A digital health psychological intervention (WebMAP Mobile) for children and adolescents with chronic pain: results of a hybrid effectiveness-implementation stepped-wedge cluster randomized trial.
A digital health psychological intervention (WebMAP Mobile) for children and adolescents with chronic pain: results of a hybrid effectiveness-implementation stepped-wedge cluster randomized trial.
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针对患有慢性疼痛的儿童和青少年的数字健康心理干预（Webmap Mobile）：混合有效性 - 实现阶梯式斜边聚类随机试验的结果。
DOI：
10.1097/j.pain.0000000000001994
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发表时间：
2020-12
期刊：
影响因子：
7.4
通讯作者：
Zhou C
中科院分区：
文献类型：
--
作者：
Palermo TM;de la Vega R;Murray C;Law E;Zhou C
补充数字内容可在文本中获得。使用混合实施-有效性设计，我们的儿童慢性疼痛数字心理干预（WebMAP）显示了成功的实施，但有效性受到适度治疗参与的限制。虽然心理治疗使患有慢性疼痛的青少年受益，但在大多数社区无法获得治疗。数字卫生干预措施为扩大这一人群的可及性和覆盖面提供了希望。采用楔形聚类随机试验设计，我们评估了数字健康心理干预对儿童慢性疼痛的有效性和实施情况。从美国8家诊所招募了143名10至17岁的慢性疼痛青年和一名护理人员。积极干预包括使用基于网络的青少年疼痛管理（WebMAP）移动应用程序和WebMAP家长网站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Reach、采用、实施和维持是实施结果。结果显示，在两种治疗条件下（WebMAP与常规护理）的年轻人随着时间的推移在疼痛和残疾方面有相似的变化。与接受常规治疗的青少年相比，WebMAP组的青少年在治疗后和随访时（患者总体印象变化）有更大的改善（d = 0.54和0.44,P < 0.05）。数字健康干预的使用是适度的和可变的；大约30%的青少年和家长完成了治疗。从治疗前到随访期间，更大的参与程度（完成模块的数量）与疼痛和残疾的显著减少相关（d = - 0.57和- 0.38,P < 0.05）。家长、青少年和提供者认为治疗是可以接受的；提供者有积极的态度，并在维护期间展示了转介。需要进一步研究以了解如何加强与数字卫生干预措施的治疗参与并优化实施。
Supplemental Digital Content is Available in the Text. Using a hybrid implementation-effectiveness design, our digital psychological intervention for pediatric chronic pain (WebMAP) demonstrated successful implementation, but effectiveness was limited by modest treatment engagement. 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.
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影响因子：
7.4
作者：
Holley AL;Zhou C;Wilson AC;Hainsworth K;Palermo TM
通讯作者：
Palermo TM
影响因子：
2.1
作者：
Cucchiaro G;Schwartz J;Hutchason A;Ornelas B
通讯作者：
Ornelas B
影响因子：
3.8
作者：
Bauer, DJ;Curran, PJ
通讯作者：
Curran, PJ
DOI：
10.1002/14651858.cd011118.pub2
发表时间：
2015-03-23
期刊：
The Cochrane database of systematic reviews
影响因子：
--
作者：
Fisher, Emma;Law, Emily;Eccleston, Christopher
通讯作者：
Eccleston, Christopher
影响因子：
4.4
作者：
Krauss, Alexander
通讯作者：
Krauss, Alexander