Stefan Elbers

195 AGRIPPA: protocol for an RCT on late-onset occurrences of relapse will not be monitored in this study. Limited funding also prevented the development of an active (mHealth) control condition. Although opting for a treatment-as-usual condition as a comparator is a widely used method, this does not control for the potential placebo effect of receiving an mHealth app. Fourth, to minimize the impact for patients to participate in this study, we have selected a limited number of outcome measures and measurement time points in addition to routine assessments. This may result in an increased recall bias or limited insight in potential factors that could explain a possible effect of the app. Finally, patients will require sufficient digital literacy skills to effectively use the app, which may lead to self-selection during the recruitment phase. The selection bias may threaten generalization. Implications for Practice Maintaining behaviour change is notoriously difficult to achieve and every small step toward decreasing relapse or understanding the specific mechanisms by which relapse occurs or is prevented will be important to the field of pain rehabilitation. Implementation of this intervention in treatment progammes may also positively empower patients to take a more proactive role in their treatment progamme and increase sharing their experiences, thoughts, and beliefs with health care providers and significant others. This may not only lead to a better patient–health care provider relationship and improved mutual understanding but is also expected to positively influence adherence to newly learned pain management strategies (Butow & Sharpe, 2013). Acknowledgments This project is funded by a SIA-RAAK publiek grant (RAAK.PUB05.002). Author Contributions SE prepared the manuscript; JP, HW, AK, ES, and RS provided feedback; JP and HW are grant holders; JP obtained medical ethical approval, is the principal investigator, and is responsible for the day-to-day management of the “AGRIPPA” research project; HW, AK, and RS are steering committee members of AGRIPPA and monitor overall progress; ES is the contact person for the treatment locations. Conflicts of Interest None declared. Abbreviations GPE: global perceived effort; ICER: incremental cost-effectiveness ratio; IMPT: interdisciplinary multimodal pain therapy; iMTQ: iMTAMedical Cost Questionnaire; iPCQ: