Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial
Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial
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DOI：
10.1097/j.pain.0000000000000348
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发表时间：
2016-01-01
期刊：
影响因子：
7.4
通讯作者：
Tai, Gabrielle
中科院分区：
文献类型：
--
作者：
Palermo, Tonya M.;Law, Emily F.;Tai, Gabrielle
互联网提供的干预措施正在成为一种解决慢性疼痛患者护理障碍的战略。这是第一个大的多中心随机对照试验的互联网提供的认知行为治疗（CBT）的儿科慢性疼痛。参与者包括273名青少年（205名女性和68名男性），年龄在11至17岁之间，患有混合性慢性疼痛疾病及其父母，他们被随机分配到平行组设计中，接受互联网提供的CBT（n = 138）或互联网提供的教育（n = 135）。在治疗前、治疗后即刻和6个月随访时完成评估。所有数据收集和程序都是在线进行的。主要分析使用线性增长模型。结果表明，与互联网教育相比，互联网CBT从基线到6个月随访的活动限制主要结局显著降低（B =-1.13，P = 0.03）。在次要结局方面，发现互联网CBT对睡眠质量（B = 0.14，P = 0.04）、减少父母流产帮助（B =-2.66，P = 0.007）和保护行为（B =-0.19，P = 0.001）以及治疗满意度（P值< 0.05）有显著的有益影响。在探索性结果中，发现互联网CBT的好处是父母感知的影响（即，减少抑郁，焦虑，对青少年疼痛的自责，以及改善父母对疼痛的行为反应）。总之，我们通过互联网提供的CBT干预措施对青少年和家长的结果产生了许多有益的影响，并最终可能导致青少年及其家庭广泛传播循证心理疼痛治疗。
Internet-delivered interventions are emerging as a strategy to address barriers to care for individuals with chronic pain. This is the first large multicenter randomized controlled trial of Internet-delivered cognitive-behavioral therapy (CBT) for pediatric chronic pain. Participants included were 273 adolescents (205 females and 68 males), aged 11 to 17 years with mixed chronic pain conditions and their parents, who were randomly assigned in a parallel-group design to Internet-delivered CBT (n = 138) or Internet-delivered Education (n = 135). Assessments were completed before treatment, immediately after treatment, and at 6-month follow-up. All data collection and procedures took place online. The primary analysis used linear growth models. Results demonstrated significantly greater reduction on the primary outcome of activity limitations from baseline to 6-month follow-up for Internet CBT compared with Internet education (b = -1.13, P = 0.03). On secondary outcomes, significant beneficial effects of Internet CBT were found on sleep quality (b = 0.14, P = 0.04), on reducing parent miscarried helping (b = -2.66, P = 0.007) and protective behaviors (b = -0.19, P = 0.001), and on treatment satisfaction (P values < 0.05). On exploratory outcomes, benefits of Internet CBT were found for parent-perceived impact (ie, reductions in depression, anxiety, self-blame about their adolescent's pain, and improvement in parent behavioral responses to pain). In conclusion, our Internet-delivered CBT intervention produced a number of beneficial effects on adolescent and parent outcomes, and could ultimately lead to wide dissemination of evidence-based psychological pain treatment for youth and their families.