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      Patients’ Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Protocol for a Systematic Review and Thematic Synthesis

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          Abstract

          Background

          Chronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes.

          Objective

          This systematic review aims to identify, appraise, and synthesize qualitative evidence on patients’ experiences with digital health interventions (DHIs) for the management of chronic pain.

          Methods

          This systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies.

          Results

          Themes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain.

          Conclusions

          This systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development.

          Trial Registration

          PROSPERO CRD42023445100; http://tinyurl.com/4z77khfs

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/52469

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          Most cited references41

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          Methods for the thematic synthesis of qualitative research in systematic reviews

          James Thomas, Angela Harden (2008)
          Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.
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            Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ

            Sandy Oliver, Allison Tong, Kate Flemming … (2013)
            Background The syntheses of multiple qualitative studies can pull together data across different contexts, generate new theoretical or conceptual models, identify research gaps, and provide evidence for the development, implementation and evaluation of health interventions. This study aims to develop a framework for reporting the synthesis of qualitative health research. Methods We conducted a comprehensive search for guidance and reviews relevant to the synthesis of qualitative research, methodology papers, and published syntheses of qualitative health research in MEDLINE, Embase, CINAHL and relevant organisational websites to May 2011. Initial items were generated inductively from guides to synthesizing qualitative health research. The preliminary checklist was piloted against forty published syntheses of qualitative research, purposively selected to capture a range of year of publication, methods and methodologies, and health topics. We removed items that were duplicated, impractical to assess, and rephrased items for clarity. Results The Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement consists of 21 items grouped into five main domains: introduction, methods and methodology, literature search and selection, appraisal, and synthesis of findings. Conclusions The ENTREQ statement can help researchers to report the stages most commonly associated with the synthesis of qualitative health research: searching and selecting qualitative research, quality appraisal, and methods for synthesising qualitative findings. The synthesis of qualitative research is an expanding and evolving methodological area and we would value feedback from all stakeholders for the continued development and extension of the ENTREQ statement.
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              Beyond PICO: the SPIDER tool for qualitative evidence synthesis.

              Alison Cooke, Debbie Smith, Alison Cooke (2013)
              Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.
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                Author and article information

                Contributors
                Ashleigh Main:
                ORCID: https://orcid.org/0009-0000-4639-7486
                Department of Computer and Information SciencesUniversity of Strathclyde26 Richmond StreetGlasgow, G1 1XHUnited Kingdom44 (0)141 552 4400ashleigh.main@strath.ac.uk
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: 2024
                Publication date (Electronic): 7 March 2024
                Volume: 13
                Electronic Location Identifier: e52469
                Affiliations
                [1 ] Department of Computer and Information Sciences University of Strathclyde Glasgow United Kingdom
                [2 ] Physical Activity for Health, School of Psychological Sciences and Health University of Strathclyde Glasgow United Kingdom
                [3 ] Department of Occupational Therapy and Human Nutrition and Dietetics, School of Health & Life Sciences Glasgow Caledonian University Glasgow United Kingdom
                Author notes
                Corresponding Author: Ashleigh Main ashleigh.main@ 123456strath.ac.uk
                Author information
                https://orcid.org/0009-0000-4639-7486
                https://orcid.org/0009-0006-1740-3078
                https://orcid.org/0009-0004-3633-5563
                https://orcid.org/0000-0002-8121-6094
                https://orcid.org/0000-0003-2683-0523
                https://orcid.org/0000-0001-5213-1596
                https://orcid.org/0000-0001-7935-3447
                Article
                Publisher ID: v13i1e52469
                DOI: 10.2196/52469
                PMC ID: 10958340
                PubMed ID: 38451694
                SO-VID: f8dc875a-4837-4463-add3-baf361aed744
                Copyright © ©Ashleigh Main, Haruno McCartney, Maryam Ibrar, Harleen Kaur Rai, Fiona Muirhead, Alexandra Mavroeidi, Roma Maguire. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.03.2024.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 4 September 2023
                Date revision requested : 25 January 2024
                Date revision received : 12 February 2024
                Date accepted : 14 February 2024
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: chronic pain,digital health,digital tool,digital health intervention,mhealth,ehealth,pain-management,person-centered,experience,protocol,patients' experiences,patient experiences,self-management,systematic review,thematic synthesis,protocol.
                Data availability:
                Keywords: chronic pain, digital health, digital tool, digital health intervention, mhealth, ehealth, pain-management, person-centered, experience, protocol, patients' experiences, patient experiences, self-management, systematic review, thematic synthesis, protocol.

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