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Pain Med. 2019 Mar 6. pii: pnz008. doi: 10.1093/pm/pnz008. [Epub ahead of print]

Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial.

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Faculty of Nursing, Laval University, Quebec City, Quebec, Canada.
Research Center of the CHU de Québec, Quebec City, Quebec, Canada.
Ingram School of Nursing, McGill University, Montréal, Québec, Canada.
Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada.
College of Nursing, Florida State University, Tallahassee, Florida, USA.
Centre de Recherche, Centre Hospitalier de l'Université Montréal (CRCHUM), Montréal, Québec, Canada.
Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire du Nord de l'Île-de-Montréal, Montréal, Québec, Canada.



1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design. A pilot randomized controlled trial (RCT) with two parallel groups.


A supraregional level 1 trauma center.


Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities.


More than 80% of eligible patients agreed to participate, and an attrition rate of ≤18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (≥4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores ≤ 10) were obtained through the end of the study.


Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.


Acute Pain; Chronic Pain; Feasibility Studies; Health Promotion; Internet; Lower Extremity; Pilot Projects; Self-Care; Wound and Injuries


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