App-based intervention among adolescents with persistent pain: a pilot feasibility randomized controlled trial

Abstract

Background Persistent pain in adolescence adversely affects everyday life and is an important public health problem. The primary aim was to determine the feasibility of an 8-week app-based self-management intervention to reduce pain and improve health-related quality of life in a community-based population of adolescents with persistent pain. A secondary aim was to explore differences in health outcomes between the intervention and control groups. Methods A sample of 73 adolescents aged 16–19 years with persistent pain from a community-based population were randomized into 2 groups. The intervention group received the Norwegian culturally adapted version of the iCanCope with PainTM app, which includes symptom tracking, goal setting, self-management strategies, and social support. The attention control group received a symptom tracking app. Feasibility was assessed as attrition rates and level of engagement (interactions with the app). The secondary outcomes included pain intensity, health-related quality of life, self-efficacy, pain self-efficacy, perceived social support from friends, anxiety and depression, and patient global impression. Statistical analyses were conducted using SPSS. Results Demographic and baseline outcome variables did not differ between the 2 groups. No differences were found between the participants completing the study and those who withdrew. Twenty-eight adolescents completed the intervention as planned (62% attrition). Both groups had a low level of app engagement. Intention-to-treat analysis (n = 19 + 14) showed no significant differences in outcomes between groups. However, the large effect size (Cohen’s d = .9) for depression suggested a lower depression score in the intervention group. Conclusions High treatment attrition and low engagement indicate the need for changes in trial design in a full-scale randomized controlled trial to improve participant retention. Trial registration The iCanCope with Pain Norway trial was retrospectively registered in Clinical Trials.gov (ID: NCT03551977). Registered 6 June 2018.

Mobile applications in adolescent psychotherapy during the COVID-19 pandemic: a systematic review

“…In total, 63% of apps provided psychoeducational content, with 77% of these apps also providing specific exercises based on the presented psychoeducation. Almost half of the apps aimed to support adolescents in specific behavior changes, with three apps focusing on setting goals ( 51 , 61 , 65 ) and three apps focusing on problem-solving strategies ( 59 , 64 , 74 ). Another frequently used feature was a toolbox with useful skills for difficult situations ( n = 9).…”

“…Four out of these nine apps provided a safety plan for suicidal or self-harm crisis management ( 66 , 69 , 78 , 80 ). Furthermore, three apps provided a diary feature for app users ( 59 , 61 , 78 ) and four apps had a community forum that enabled app users to communicate with other affected adolescents ( 49 , 54 , 65 , 75 ).…”

“…As for feasibility studies that also examined (preliminary) effectiveness, 71% of these used an observational one-group cohort study design without a control group. The other four studies conducted a randomized controlled trial, with two studies comparing results with a wait list control group ( 63 , 70 ), one study using treatment as usual ( 72 ) and one study including an attention control group ( 65 ). Sample sizes ranged from three to 248, with a total of 774 participants across the 14 studies.…”

“…Intervention periods lasted between 2 and 12 weeks, with two studies requiring daily app usage ( 60 , 62 ) and three studies requiring app use frequency of at least once a week ( 63 , 64 , 68 ). Of the 14 included feasibility studies with preliminary effectiveness outcomes, three studies registered their clinical trial ( 63 , 65 , 72 ) and one also published a study protocol ( 72 ).…”

Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing

“…Mobile phone apps might be particularly useful for digital native adolescents. However, some studies have found low levels of engagement for pediatric pain self-management apps, suggesting that further research is needed to understand how adoption can be enhanced [ 13 , 14 ]. In an adult cohort, allowing people with chronic pain to be able to tell their own story through a comprehensive assessment has been identified as a key component in enhancing the experience of pain education [ 11 ].…”