An Internet Intervention for Childhood Constipation and Encopresis

描述（由申请人提供）：估计有1.5%至7.5%的儿童患有粪污（粪便污染）。其中最有效的治疗方法之一是加强如厕训练（ETT）。在3个月、6个月和12个月的随访中，由熟练和知识渊博的临床医生进行ETT治疗的效果是单纯强化医疗管理的两倍。我们已经成功地将ETT转变为一种交互式互联网干预，一种任何人都可以通过计算机和互联网访问的网络程序。该计划已被证明对标准临床护理具有显著的附加价值，并且基于我们开发的通过互联网干预实现治疗行为改变的理论模型。到目前为止，这种针对儿童隐入症的互联网干预只提供给目前正在接受医疗保健提供者治疗的个人。为了显著增加其广泛传播的潜力，提出了一项新的临床试验，其中家庭可以自我参考干预措施。此外，由于依从性通常是互联网干预的一个重要问题，对于不同程度的不依从性，将作为一项大型、全国性、随机临床试验的一部分，评估涉及分级护理方法的增强条件，并提供分级支持（自动电子邮件、个性化电子邮件、电话支持）。我们提出了一个为期四年的项目，在这个项目中，我们将实验性地测试干预的短期和长期效益，并将其与使用系统的阶梯式护理方法进行比较，以增强依从性并最终改善症状。对照组将使用一个静态的教育网站。成本效益分析将被评估和记录。我们假设，在治疗后6周和12个月，儿童隐尿症网络干预将比静态网站更有效，包括减少隐尿症症状（包括更少的事故，厕所内脑损伤增加，以及去厕所的次数增加），行为改变（通过可接受的清洁，泻药，紧张，如厕和日常）和降低成本（就诊，药物使用，缺课/工作日，尿布使用）。我们还预测，与标准程序相比，该程序的阶梯式护理版本将产生更高的网站利用率，从而改善行为改变和症状减少。虽然阶梯式护理的总成本可能会更高，但我们希望成本效益分析表明，这种增加的成本对于所研究的特定人群是可以接受的。还将对我们的网络干预模型进行额外的测试。相关性：互联网干预可以以低成本提供复杂和个性化的治疗。该应用程序计划为患有隐症的儿童提供一个项目，并评估“直接面向消费者”的效果。它还试图通过整合各种方法来提高对项目的依从性，从而提高成功率。这项研究的结果将对网络入侵的管理和一般的网络干预产生深远的影响。

DESCRIPTION (provided by applicant): An estimated 1.5 percent to 7.5 percent of children suffer from encopresis (fecal soiling). One of the most effective ways of treating encopresis is with Enhanced Toilet Training (ETT). ETT is twice as effective as intensive medical management alone at 3, 6, and 12-month follow-up when delivered by skilled and knowledgeable clinicians. We have successfully transformed ETT into an interactive internet intervention, a web program accessible by anyone with a computer and internet access. This program has been shown to have significant additive value to standard clinical care, and is based on a theoretical model we developed for therapeutic behavior change achieved through internet interventions. To date, this Internet intervention for pediatric encopresis has only been offered to individuals who are currently in treatment with a health care provider. In order to significantly increase its potential for wide-spread dissemination, a new clinical trial is proposed in which families can self-refer to the intervention. In addition, as adherence is often a significant issue with internet interventions, an enhanced condition involving a stepped care approach with graduated levels of support (automated email, personalized email, phone support) for different levels of non-adherence will be evaluated as part of a large, national, randomized clinical trial. We propose a four year project in which we will experimentally test the short and long term benefits of the intervention as compared to use of the system with a stepped care approach to enhance adherence and ultimately symptom improvement. A static, educational website will be used with the control group. Cost-benefit analyses will be evaluated and documented. We hypothesize that the pediatric encopresis internet intervention will be more effective than a static website at 6 weeks and 12 months post treatment in terms of encopretic symptom reduction (including fewer accidents, increased BMs in toilet, and increased trips to the bathroom), behavior change (measured by acceptable cleanout, laxatives, straining, toileting, and routine), and reduced costs (doctor visits, medication usage, missed school/work days, diapers used). We also predict that the stepped care version of the program, as compared to the standard program, will produce greater website utilization and thus improved behavior change and symptom reduction. While overall cost will likely be higher with stepped care, we expect cost-benefit analyses to show that this increased cost is acceptable for a certain segment of the population studied. Additional testing of our model for internet interventions will also be conducted. Relevance: Internet interventions can provide sophisticated and personalized treatment at low cost. This application plans to take a program for children with encopresis and evaluate how effective it is when offered "direct-to-consumers." It also attempts to increase success by integrating methods to improve adherence to the program. Findings from this study will have far reaching implications for the management of encopresis in particular and internet interventions in general.