An Internet Intervention for Childhood Constipation and Encopresis

描述(由申请人提供)：估计有1.5%至7.5%的儿童患有大小便失禁(粪便污垢)。治疗大小便失禁最有效的方法之一是加强如厕训练(ETT)。ETT在由熟练和有知识的临床医生提供3、6和12个月的随访时，其效率是单独强化医疗管理的两倍。我们已经成功地将ETT转变为交互式互联网干预，一个任何有计算机和互联网接入的人都可以访问的网络程序。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，这种针对儿科包茎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，提出了一种新的临床试验，在该试验中，家庭可以自我参考干预。此外，由于依从性通常是互联网干预的一个重要问题，将作为一项大型的全国性随机临床试验的一部分来评估一种增强型条件，该条件包括针对不同程度的不依从性的分级支持(自动电子邮件、个性化电子邮件、电话支持)的分步护理方法。我们提出了一个为期四年的项目，在该项目中，我们将通过实验测试干预的短期和长期好处，并与使用分级护理方法的系统进行比较，以提高依从性并最终改善症状。控制组将使用一个静态的教育网站。将对成本效益分析进行评估和记录。我们假设，在治疗后6周和12个月，儿科大小便失禁互联网干预将在以下方面比静态网站更有效：减少大小便症状(包括更少的事故，增加厕所里的BMS，增加上厕所的次数)，行为改变(通过可接受的清洁、泻药、紧张、如厕和常规来衡量)，以及降低成本(就诊次数、用药情况、旷课/工作天数、使用的尿布)。我们还预测，与标准计划相比，分级护理版本的计划将产生更高的网站利用率，从而改善行为改变和症状减轻。虽然分级护理的总成本可能会更高，但我们预计成本效益分析将表明，这种增加的成本对研究人口的特定部分来说是可以接受的。我们还将对我们的互联网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。这个应用程序计划为有包茎失禁的儿童提供一个程序，并评估当它被“直接提供给消费者”时的效果如何。它还试图通过整合各种方法来提高对计划的遵从性，从而增加成功。这项研究的发现将对特别是加密的管理以及一般的互联网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.