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针对功能性腹痛儿童及其父母的基于网络的心理社会干预对家庭的影响及体验:一项混合方法的试点随机对照试验

Effects and Experiences of Families Following a Web-Based Psychosocial Intervention for Children with Functional Abdominal Pain and Their Parents: A Mixed-Methods Pilot Randomized Controlled Trial.

作者信息

Nieto Rubén, Boixadós Mercè, Ruiz Gemma, Hernández Eulàlia, Huguet Anna

机构信息

eHealth Lab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.

PSiNET Research Group, Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.

出版信息

J Pain Res. 2019 Dec 31;12:3395-3412. doi: 10.2147/JPR.S221227. eCollection 2019.

Abstract

PURPOSE

To evaluate post-treatment efficacy of DARWeb (online psychosocial intervention for children with functional abdominal pain) using a randomized clinical trial design and combining quantitative and qualitative data.

PATIENTS AND METHODS

Twenty-five families with children with FAP in the experimental group (EG: accessed to DARWeb) and 36 in the control group (CG: wait-list) were compared. Children and parents completed measures of abdominal pain severity (primary outcome), quality of life, and satisfaction. Moreover, children completed measures of depression, functional disability, catastrophizing and coping strategies; parents completed measures about parental responses to their children's pain. Families also answered open questions and were interviewed.

RESULTS

A higher percentage of children in the EG achieved a significant clinical change in abdominal pain severity from the parents' perspective (28% in the EG vs 8.33% in the CG). There was a significantly greater reduction in pain frequency in the EG compared to the CG (both from the children's and parents' perspectives) from mixed repeated-measures analyses of variance (there was not a significant interaction in total scores of pain severity). A higher percentage of children in the EG improved in quality of life and depression compared to the CG (results from mixed methods repeated-measures analyses of variances were not significant). However, there were no differences for disability, pain catastrophizing or the coping strategies assessed from the children's perspective; neither from the parents' assessment of quality of life. There were significant interactions for parents' solicitousness responses and promotion of well behaviors in the expected directions. Families were quite satisfied with the intervention, and the qualitative results confirmed an improvement in pain and having learned important coping strategies.

CONCLUSION

Our results support the efficacy of our intervention, but future studies are needed with different profiles of initial severity of the pain problem, longer follow-ups, and other conditions.

摘要

目的

采用随机临床试验设计并结合定量和定性数据,评估DARWeb(针对功能性腹痛儿童的在线心理社会干预)的治疗后疗效。

患者与方法

比较了25个有功能性腹痛儿童的实验组家庭(EG组:可使用DARWeb)和36个对照组家庭(CG组:等待名单组)。儿童和家长完成了腹痛严重程度(主要结局)、生活质量和满意度的测量。此外,儿童完成了抑郁、功能残疾、灾难化思维和应对策略的测量;家长完成了关于父母对孩子疼痛反应的测量。家庭还回答了开放性问题并接受了访谈。

结果

从家长的角度来看,EG组中更高比例的儿童在腹痛严重程度上实现了显著的临床变化(EG组为28%,CG组为8.33%)。通过混合重复测量方差分析,与CG组相比,EG组的疼痛频率显著降低(从儿童和家长的角度来看均如此)(疼痛严重程度总分无显著交互作用)。与CG组相比,EG组中更高比例的儿童在生活质量和抑郁方面有所改善(混合方法重复测量方差分析结果不显著)。然而,从儿童的角度评估的残疾、疼痛灾难化思维或应对策略方面没有差异;从家长对生活质量的评估来看也没有差异。在父母的关切反应和促进良好行为方面存在显著的预期方向的交互作用。家庭对干预相当满意,定性结果证实疼痛有所改善且学到了重要的应对策略。

结论

我们的结果支持了我们干预措施的疗效,但未来需要针对疼痛问题初始严重程度不同、随访时间更长以及其他条件的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f060/6997197/57c0e76485b6/JPR-12-3395-g0001.jpg

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