From hands-on to remote: moderators of response to a novel self-management telehealth program during the COVID–19 pandemic

Carlos Gevers-Montoro, Zoha Deldar, Andrea Furlan, Eric Arthur Lazar, Erfan Ghalibaf, Arantxa Ortega de Mues, Ali Khatibi

Research output: Contribution to journalArticlepeer-review


Background: In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management program.

Methods: A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self-management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for two to four weeks, while rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety.

Results: A total of 168 patients completed the first two weeks of the program, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the program was associated with lower pain intensity, although moderated by the degree of motivation.

Conclusions: In the context of COVID–19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.

Original languageEnglish
JournalEuropean Journal of Pain
Publication statusAccepted/In press - 4 May 2022


  • Telehealth
  • Pain self-management
  • Moderation
  • Adherence
  • Fear-avoidance
  • Chiropractic


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