Applied Psychophysiology and Biofeedback

, Volume 37, Issue 2, pp 81–89 | Cite as

Do Personalized Feedback Messages about Activity Patterns Stimulate Patients with Chronic Low Back Pain to Change their Activity Behavior on a Short Term Notice?

  • Marit G. H. Dekker- van Weering
  • Miriam M. R. Vollenbroek-Hutten
  • Hermie J. Hermens


The aim of this study was to explore whether patients responded to personalized messages on top of continuous visual feedback by changes in activity patterns and whether this response is related to the stages of change and the pain intensity levels. Patients wore a movement sensor and a PDA for 2 weeks and received continuously feedback and time-related messages to influence activity behavior. The response was calculated by calculating the activity 30 min before and after a message. In addition, the readiness to change was measured with the Stage of Change questionnaire and pain intensity was measured on a visual analogue scale. Sixteen patients participated, receiving a total of 517 messages. Overall, patients responded to personalized messages (p < .049), with a higher response in the morning. Patients in different stages of change responded differently to the messages (p = .009) and the response was significantly related to the pain intensity levels (Pearson correlation −.226) in the second week of feedback. This study suggests that personalized messages have the potential to influence activity behavior. It seems relevant to take time of the day, the stages of change and pain intensity levels of the patient into account to further optimize the feedback strategy used.


Personalized feedback Daily activities Accelerometry Chronic low back pain 


  1. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  2. Bickmore, T., Gruber, A., & Intille, S. (2008). Just-in-time automated counseling for physical activity promotion. AMIA Annual Symposium Proceedings, 880.Google Scholar
  3. Bolton, J. E. (1999). Accuracy of recall of usual pain intensity in back pain patients. Pain, 83(3), 533–539.PubMedCrossRefGoogle Scholar
  4. Bousema, E. J., Verbunt, J. A., Seelen, H. A., Vlaeyen, J. W., & Knottnerus, J. A. (2007). Disuse and physical deconditioning in the first year after the onset of back pain. Pain, 130, 279–286.PubMedCrossRefGoogle Scholar
  5. Bouten, C. V., Verboeket-van de Venne, W. P., Westerterp, K. R., Verduin, M., & Janssen, J. D. (1996a). Daily physical activity assessment: Comparison between movement registration and doubly labeled water. Journal of Applied Physiology, 81, 1019–1026.PubMedGoogle Scholar
  6. Bouten, C. V., Verboeket-van de Venne, W. P., Westerterp, K. R., Verduin, M., & Janssen, J. D. (1996b). Daily physical activity assessment: Comparison between movement registration and doubly labeled water. Journal of Applied Physiology, 81(2), 1019–1026.PubMedGoogle Scholar
  7. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Erlbaum.Google Scholar
  8. Engel, G. L. (1977). The care of the patient: Art or science? The Johns Hopkins Medical Journal, 140, 222–232.PubMedGoogle Scholar
  9. Glynn, C. J., & Lloyd, J. W. (1976). Diurnal variation and individual differences in the perception of intractable pain. Journal of Psychosomatic Research, 20(4), 289–301.PubMedCrossRefGoogle Scholar
  10. Guirao-Goris, J. A., Cabrero-Garcia, J., Moreno Pina, J. P., & Munoz-Mendoza, C. L. (2009). Structured review of physical activity measurement with questionnaires and scales in older adults and the elderly. Gaceta Sanitaria, 23(4), 334.PubMedCrossRefGoogle Scholar
  11. Hasenbring, M., Hallner, D., & Klasen, B. (2001). Psychological mechanisms in the transition from acute to chronic pain: Over- or underrated? Schmerz, 15, 442–447.PubMedCrossRefGoogle Scholar
  12. Hellsten, R., Norman, G., Braun, L., Coday, M., Garber, C., Matthews, C., et al. (2008). Accumulation of behavioral validation evidence for physical activity stage of change. Health Psychology, 27, 43–53.CrossRefGoogle Scholar
  13. Jamison, R. N., & Brown, G. K. (1991). Validation of hourly pain intensity profiles with chronic pain patients. Pain, 45, 123–128.PubMedCrossRefGoogle Scholar
  14. Jensen, M. P., Strom, S. E., Turner, J. A., & Romano, J. M. (1992). Validity of the Sickness Impact Profile Roland scale as a measure of dysfunction in chronic pain patients. Pain, 50, 157–162.PubMedCrossRefGoogle Scholar
  15. Kraaimaat, F. W., & Evers, A. W. (2003). Pain-coping strategies in chronic pain patients: Psychometric characteristics of the pain-coping inventory (PCI). International Journal of Behavioral Medicine, 10(4), 343–363.PubMedCrossRefGoogle Scholar
  16. Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011). Stages of change. Journal of Clinical Psychology, 67, 143–154.PubMedCrossRefGoogle Scholar
  17. Olaogun, M. O. B., Adedoyin, R., Ikem, I., & Anifaloba, O. (2004). Reliability of rating low back pain with a visual analogue scale and a semantic differential scale. Physiotherapy Theory and Practice, 2(8), 135–142.CrossRefGoogle Scholar
  18. Peters, M. L., Sorbi, M. J., Kruise, D. A., Kerssens, J. J., Verhaak, P. F., & Bensing, J. M. (2000). Electronic diary assessment of pain, disability and psychological adaptation in patients differing in duration of pain. Pain, 84, 181–192.PubMedCrossRefGoogle Scholar
  19. Plotnikoff, R. C., Hotz, S. B., Birkett, N. J., & Courneya, K. S. (2001). Exercise and the transtheoretical model: A longitudinal test of a population sample. Preventive Medicine, 33, 441–452.PubMedCrossRefGoogle Scholar
  20. Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48.Google Scholar
  21. Roland, M., & Fairbank, J. (2000). The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine, 15, 3115–3124. Review.CrossRefGoogle Scholar
  22. Ryan, R. M., & Deci, E. L. (2008). A self-determination theory approach to psychotherapy: The motivational basis for effective change. Canadian Psychology/Psychologie canadienne, 49, 186–193.CrossRefGoogle Scholar
  23. Spenkelink, C. D., Hutten, M. M., Hermens, H. J., & Greitemann, B. O. (2002). Assessment of activities of daily living with an ambulatory monitoring system: A comparative study in patients with chronic low back pain and nonsymptomatic controls. Clinical Rehabilitation, 16, 16–26.PubMedCrossRefGoogle Scholar
  24. Stratford, P. W., Binkley, J. M., & Riddle, D. L. (1998). Sensitivity to change of the Roland Morris Back Pain Questionnaire. Part 1. Physical Therapy, 78, 1186–1196.PubMedGoogle Scholar
  25. van Tulder, M. W., Koes, B., Malmivaara, A. (2006). Outcome of non-invasive treatment modalities on back pain: An evidence-based review. European Spine Journal (Suppl 1), S64–S81. (Epub 2005 1. Review).Google Scholar
  26. van Weering, M. G., Vollenbroek-Hutten, M. M., Tönis, T. M., & Hermens, H. J. (2009). Daily physical activities in chronic lower back pain patients assessed with accelerometry. European Journal of Pain, 13, 649–654.PubMedCrossRefGoogle Scholar
  27. van Weering, M. G., Vollenbroek-Hutten, M. M., & Hermens, H. J. (2011a). The relationship between objectivity and subjectivity measured activity levels in people with chronic low back pain. Clinical Rehabilitation, 25(3), 256–263.PubMedCrossRefGoogle Scholar
  28. van Weering, M. G. H., Vollenbroek-Hutten, M. M. R., Hermens, H. J. (2011). Potential value of an activity-based feedback system for treatment of patients with chronic low back pain. Submitted.Google Scholar
  29. Verbunt, J. A., Westerterp, K. R., van der Heijden, G. J., Seelen, H. A., Vlaeyen, J. W., & Knottnerus, J. A. (2001). Physical activity in daily life in patients with chronic low back pain. Archives of Physical Medicine and Rehabilitation, 82, 726–730.PubMedCrossRefGoogle Scholar
  30. Verbunt, J. A., Seelen, H. A., Vlaeyen, J. W., van de Heijden, G. J., Heuts, P. H., Pons, K., et al. (2003). Disuse and deconditioning in chronic low back pain: Concepts and hypotheses on ontributing mechanisms. European Journal of Pain, 7, 9–21.PubMedCrossRefGoogle Scholar
  31. Verbunt, J. A., Smeets, R. J., Wittink, H. M. (2010). Cause or effect? Deconditioning and chronic low back pain. Pain 149, 428–430. (Epub 2010 12. Review).Google Scholar
  32. Vlaeyen, J. W., Kole-Snijders, A. M., Boeren, R. G., & van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62, 363–372.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Marit G. H. Dekker- van Weering
    • 1
  • Miriam M. R. Vollenbroek-Hutten
    • 1
    • 2
  • Hermie J. Hermens
    • 1
    • 2
  1. 1.Roessingh Research and DevelopmentEnschedeThe Netherlands
  2. 2.Faculty of Electrical Engineering, Mathematics and Computer ScienceUniversity of TwenteEnschedeThe Netherlands

Personalised recommendations