Jointstrong intervention for juvenile arthritis

描述（由申请人提供）：这项R21试点研究涉及国家关节炎、肌肉骨骼和皮肤疾病研究所（NIAMS）的行为和生物心理社会研究优先事项，以进行非药物干预研究，包括基于技术的干预，用于慢性症状，如疼痛。慢性或复发性疼痛是幼年型关节炎（JA）的主要特征。大约25%至30%的儿童报告中度至重度疼痛，绝大多数患有JA的儿童报告至少有一些疼痛，每天持续30分钟至24小时，平均每天4.3小时。此外，长期随访显示，被诊断患有JA的成年人报告相对于性别匹配的健康病例显着更大的疼痛，疲劳和残疾。因此，对于许多患有JA的儿童来说，疼痛是一个严重的问题，持续到成年，并与严重的残疾有关。而且，尽管在药物治疗方面取得了进展，但儿童疼痛。该应用程序的主要目的是开发和试点测试“Jointstrong”，这是一种基于计算机的连续性认知行为干预，用于JA儿童疼痛。这项试点研究将随机分配36名8至12岁的JA儿童到Jointstrong计划或等待名单对照组。在基线、治疗后即刻和3个月随访时，将在两周内进行疼痛强度、持续时间和频率、情绪和压力以及生活质量的每日日记测量。假设接受Jointstrong联合标准医疗护理的儿童在疼痛、情绪和压力以及生活质量指标方面的改善程度大于标准医疗护理（等待名单）对照组的儿童。如果这项初步研究成功，将提出一项更大规模的R 01临床试验，以进一步验证Jointstrong项目。项目叙述：为患有慢性疼痛的儿童开发基于计算机的连续性疼痛管理程序，如JA，可以具有成本效益，并且可以通过CD-ROM程序或网络轻松传播给患者和家庭。这些计划还可以降低医疗保健费用和功能障碍，改善慢性或复发性疼痛儿童的生活质量。

DESCRIPTION (provided by applicant): This R21 pilot study addresses behavioral and biopsychosocial research priorities of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) to conduct studies of non-pharmacological interventions, including technology-based interventions, for chronic symptoms such as pain. Chronic or recurrent pain is central feature of juvenile arthritis (JA). About 25 to 30 percent report moderate to severe pain and the great majority of children with JA report at least some pain lasting from 30 minutes to 24 hours a day, with a mean of 4.3 hours per day. In addition, long-term follow up shows that the adults who were diagnosed with JA report significantly greater pain, fatigue, and disability relative to gender-matched healthy cases. Thus, for many children with JA pain is a significant problem that persists into adulthood and is associated with significant disability. And, in spite of advancements in pharmacological treatments foonic childhood pain. The primary aim of this application is to develop and pilot test "Jointstrong," an adjunctive computer-based cognitive-behavioral intervention for pain in children with JA. This pilot study will randomly assign 36 children, 8 to 12 years with JA to the Jointstrong program or a wait-list control group. Daily diary measures of pain intensity, duration, and frequency, mood and stress, as well as quality of life measures will be taken during two-week intervals at baseline, immediate post-treatment, and 3-month follow-up. Hypotheses are that children who receive the Jointstrong in combination with standard medical care will demonstrate greater improvement on the pain, mood and stress, and quality of life measures than children in a standard medical care (wait-list) control group. If this pilot study is successful, a larger R01 clinical trial will be proposed to further validate the Jointstrong program. PROJECT NARRATIVE: The development of computer-based adjunctive pain management programs for children with chronic pain, such as JA, can be cost-effective and easily disseminated to patients and families via CD-ROM programs or on the Web. These programs can also reduce health care costs and functional disability and improve the quality of life for children with chronic or recurrent pain.