1 Slattery BW, et al. BMJ Open 2019;9:e012671. doi:10.1136/bmjopen-2016-012671 Open access Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: protocol for a randomised controlled trial Brian W Slattery, 1,2 Laura L O'Connor, 1 Stephanie Haugh, 1 Katie Barrett, 1 Kady Francis, 1 Christopher P Dwyer, 1 Siobhan O'Higgins, 1 Line Caes, 1 Jonathan Egan, 1 Brian E McGuire 1 To cite: Slattery BW, O'Connor LL, Haugh S, et al. Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: protocol for a randomised controlled trial. BMJ Open 2019;9:e012671. doi:10.1136/ bmjopen-2016-012671 ► Prepublication history and additional material for this paper are available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2016- 012671). Received 25 April 2018 Revised 15 November 2018 Accepted 31 January 2019 For numbered affliations see end of article. Correspondence to Dr Brian W Slattery; brian.slattery@dcu.ie Protocol © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Introduction Multimorbidity refers to the presence of two or more chronic health conditions within one person, where no one condition is primary. Research suggests that multimorbidity is highly correlated with chronic pain, which is pain lasting longer than 3 months. Psychotherapeutic interventions for people living with chronic illness have resulted in reduced symptom reporting and improved psychological well-being. There is a dearth of research, however, using online psychotherapy for people living with multimorbidity where chronic pain is a central condition. This study will compare the effectiveness of an online acceptance and commitment therapy (ACT) intervention with a waiting list control condition in terms of improving health- related quality of life (HRQoL) and reducing levels of pain interference in people with chronic pain and at least one other condition. Methods and analysis 192 adult participants with non- malignant pain that persists for at least 3 months and at least one other medically diagnosed condition will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. A waiting list group will be offered the ACT intervention after the 3-month follow-up period. HRQoL and pain interference will act as the primary outcomes. Data will be analysed using a linear mixed model and adjusted to account for demographic and clinical variables as necessary. A Study Within a Trial will be incorporated to examine the effect on recruitment and retention of showing participants an animated educational video. Ethics and dissemination Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via peer reviewed journal articles and conference presentations. Trial registration number ISRCTN22343024. INTRODUCTION  Background and rationale Multimorbidity Multimorbidity is defined ‘as the co-existence of two or more chronic conditions, where one is not necessarily more central than the Strengths and limitations of this study ► Interventions for people with chronic health prob- lems tend to focus on one condition, and do not account for other symptoms or conditions a person may have. ► Research has shown that people with chronic pain typically have at least one other chronic health con- dition. To our knowledge this is the frst randomised control trial to target the improvement of important health outcomes for people with chronic pain and multimorbidity. ► The aims of this study are novel and would provide useful information for both the applied and research communities, as well as potentially reducing pain interference and improving health-related quality of life for patients. ► This is the frst study to adopt acceptance and com- mitment therapy (ACT) for multimorbidity and chron- ic pain and there may be issues with the adaptation. That said, the adaptation for the current study was supervised by a clinical psychologist who specialis- es in ACT and chronic pain and we do not envisage any issues, moreover, the effcacy of the programme as an intervention, is an empirical question and one which the study aims to answer. on April 25, 2020 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2016-012671 on 9 May 2019. Downloaded from