Strength Back The development and evaluation of a digital health intervention for spinal surgery patients based on Acceptance & Commitment Therapy and positive psychology
Annemieke van der Horst is a PhD student in the department of Psychology, Health & Technology. (Co)Promotors are prof.dr. K.M.G. Schreurs, prof.dr. E.T. Bohlmeijer and dr. S.M. Kelders from the faculty of Behavioural, Management and Social Sciences.
There is a need for psychological interventions for spinal surgery patients supporting their long-term recovery. Acceptance and Commitment Therapy and positive psychology seem promising as a theoretical basis for such an intervention. Although both ACT and PP have been proven effective for a wide range of physical and mental conditions, including in the form of digital health interventions, their benefits for spinal surgery patients have not been studied.
The aim of this thesis was to develop and evaluate a digital intervention for spinal surgery patients based on ACT and positive psychology.
The first study of this thesis describes a systematic scoping review into current digital interventions for spinal surgery patients and existing evidence for acceptance and effects of these interventions. The study demonstrated that digital health interventions seem promising for spinal surgery patients, but that they mainly focus on physical outcomes, moreover, small sample sizes and the lack of clarity on the use of a theoretical base and working mechanisms hamper implementation, transferability and generalizability.
Subsequently, the second study of this thesis describes a qualitative study with spinal surgery patients and healthcare professionals. This study indicates that surgery takes place in the context of a personal history full of health-related experiences, beliefs and expectations that may promote maladaptive coping and emotion regulation strategies.
The third study describes the developmental process of the digital health intervention “Strength Back”. The interviews confirmed the need for a digital intervention. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being.
In the fourth study, a pilot feasibility study was conducted to explore the possible effects and the acceptability by spinal surgery patients of the developed intervention, “Strength Back”. Significant effects favoring the intervention group were found on emotional and overall well-being and pain intensity. Recruitment and adherence was high. The majority of the participants would recommend the intervention to future patients.
Finally, the results of all studies are summarized and discussed. The strengths and limitations and implications for future research are discussed.