Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States.
Departments of Anesthesiology and Pain Medicine and.
Pain. 2020 Dec;161(12):2763-2774. doi: 10.1097/j.pain.0000000000001994.
Although psychological treatments benefit youth with chronic pain, treatment is not accessible in most communities. Digital health interventions offer promise for expanding access and reach to this population. Using a stepped-wedge cluster randomized trial design, we evaluated effectiveness and implementation of a digital health delivered psychological intervention for pediatric chronic pain. One hundred forty-three youth, aged 10 to 17 years, with chronic pain and a caregiver were recruited from 8 clinics in the United States. Active intervention included access to the Web-based Management of Adolescent Pain (WebMAP) Mobile app and the WebMAP parent web site to learn pain self-management skills. Effectiveness outcomes included pain intensity, disability, and patient global impression of change, while Reach, Adoption, Implementation, and Maintenance were implementation outcomes. Results showed that youth in both treatment conditions (WebMAP vs Usual Care) had similar changes over time in pain and disability. Youth in the WebMAP condition perceived greater improvement (patient global impression of change) at post-treatment and follow-up (d's = 0.54 and 0.44, P < 0.05) compared with youth receiving usual care. Use of the digital health intervention was modest and variable; approximately 30% of youth and parents completed treatment. Greater engagement (number of completed modules) was associated with significantly greater reductions in pain and disability from pre-treatment to follow-up (d's = -0.57 and -0.38, P < 0.05). Parents, youth, and providers found treatment acceptable; providers had positive attitudes and demonstrated referrals over a maintenance period. Further research is needed to understand how to enhance treatment engagement with digital health interventions and optimize implementation.
虽然心理治疗对慢性疼痛的青少年有益，但在大多数社区都无法获得治疗。数字健康干预措施为扩大该人群的获得途径和覆盖面提供了希望。我们采用阶梯式楔形集群随机试验设计，评估了一种针对儿科慢性疼痛的数字健康心理干预措施的有效性和实施情况。从美国的 8 个诊所招募了 143 名年龄在 10 至 17 岁之间、患有慢性疼痛和照顾者的青少年。主动干预包括访问基于 Web 的青少年疼痛管理（WebMAP）移动应用程序和 WebMAP 父母网站，以学习疼痛自我管理技能。有效性结果包括疼痛强度、残疾和患者对变化的总体印象，而可达性、采用率、实施率和维持率则是实施结果。结果表明，接受 WebMAP 治疗（WebMAP 与常规护理）的青少年在疼痛和残疾方面的变化相似。在治疗后和随访时，WebMAP 组的青少年（患者对变化的总体印象）感知到更大的改善（d 值分别为 0.54 和 0.44，P < 0.05），而接受常规护理的青少年则没有。数字健康干预措施的使用量适中且变化不定；大约 30%的青少年和家长完成了治疗。更高的参与度（完成模块的数量）与从治疗前到随访时疼痛和残疾的显著减少相关（d 值分别为-0.57 和-0.38，P < 0.05）。父母、青少年和提供者都认为治疗是可以接受的；提供者在维持期表现出积极的态度和转介。需要进一步研究如何增强数字健康干预措施的治疗参与度并优化实施。
