Electronic diaries as a tool to improve pain management: is there any evidence? Patient compliance with paper and electronic diaries. Intensive momentary reporting of pain with an electronic diary: reactivity, compliance, and patient satisfaction A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability Electronic diary assessment of pain-related variables: is reactivity a problem? Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study. The usefulness of a daily pain management diary for outpatients with cancer-related pain. Evaluation of the use of a pain diary in chronic cancer pain patients at home [Validation of electronic by conventional pain diaries]. Analgesic adherence measurement in cancer patients: comparison between electronic monitoring and diary. Pain Assessment in Patients With Fibromyalgia Syndrome: A Consideration of Methods for Clinical Trials Assessing pain in persons with dementia: relationships among the non-communicative patient's pain assessment instrument, self-report, and behavioral observations. Validating nurses' and nursing assistants' report of assessing pain in older people with dementia. University students' notebook computer use: lessons learned using e-diaries to report musculoskeletal discomfort The cost diary: a method to measure direct and indirect costs in cost-effectiveness research. A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients?
OBJECTIVE Chronic pain is a common and costly syndrome which affects approximately one in three US adults . Factors such as shortened length of the medical visit , increased availability of technological approaches to care , and a more informed patient all suggest that a new paradigm is required for chronic pain management . Although much has been written about the use of electronic diaries in clinical trials , little has been presented about the use of these diaries in clinic practice and their potential for changing pain behavior . The intent of this preliminary study is to measure accessibility and usability of a software program design ed for use on a personal digital assistant and to discuss how the software program may impact clinic practice and patient behavior . METHODS We present the results of a preliminary , r and omized , comparison , crossover trial of 36 chronic pain patients who were asked to monitor their pain , mood , activity interference , medication use , and pain location on either a paper or electronic diary for 2 weeks . Patients in the electronic diary condition were able to observe changes in their ratings over time and view them on a secure web site . RESULTS No differences were found between paper and electronic tracking on pain descriptors , pain interference , mood , or helpfulness of medication . Similar to past findings , patients found the electronic diary easier to use ( P < 0.0001 ) and would continue using it ( P < 0.05 ) over paper if given the choice . Importantly , patients using the electronic diary reported more frequently that a provider suggested medication change ( P < 0.05 ) based on feedback from the electronic diary . One trend requiring further investigation is that electronic diary users reported that the diary enabled them and their doctor to make care adjustments according to changes in pain status . CONCLUSION This study goes beyond previous research on preference and data quality to investigate how the information provided may affect patient and physician perspectives toward pain management . Although not the initial intent of this study , findings indicate that electronic tracking may provide information which can affect management decisions . A follow-up study is ongoing to investigate these initial results . If found to be true , electronic monitoring may have broad implication s for health care , policy , and improvement in quality of care for chronic pain sufferers in the future Paper diaries are commonly used in health care and clinical research to assess patient experiences . There is concern that patients do not comply with diary protocol s , possibly invalidating the benefit of diary data . Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features .  Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries . Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days . Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries ( defined by comparing the written times and the electronically-recorded times of diary use ) . Actual compliance was recorded by the electronic diary . Participants su bmi tted diary cards corresponding to 90 % of assigned times ( + /-15 min ) . However , electronic records indicated that actual compliance was only 11 % , indicating a high level of faked compliance . On 32 % of all study days the paper diary binder was not opened , yet reported compliance for these days exceeded 90 % . For the electronic diary , the actual compliance rate was 94 % . In summary , participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features . The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information & NA ; Patient self‐reports are the primary method for capturing the experience of pain , and diaries are often used to collect patient self‐reports . This study was design ed to determine if momentary monitoring of pain with an electronic diary affected pain levels over time , if it affected weekly recall of pain , and if daily sampling density affected compliance rates and patients ’ reactions to the study . Ninety‐one patients with chronic pain were r and omized into four groups with differing levels of momentary monitoring over 2 weeks . Little support was found for reactivity defined as temporal shifts in pain over the study or as changes in recalled weekly pain due to momentary monitoring . Compliance with the electronic diary protocol was 94 % or better , and was not related to sampling density . Patients reported little difficulty with the diary procedures and were not unduly burdened by the protocol & NA ; Electronic diary assessment of pain and disability has become increasingly popular in adult chronic pain research but use of this methodology with children has received limited attention . The aim of this study was to compare two formats of a prospect i ve daily diary ( h and held computer = e‐diary ; paper diary = p‐diary ) on children 's compliance , accuracy , and acceptability ratings . Sixty children , ages 8–16 ( M=12.3 ) with headaches or juvenile idiopathic arthritis , were r and omized to receive either  e‐diaries administered via home visits ( n=30 ) or  p‐diaries  ( n=30 ) h and ed out during clinic visits for return by mail . Results demonstrated significant mean differences in diary entries completed between groups , with children with e‐diaries completing more days ( M=6.6 ) compared to children with p‐diaries ( M=3.8 ) , P<0.001 . Diaries returned by children in the p‐diary group contained significantly more errors and omissions compared to diaries returned by children in the e‐diary group ( which contained none ) , P<0.001 . Children rated both diary formats as highly acceptable and easy to use . A significant gender × diary format interaction ( P<0.01 ) was found for compliance where boys demonstrated greater compliance with the e‐diary format . Findings demonstrated that the e‐diary was feasible to use with children and showed significantly greater compliance and accuracy in diary recording compared to traditional paper diaries in a population of children with recurrent pain UNLABELLED Reactive measures ( measures that change the phenomenon assessed ) cause problems in interpreting any changes observed . This study examined whether electronic daily diary measures of pain , activity interference , mood , and pain beliefs were reactive in terms of both observable data and patient-reported effects . Patients with chronic temporom and ibular disorder pain ( N = 71 , 86 % female ) completed electronic diaries 3 times daily for approximately 2 weeks and subsequently reported perceived effects on symptom-related variables . Seventy-three percent of patients reported that the assessment affected their pain , whereas 51 % , 45 % , and 39 % thought that it affected their daily activities , mood , and beliefs , respectively . In contrast , there was little objective evidence of reactivity as observed in the electronic diary ratings ; changes over 14 days were small ( eg , predicted changes on 0 to 10 scales : positive mood , .1 ; pain , -.3 ; perceived control , -.5 ) and not statistically significant . Subjective reactivity was generally not significantly related to objective reactivity . The data suggest that patients view daily assessment as having positive and negative effects on pain-related variables , but pain-related measures do not show reactive effects . PERSPECTIVE Electronic daily diary assessment methods hold the potential to increase knowledge concerning patients ' experiences with pain and sequential relations between pain-related variables , but only if the measurement process is nonreactive . This study provides evidence that electronic diary assessment of pain-related variables is nonreactive BACKGROUND Daily diaries are a useful way of measuring fluctuations in pain-related symptoms . However , traditional diaries do not assure the gathering of data in real time , not solving the problem of retrospective assessment . Ecological momentary assessment ( EMA ) by means of electronic diaries helps to improve repeated assessment . However , it is important to test its feasibility in specific population s in order to reach a wider number of people who could benefit from these procedures . METHODS The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition , fibromyalgia and low familiarity with technology . Forty-seven participants were r and omly assigned to one of two conditions : ( 1 ) paper diary - smartphone diary and ( 2 ) smartphone diary - paper diary , using each assessment method for 1 week . RESULTS The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings . Besides , this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital , with an important proportion of participants with low level of education and low familiarity with technology . CONCLUSIONS The findings of this study support the use of smartphones for EMA even in specific population s with a specific pain condition , fibromyalgia and with low familiarity with technology . These methods could help clinicians and research ers to gather more accurate ratings of relevant pain-related variables even in population s with low familiarity with technology PURPOSE / OBJECTIVES To describe the usefulness of daily pain management diaries to out patients with cancer who participated in a r and omized clinical trial of the PRO-SELF Pain Control Program .  DESIGN R and omized clinical trial in which a daily pain management diary was used for data collection in the control group and for data collection and nurse coaching regarding the pain management program in the intervention group . SETTING Seven outpatient oncology setting s. SAMPLE 155 patients with pain from bone metastases and 90 family caregivers . METHODS Content and statistical analysis of audiotaped answers to a semistructured question naire . MAIN RESEARCH VARIABLES Patients ' and family caregivers ' perceptions of the usefulness of a  daily pain management diary ; specific ways in which the diary was used . FINDINGS Patients in both the intervention ( 75 % ) and control groups ( 73 % ) found the diary useful . The diary was used to heighten awareness of pain , guide pain management behavior , enhance a sense of control , and facilitate communication . Family caregivers in both groups also reported that the diary was useful . CONCLUSIONS The completion of a daily pain management diary is useful to patients and family caregivers and may function as an intervention for self-care . IMPLICATION S FOR NURSING Research -based evidence supports the importance of using a daily pain management diary in clinical practice Systematic assessment of pain is the basis for adequate pain treatment . In the home situation , however , it is difficult to assess patients ' pain intensity . A group of 159 cancer patients who had been admitted to a cancer hospital with pain caused by cancer , cancer therapy , or illness that persisted for at least 1 month received a pain diary .  These patients were asked to register their pain intensity at home . Patients were instructed by a nurse to record their Present Pain Intensity on a scale from 0 - 10 once every morning and every evening for a period of 2 months . In this study , the use of a pain diary in cancer pain patients at home was evaluated . To determine the effects of the pain diary , patients were interviewed at baseline , at 2 , 4 , and 8 weeks postdischarge .  Pain intensity scores were obtained both by patient interviews and from the pain diary . Results show that the use of a  pain diary  is an appropriate way to assess patients ' pain intensity at home . Patients ' compliance was high ( 86 % ) , even in seriously ill patients . When comparing pain scores obtained by patient interview with scores obtained by pain diary  , results showed that Present Pain Intensity scores , rather than Average Pain Intensity scores , should be used in both the clinical and the home setting because patients ' recall accuracy depends , in part , on the stability of the pain . Because the pain intensity scores fluctuate greatly during the day and over a period of time , the use of a pain diary is useful in the home setting . In 60 % of the patients , completing the pain scores helped them to cope with the pain A new type of electronic pain diary was vali date d in an open , r and omized , crossover study . The main target variables were the comparison of the correctly realized pain assessment entries as well as the recording of the number of adverse events . Selected for the study were 20 patients , who were either hospitalized , partially-hospitalized or treated on an out-patient basis , with painful spondylogenic spinal syndrome or osteoarthritis of the trunk-proximal large joints . The patients were r and omly-assigned to the two groups . The first group initially received the conventional diary and thereafter the electronic diary ; the sequence was reversed for the second group . The drug therapy consisted of the NSAID , Ibuprofen , at an individually-adjusted dosage . Additional therapeutic measures were carried out by all the patients . The electronic pain diary proved to be equivalent to the conventional diary with regard to adherence of the pain assessment entry times . At a defined equivalence range of + /- 20 % , the statistical comparison showed that the limits were never exceeded . The equivalence test of And erson-Hauck showed a significance level of p less than 0.0001 . The minimum equivalence range was + /- 2 % . It therefore follows , that the conventional method of data recording can indeed be fully replaced by the electronic method . Comparing the individual data of the 16 patients , from whom entries with both the electronic as well as the conventional pain diaries were su bmi tted , a clear tendency for increased entries on adverse events in the electronic diary ( C.D. 6.4 + /- 10.5/E.D. 36.4 + /- 44.1 ) was demonstrated . No significant difference , however , was shown for the number of patients making data entries on adverse events in the electronic pain diary compared to those patients , who made their entries on adverse events in the conventional diary . According to the data from the physicians and patients , the  Ibuprofen treatment results in an improvement in 90%/75 % of cases , respectively . Likewise , the functional impairment of the affected joints as well as the swelling decreased markedly . The advantages of the electronic data recording system , i.e. closely-meshed controls can be carried out , transcriptional errors are minimized , data can be processed on-line , no possibility to subsequently change an entry , st and in contrast to the feature that there is no possibility to make free-style entries . The employment of the electronic system in the recording of individual data and subjective data represents a substantial improvement with regard to the quantity and quality of the data Adherence to analgesics in cancer patients has scarcely been studied . In this study , the Medication Event Monitoring System ( MEMS ) and medication diaries were compared with respect to feasibility and adherence measurements .  Forty-six out patients with nociceptive pain caused by cancer were asked to use MEMS for their analgesics and to record their medication usage in a diary for four weeks . Seventy-nine percent of the patients used MEMS for the full four-week period ; 70 % did so for the diary . The majority of patients were satisfied with both MEMS and diary . Adherence data assessed by MEMS and diary were comparable . Patients used the amount of analgesics adequately ( taking adherence : 87 % ) but took them irregularly ( timing adherence : 53 % ) . Subgroup analyses in patients using single and multiple analgesic regimens confirmed the comparable suitability of both methods . MEMS and a medication diary are equally useful for analgesic adherence measurement in cancer patients with pain Objective : This study was design ed to compare 3 commonly used method ologies for assessing clinical pain during trials involving patients diagnosed with fibromyalgia syndrome . Baseline characteristics , characteristics over time , and compliance were evaluated for each of the methods . Methods : Fourteen patients diagnosed with fibromyalgia syndrome were asked to monitor their symptoms of pain using 3 different strategies over a 12-week period : 1 ) real-time pain reports were collected on an electronic diary using r and omly-scheduled audible prompts ; 2 ) end-of-week reports asked patients to rate their mean pain over the past week on the electronic diary ; and 3 ) monthly in-clinic reports asked patients to rate their mean pain for the week using a traditional paper and pencil diary . Results : Significantly different baseline values were obtained for the 3 methods . Paper and pencil produced the highest values , and real-time pain reports produced the lowest baseline values . Pain ratings were more likely to reflect decreases in the 2 methods relying on recall than the real-time strategy . The average adherence with pain monitoring using the electronic diary was 85 % , which was superior to the adherence for the recall measures completed during the clinic visits . Conclusion : Pain assessment methods relying on recall might contribute to an apparent improvement in clinical trials in the absence of an intervention ; such an effect has been considered a “ placebo response . ” Future clinical trials might consider using a real-time approach to pain assessment  , which in this study appeared to mitigate against seeing improvement in the absence of an intervention and demonstrated higher levels of patient adherence Pain is a common problem for many older adults , with up to 50 % of community-dwelling and 70 % to 80 % of nursing home residents experiencing pain regularly . Effective  pain  management requires thorough assessment , appropriate intervention , and systematic re assessment . Pain assessment , however , is complicated by dementia , which impairs memory , reasoning , recognition , and communication , and affects elders ' ability to verbally report pain . As such , observational measures are needed to assess pain in this vulnerable population . The Non-communicative Patient 's Pain Assessment Instrument ( NOPPAIN ) was developed for this purpose , but more validation of this measure is needed . Thus , the purpose of this study was to ( 1 ) evaluate reliability of the NOPPAIN tool when used by nurses and to ( 2 ) compare NOPPAIN ratings with self-report and other well-established behavioral rating procedures . Forty participants ( 20 cognitively intact and 20 impaired ) were r and omly selected for this study from a larger sample . In the parent study , participants were asked to perform everyday activities ( i.e. , sit , st and , walk in place , transfer in and out of bed ) while being videotaped . The tapes , all previously scored using microanalytic observational coding , were rated again by naïve raters using the NOPPAIN measure . Results indicated ( 1 ) high inter- and intrarater reliability of the NOPPAIN and ( 2 ) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding . Findings support the reliability and validity of the NOPPAIN measurement tool and suggest this easy-to-use tool may be adequate for measuring pain indicators in older adults AIMS AND OBJECTIVES To evaluate the usefulness of  registered nurses ' ( RNs ) and nursing assistants ' ( NAs ) pain report among 304 institutional older people with dementia and eluci date the factors influencing the agreement of pain reports within dyadic assessors . BACKGROUND Using informant reports has been suggested as an effective strategy to solve the dilemma of pain assessment in people with dementia . However , the validity of pain information provided by institutional caregivers is still under-investigated . DESIGN A prospect i ve study was undertaken in six dementia special care units in Northern Taiwan . METHODS Both the four-item pain inventory and Doloplus-2 scale were used to investigate different raters ' pain reports . RESULTS Across pain variables , fair to moderate agreement was noted in RNs ' assessment ( Kappa = 0.29 - 0.42 ) , but poor agreement in NAs assessment ( Kappa = 0.11 - 0.24 ) . Comparing mean scores on intensity , frequency of pain and Doloplus-2 , statistically systematic bias existed in most pairs , but the greater bias occurred in NAs ' assessment . In logistic regression analysis , when pain was assessed by the  pain inventory  , residents ' cognitive impairment level and caregiver 's age were associated with the agreement of pain presence perceived in either resident-nurse or resident-NA pairs . Nevertheless , when pain was rated by the Doloplus-2 scale , only residents ' physical function influenced the agreement of pain report for both research assistants (RAs)-nurse and RAs-NA pairs . CONCLUSIONS Nurses ' pain report across pain variables may be more reliable than NAs . Furthermore , factors influencing the agreement of pain assessed by self-report measurement or behavioural observations may be different , needing further investigation . RELEVANCE TO CLINICAL PRACTICE Pain inquiry and behavioural observation should be performed routinely as the fifth vital sign for developing effective care plans . Institutional caregivers should be used as alternative or complementary informants for assessing pain in older people with dementia The objective of this pilot study was to identify if notebook accessories ( ergonomic chair , desktop monitor and notebook riser ) combined with a wireless keyboard , mouse and participatory ergonomics training would have the greatest impact on reducing  self-reported upper extremity musculoskeletal discomfort in university students . In addition to pre-post computing and health surveys , the Ecological Momentary Assessment was used to capture change in discomfort over time using a personal digital assistant ( PDA ) as the e-diary . The PDA was programmed with a survey containing 45 questions . Four groups of university students were r and omised to either intervention ( three external computer accessories ) or to control . Participants reported less discomfort with the ergonomic chair and notebook riser based on the pre-post survey data and the e-diary/PDA ANOVA analysis . However , the PDA data , adjusted for the effect of hours per day of computer use , showed no benefit of the chair and limited benefit from the riser . Statement of Relevance : University students ' use of notebook computers has increased . This study found evidence of a positive effect of an adjustable chair or notebook riser when combined with ergonomic training on reducing discomfort . Daily  notebook computer use of 4 h was confirmed as a risk factor . Without some form of ergonomic intervention , these students are likely to enter the workforce with poor computing habits , which places them on the road to future injuries as technology continues to play a dominant role in their lives From a societal perspective long-term clinical trials or follow-up studies should preferably not only include an evaluation of the health effect for the patient , but also an economic evaluation . In order to yield comprehensive medical and nonmedical re source use data , we at least partly depend on respondents ' recall for collecting these costing data . A patient cost diary  was developed in order to estimate total re source use , expenses , and lost production due to illness and treatment . We applied the cost diary in two r and omized clinical trials evaluating the cost-effectiveness of behavioral rehabilitation in 205 fibromyalgia and chronic low back pain patients . The use of the diary was evaluated , study ing the feasibility , the influence of the period of data collection on the results , and some aspects of validity . Eighty-five percent of the patients completed at least one diary and in total 68 % of the diaries were returned . Although the results for the three alternative periods of data collection ( keeping the diary 1 week every month , 2 weeks every 2 months , or a full year ) were not significantly different , they were only moderately correlated . Finally , self-reported specialist care contacts were generally in agreement with data from an insurance company . However , for physiotherapy contacts there were differences between the self-reported and insurance data . This study shows how the  cost diary  might be used successfully in cost-effectiveness studies Background Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions .  Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders , but research on smartphone interventions for persons with chronic pain is limited . Objective The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program . Methods A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were r and omized into 2 groups : with or without a smartphone intervention after the rehabilitation . The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone . Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts , feelings , and activities . The registered diaries were immediately available to a therapist who su bmi tted personalized written feedback daily based on cognitive behavioral principles . Both groups were given access to a noninteractive website after discharge to promote constructive self-management . Outcomes were measured with self-reported question naires . The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale ( score range 0 - 52 ) . Secondary outcomes included acceptance of pain , emotional distress , functioning , and symptom levels . Results Of the 140 participants , 112 completed the study : 48 in the intervention group and 64 in the control group . Immediately after the intervention period , the intervention group reported less catastrophizing ( mean 9.20 , SD 5.85 ) than the control group ( mean 15.71 , SD 9.11 , P<.001 ) , yielding a large effect size ( Cohen ’s d=0.87 ) for study completers . At 5-month follow-up , the between-group effect sizes remained moderate for catastrophizing ( Cohen ’s d=0.74 , P=.003 ) , acceptance of pain ( Cohen ’s d=0.54 , P=.02 ) , and functioning and symptom levels ( Cohen ’s d=0.75 , P=.001 ) . Conclusions The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation . Trial Registration Clinical trials.gov NCT01236209 ; http://www . clinical trials.gov/ct2/show/NCT01236209 ( Archived by WebCite at http://www.webcitation.org/6DUejLpPY The purpose of this r and omized , controlled , home care intervention was to test the effectiveness of two nurse-targeted , e-mail-based interventions to increase home care nurses ' adherence to pain assessment and management guidelines , and to improve patient outcomes . Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain . The basic intervention consisted of a patient-specific , one-time e-mail reminder highlighting six pain-specific clinical recommendations . The augmented intervention supplemented the initial e-mail reminder with provider prompts , patient education material , and clinical nurse specialist outreach .  Over 300 nurses were r and omized and outcomes of 673 of their patients were review ed . Data collection involved clinical record abstract ion of nurse care practice s and patient interviews completed approximately 45 days after start of care . The intervention had limited effect on nurse-documented care practice s but patient outcomes were positively influenced . Patients in the augmented group improved significantly over the control group in ratings of pain intensity at its worst , whereas patients in the basic group had better ratings of pain intensity on average . Other outcomes measures were also positively influenced but did not reach statistical significance . Our findings suggest that although reminders have some role in improving cancer pain management , a more intensive approach is needed for a generalized nursing workforce with limited recent exposure to state-of-the-art pain management practice
Compliance was generally high , and positively associated with shorter diaries , age , having a user 's manual , financial compensation and using an alarm .
Electronic diaries are increasingly used to assess daily pain in many different forms and population s. This systematic review aims to survey the characteristics of studies using electronic pain diaries and to examine how these characteristics affect compliance .