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Use of an Ecological Momentary Assessment Application to Assess the Effects of Auricular Point Acupressure for Chronic Low Back Pain

Lin, Wei-Chun, MD, MS; Burke, Lora, PhD, MPH, RN; Schlenk, Elizabeth A., PhD, RN; Yeh, Chao Hsing, PhD, RN

CIN: Computers, Informatics, Nursing: May 2019 - Volume 37 - Issue 5 - p 276–282
doi: 10.1097/CIN.0000000000000478

The purpose of this pilot study was to assess the feasibility and usability of an ecological momentary assessment smartphone application. The app collected real-time data on chronic low back pain and time-contingent ecological momentary assessment surveys during a 4-week auricular point acupressure intervention, and on the consistency between recalled and momentary clinical measures. Eighteen participants received auricular point acupressure treatment weekly for 4 weeks. Each participant was provided a smartphone with the ecological momentary assessment application installed, along with instructions for use. The primary outcomes comprised pain intensity, pain interference with daily activity, sleep quality score, and medication usage. System Usability Scale and adherence were also measured. According to the results, the rate of adherence for completion of the random ecological momentary assessment survey was 87%. The usability score for the ecological momentary assessment application was reported as 78. The average recalled pain intensity was higher than the mean momentary pain intensity. Self-reported average pain interference with daily activities showed a similar result. Spearman rank correlation coefficients were greater than +0.70; P < .01 for the associations among recalled and momentary measurements. In conclusion, the study demonstrated promising adherence rates and supported the usability and feasibility of using an ecological momentary assessment application on a smartphone to collect real-time data on chronic lower back pain, which eliminated recall bias.

Author Affiliation: University of Pittsburgh School of Nursing, PA (Drs Lin, Burke, and Schlenk); Johns Hopkins School of Nursing, Baltimore, MD (Dr Yeh).

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Chao Hsing Yeh, PhD, RN, Johns Hopkins School of Nursing, 525 N Wolfe St, Room 421, Baltimore, MD 21205 (

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