain interference, pain intensity, depression, anxiety, health-related quality of life, participants’ rating of overall improvement, and ACT-related process variables. Using the Cochrane Collaboration’s tool and GRADE, reviewers will independently check for risk of bias, quality of evidence, and strength of recommendations. In the individual participant data meta-analysis, we will use a one-step approach where participants are clustered with studies and data from all studies are modeled simultaneously. For analyses, we will use mixed-effects models. Additionally, we will employ a meta-analysis with aggregate data and compare the results of both meta-analyses.DiscussionThis collaborative meta-analysis of individual participant data from randomized controlled trials of ACT for chronic pain versus control conditions will demonstrate how the known benefits of ACT for chronic pain vary across different subtypes of the chronic pain population. The results of the meta-analyses will be based on a comprehensive search of multiple databases and will help to inform future clinical trials and decision-making on the use of ACT in chronic pain and improve the quality, design, and reporting of future trials in this field.Systematic review registrationPROSPERO CRD42019120901.
Highlights
Acceptance and commitment therapy (ACT) can be effective in treating chronic pain
Chronic pain is defined as pain lasting more than 3 months and can be seen as a disease in its own right [1]
It can overcome predefined hypotheses that were applied in each included primary study and allows for an overview of factors that may be crucial to treatment effects observed in ACT for chronic pain
Summary
Despite evidence supporting the effectiveness of ACT, uncertainties remain regarding which subgroups in the chronic pain population are likely to benefit most and least. The prevalence rates of chronic pain are in the range of 27% in European countries [2], equivalent to international estimates [3, 4] This condition is associated with a high disease burden in terms of personal suffering, low quality of life, and high economic costs, and is considered as a major health care problem worldwide [5, 6]. The biopsychosocial approach is regarded as the gold standard in the treatment of chronic pain [8, 9] Psychological interventions, such as the acceptance and commitment therapy (ACT), constitute a core component within this approach. The British Pain Society recommends ACT in the treatment of chronic pain [31] and ACT has been implemented in public care for patients with chronic pain in some countries, considerable barriers to implement psychological interventions have been observed [32]
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