Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
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Here is something that all Europeans find of prime importance: affordable access to good health care; high quality elderly care; being able to live independently, even if you are handicapped or chronically ill.
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In this chapter the autor explores the contours and possible effects of the WMO for the local government level. First she gives a short overview of the main features of the WMO (PAR. 2.5). Then she describes the challenges that local government is confronted with, especially the political decisions that have to be taken at the local level (PAR. 2.3). The question to be answered is whether or not the WMO means an impulse for local democracy in the Netherlands. To that purpose, two quick comparisons are made (PAR. 2.4): with other decentralisation operations in the Netherlands, and with the decentralisation of social care and welfare in Sweden. These comparisons make it possible to determine two main conditions for creating an impulse for local politics, which are presented in PAR. 2.5. The article ends by some concluding remarks on the effect of the WMO on the local democracy in the Netherlands.
