Mobile Web-Based Monitoring and Coaching: Feasibility in Chronic Migraine

Background The Internet can facilitate diary monitoring (experience sampling, ecological momentary assessment) and behavioral coaching. Online digital assistance (ODA) is a generic tool for mobile Web-based use, intended as an adjuvant to face-to-face or Internet-based cognitive behavioral treatment. A current ODA application was designed to support home-based training of behavioral attack prevention in chronic migraine, focusing on the identification of attack precursors and the support of preventive health behaviour. Objective The aim was to establish feasibility of the ODA approach in terms of technical problems and participant compliance, and ODA acceptability on the basis of ratings of user-friendliness, potential burden, and perceived support of the training for behavioral attack prevention in migraine. Methods ODA combines mobile electronic diary monitoring with direct human online coaching of health behavior according to the information from the diary. The diary contains three parts covering the following: (1) migraine headache and medication use, (2) attack precursors, and (3) self-relaxation and other preventive behavior; in addition, menstruation (assessed in the evening diary) and disturbed sleep (assessed in the morning diary) is monitored. The pilot study consisted of two runs conducted with a total of five women with chronic migraine without aura. ODA was tested for 8.5 days (range 4-12 days) per participant. The first test run with three participants tested 4-5 diary prompts per day. The second run with another three participants (including one subject who participated in both runs) tested a reduced prompting scheme (2-3 prompts per day) and minor adaptations to the diary. Online coaching was executed twice daily on workdays. Results ODA feasibility was established on the basis of acceptable data loss (1.2% due to the personal digital assistant; 5.6% due to failing Internet transmission) and good participant compliance (86.8% in the second run). Run 1 revealed some annoyance with the number of prompts per day. Overall ODA acceptability was evident by the positive participant responses concerning user-friendliness, absence of burden, and perceived support of migraine attack prevention. The software was adapted to further increase the flexibility of the application. Conclusions ODA is feasible and well accepted. Tolerability is a sensitive issue, and the balance between benefit and burden must be considered with care. ODA offers a generic tool to combine mobile coaching with diary monitoring,independently of time and space. ODA effects on improvement of migraine remain to be established.

[1]  J. Passchier,et al.  The preliminary effectiveness of migraine lay trainers in a home-based behavioural management training. , 2006, Patient education and counseling.

[2]  A. Stone,et al.  Measuring clinical pain in chronic widespread pain: selected methodological issues. , 2003, Best practice & research. Clinical rheumatology.

[3]  J. Smyth,et al.  Ecological Momentary Assessment Research in Behavioral medicine , 2003 .

[4]  D. Wantland,et al.  The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes , 2004, Journal of medical Internet research.

[5]  Peter J. Goadsby,et al.  A Report on the Journal 2004 , 2004 .

[6]  M. Csíkszentmihályi,et al.  Validity and Reliability of the Experience‐Sampling Method , 1987, The Journal of nervous and mental disease.

[7]  S. Shiffman,et al.  Capturing momentary, self-report data: A proposal for reporting guidelines , 2002, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[8]  T. Meijman,et al.  Vagal cardiac control throughout the day: the relative importance of effort–reward imbalance and within-day measurements of mood, demand and satisfaction , 2001, Biological Psychology.

[9]  J. Bensing,et al.  Electronic Momentary Assessment in Chronic Pain I: Psychological Pain Responses as Predictors of Pain Intensity , 2006, The Clinical journal of pain.

[10]  Timothy J Trull,et al.  Assessing clients in their natural environments with electronic diaries: rationale, benefits, limitations, and barriers. , 2007, Psychological assessment.

[11]  S. Armeli,et al.  Multilevel daily process designs for consulting and clinical psychology: a preface for the perplexed. , 1999, Journal of consulting and clinical psychology.

[12]  High-Density Assessment of the Ihs Classification Criteria for Migraine Without Aura: A Prospective Study , 1999, Cephalalgia : an international journal of headache.

[13]  Feasibility of an electronic diary in clinical burnout , 2006, International journal of behavioral medicine.

[14]  D. Kahneman,et al.  Would You Be Happier If You Were Richer? A Focusing Illusion , 2006, Science.

[15]  J. Vlaeyen,et al.  An electronic diary assessment of the effects of distraction and attentional focusing on pain intensity in chronic low back pain patients. , 2006, British journal of health psychology.

[16]  S. Shiffman,et al.  Ecological Momentary Assessment (Ema) in Behavioral Medicine , 1994 .