An Internet Intervention for Childhood Constipation and Encopresis

描述（由申请人提供）：估计有1.5%至7.5%的儿童患有大便失禁（粪便污染）。治疗大便失禁最有效的方法之一是加强厕所训练（ETT）。当由熟练和知识渊博的临床医生提供时，ETT在3、6和12个月随访时的有效性是单独强化医疗管理的两倍。我们已经成功地将ETT转变为一个互动的互联网干预，一个任何拥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着的附加价值，并且基于我们为通过互联网干预实现治疗行为改变而开发的理论模型。到目前为止，这种针对小儿大便失禁的互联网干预仅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，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，因此将评估一种增强的条件，包括针对不同程度的不依从性的分级护理方法（自动电子邮件，个性化电子邮件，电话支持），作为大型，国家，随机临床试验的一部分。我们提出了一个为期四年的项目，在该项目中，我们将实验性地测试干预的短期和长期效益相比，使用该系统与分步护理方法，以提高依从性，并最终改善症状。一个静态的，教育网站将与控制组使用。将对成本效益分析进行评价和记录。我们假设，在治疗后6周和12个月，儿童大便失禁互联网干预在减少大便失禁症状方面比静态网站更有效（包括更少的事故，增加在厕所的BM，并增加前往浴室），行为改变（通过可接受的清洁、泻药、紧张、排便和常规来衡量）和降低的成本（看医生、药物使用、缺课/工作日、使用尿布）。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大的网站利用率，从而改善行为改变和症状减轻。虽然整体成本可能会更高，分步护理，我们预计成本效益分析表明，这种增加的成本是可以接受的研究人口的某一部分。还将对我们的互联网干预模式进行进一步测试。相关性：互联网干预措施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尿失禁的儿童制定一个计划，并评估“直接面向消费者”提供该计划的有效性。“它还试图通过整合方法来提高对该计划的遵守程度，从而提高成功率。这项研究的结果将对特别是排便的管理和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.