Jointstrong intervention for juvenile arthritis

描述（由申请人提供）：本R21试点研究解决了国家关节炎、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，以开展非药物干预措施的研究，包括基于技术的干预措施，用于慢性症状，如疼痛。慢性或复发性疼痛是青少年关节炎（JA）的中心特征。大约25%到30%的患者报告中度到重度疼痛，绝大多数JA患儿报告每天至少持续30分钟到24小时的疼痛，平均每天4.3小时。此外，长期随访显示，与性别匹配的健康病例相比，被诊断患有JA的成年人报告的疼痛、疲劳和残疾明显更大。因此，对于许多患有JA的儿童来说，疼痛是一个持续到成年的重要问题，并与严重的残疾有关。而且，尽管儿童疼痛的药物治疗取得了进步。该应用程序的主要目的是开发和试点测试“Jointstrong”，这是一种辅助的基于计算机的认知行为干预，用于JA儿童的疼痛。这项试点研究将随机分配36名8至12岁的JA儿童到Jointstrong项目或等候名单对照组。每日日记测量疼痛强度、持续时间和频率、情绪和压力以及生活质量测量将在基线、治疗后立即和3个月随访期间进行两周的间隔。假设接受Jointstrong与标准医疗护理相结合的儿童在疼痛、情绪和压力以及生活质量方面比接受标准医疗护理（等候名单）对照组的儿童表现出更大的改善。如果这项初步研究成功，将提出一项更大规模的R01临床试验，以进一步验证Jointstrong计划。项目描述：为患有慢性疼痛的儿童开发基于计算机的辅助疼痛管理程序，如JA，可以具有成本效益，并且易于通过CD-ROM程序或在网络上传播给患者和家属。这些项目还可以减少医疗保健费用和功能性残疾，并改善患有慢性或复发性疼痛的儿童的生活质量。

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.