The Use of a Comfort Tote to Improve Recovery in Pediatric and Adolescent Patients After Surgery

The Use of the Comfort Tote Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: a Randomized Controlled Trial Pilot Study

The goal of this clinical trial is to learn if the use of Comfort Tote can treat pain and anxiety in adolescents with idiopathic scoliosis undergoing posterior spinal fusion. The study aims to answer two questions:

1. To characterize the effectiveness and determine the impact of integrative therapy interventions of the Comfort Tote use in reducing self-reported pain, anxiety, and stress among pediatric patients with AIS undergoing PSF. By comparing self-reported pain, anxiety, and stress scores, as well as documented Morphine Milligram Equivalents (MMEs) and Numeric Rating Scale (NRS) pain scores, between patients using non-therapeutic and therapeutic Comfort Totes.
2. To evaluate the impact of an educational video on the use of the Comfort Tote. This will assess whether the inclusion of instructional content enhances understanding and application of the Comfort Tote, thereby improving patient outcomes in pain management, anxiety reduction, and overall satisfaction with care. It is hypothesized that the therapeutic Comfort Tote intervention with the educational video will provide the highest patient satisfaction and greater tote usage, with decreased patient pain, stress, and anxiety levels. The findings from this pilot study will provide crucial insights into establishing a new standard of care for pediatric patients undergoing PSF and potentially provide baseline data for use in larger, multicenter randomized controlled trials.

Study Overview

• Status: Not yet recruiting
• Conditions: Anxiety; Postoperative Nausea and Vomiting; Adolescent Idiopathic Scoliosis; Postoperative Pain, Acute
• Intervention / Treatment: Other: The Therapeutic Comfort Tote; Other: The Modified Comfort Tote

Detailed Description

The single-blind randomized controlled trial pilot study will include 50 adolescent participants aged 12 to 21, evenly distributed between the two study arms: a non-therapeutic modified Comfort Tote with written instructions and a therapeutic Comfort Tote with written instructions and an educational video. The RCT will be a single-blind study, with patients blinded to the intervention they receive. All totes will be available in English and Spanish, and patients will receive them during the pre-operative visit with the orthopedics team post-randomization. The non-therapeutic Comfort Tote will contain the following items: journal, coloring book, coloring pencils/markers, stuffed animal, non-scented hand lotion, earplugs, sleep eye mask, and fidget spinner/pop-it. This Tote will come with written instructions. The therapeutic Comfort Tote will contain the following items: aromatherapy kit including two essential oils: Balance and Clear, a firm and soft stress ball, five acupressure points including a plasticized map, Mindful Breathing, ImaginAction, EFT/Tapping, and a journal with prompts and coloring pencils included. The patients will also receive written instructions and watch a video outlining the contents of the tote and how to use each item.

Both prospective and retrospective methods will be used. A survey will be delivered at the final, postoperative in-hospital appointment between patients and their surgical team. The survey will evaluate their experience with the Comfort Tote. Primary outcomes include the impact of each Comfort Tote item on post-operative pain, stress, and anxiety scores. These will be assessed through a Qualtrics survey using a scale ranging from "did not help at all" to "helped a little" to "helped a lot". Every patient will be linked to a respective page to receive a Qualtrics survey, and this link will be texted/emailed to them. Caregivers will also receive a Qualtrics survey about their experiences with the Comfort Tote, sent via text or email. General patient pain scores will also be evaluated using measures in EPIC, including the Numeric Rating Scale (NRS).

Secondary outcomes include tote item usage, length of hospital stay (LOS), Intensive Care Unit (ICU) LOS, total direct costs (TDC), morphine milligram equivalents (MME) administered during the hospital stay, opioid prescriptions at discharge, surgical site infections, readmissions or unanticipated return to clinic, and mobility scores through the AM PAC mobility score determined by physical therapy. Tote usage indicates results from patients recording which tote components they used, collected through a post-operative Qualtrics survey. Secondary outcomes will also include whether or not patients took Gabapentin, and patients will receive a calendar with instructions upon discharge to document opioid use at home. Caregivers will also be surveyed at the final postoperative in-hospital appointment to understand their experiences with the Comfort Tote.

Aim 1: Evaluate whether the Comfort Tote intervention leads to greater reductions in self-reported pain, stress, and anxiety among patients diagnosed with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF).

Aim 2: Assess the effect of the therapeutic Comfort Tote on hospital resource utilization - specifically length of stay, ICU days, and direct costs - as well as opioid exposure, including in-hospital morphine milligram equivalents and opioid prescriptions at discharge. Additionally, this study will examine clinical outcomes, including surgical-site infections, unanticipated readmissions or clinic visits, and discharge mobility, using AM-PAC mobility scores.

Aim 3: Assess patient caregivers' experiences with and perceptions of the Comfort Tote's usefulness using data collected via a brief structured survey.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients of all genders, racial, and ethnic groups aged between 10 and 21 that have had been diagnosed with AIS requiring surgical correction with PSF.
• Patients must be scheduled to undergo PSF at Morgan Stanley Children's Hospital of NYP.
• The patients and their parent(s)/legal guardian(s) must also provide informed consent, for those under 18 years old.
• The patient population will include mental health conditions such as anxiety and/or depression and all surgery levels.

Exclusion Criteria:

• Patients who have had growing rods and revisions, those who have local or systemic infections, those with anemia, cardiovascular diseases, or osteoporosis, and patients with severe medical comorbidities such as neurological or developmental condition that precludes engagement with the Comfort Tote
• Patients with two or more chronic conditions (excluding AIS)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Therapeutic Comfort Tote; Participants will be randomly assigned to receive the Therapeutic Comfort Tote.	Other: The Therapeutic Comfort Tote; The therapeutic Comfort Tote will contain the following items: aromatherapy kit including two essential oils: Balance and Clear, a firm and soft stress ball, five acupressure points including a plasticized map, Mindful Breathing, ImaginAction, EFT/Tapping, and a journal with prompts and coloring pencils included. The patients will also receive written instructions and watch an educational video outlining the contents of the tote and how to use each item.
Placebo Comparator: Modified Comfort Tote; Participants will be randomly assigned to receive the Modified Comfort Tote.	Other: The Modified Comfort Tote; The non-therapeutic Comfort Tote will contain the following items: journal, coloring book, coloring pencils/markers, stuffed animal, non-scented hand lotion, earplugs, sleep eye mask, and fidget spinner/pop-it. This Tote will come with written instructions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Outcome: Pain	Impact of each item used in the Comfort Tote on post-operative pain. This will be assessed through a Qualtrics survey across a scale ranging from did not help at all, helped a little, or helped a lot. The number of participants who responded to each of the three options will be reported. Every patient will be linked to a respective page to receive a Qualtrics survey, and this link will be texted/emailed to them.	From surgery date up to four weeks after surgery
Primary Outcome: Stress	Impact of each item used in the Comfort Tote on post-operative stress. This will be assessed through a Qualtrics survey across a scale ranging from did not help at all, helped a little, or helped a lot. The number of participants who responded to each of the three options will be reported. Every patient will be linked to a respective page to receive a Qualtrics survey, and this link will be texted/emailed to them.	From surgery date up to four weeks after surgery
Primary Outcome: Anxiety	Impact of each item used in the Comfort Tote on post-operative anxiety. This will be assessed through a Qualtrics survey across a scale ranging from did not help at all, helped a little, or helped a lot. The number of participants who responded to each of three options will be reported. Every patient will be linked to a respective page to receive a Qualtrics survey, and this link will be texted/emailed to them.	From surgery date up to four weeks after surgery
Primary Outcome: Patient Pain scores	General patient pain scores will be evaluated through measures in EPIC, including Numeric Rating Scale (NRS) pain scores (0-10, 0 being no pain, and 10 being the most severe pain experienced).	From surgery date up to four weeks after surgery
Primary Outcome: Caregiver's impression	Caregivers will also receive a Qualtrics survey to understand their experiences with the Comfort Tote, which will be texted/emailed to them. The scale will include a range of responses from did not help, to help a little, to help a lot. The number of participants who responded to each of the three options will be reported.	From surgery date up to four weeks after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Secondary Outcomes: Tote items usage	Secondary outcomes include tote item usage. Tote usage indicates results from patients recording which tote components they used, collected through a post-operative Qualtrics survey. The patients will register if they used the item even once - yes, no, or not sure.	From surgery date up to four weeks after surgery
Length of stay	Secondary outcomes include length of hospital stay (LOS) in days.	From surgery date until discharge date, assessed up to four weeks after surgery
ICU LOS	Secondary outcomes include Intensive Care Unit (ICU) LOS in days.	From surgery date until discharge date, assessed up to four weeks after surgery
Total direct cost	Secondary outcomes include total direct costs (TDC) in dollars.	From surgery date until discharge date, assessed up to four weeks after surgery
MME use during hospital admission	Secondary outcomes include morphine milligram equivalents (MME) administered during the hospital stay from the EPIC-recorded pain team's notes.	From surgery date until discharge date, assessed up to four weeks after surgery
Opioid prescriptions at discharge	Secondary outcomes include opioid prescriptions at discharge in total milligrams and milligrams per dose.	From discharge from hospital until up to four weeks after surgery
Surgical site infections	Secondary outcomes include surgical site infections.	From surgery date until up to four weeks after surgery
Readmissions	Secondary outcomes include readmissions, defined as hospital admissions within 30 days of discharge.	Assessed up to 4 weeks after surgery
Unanticipated return to clinic	Secondary outcomes include unanticipated return to clinic.	Assessed up to 4 weeks after surgery
Mobility Scores	Secondary outcomes include mobility scores via AM PAC mobility scores assigned by physical therapy. Includes six possible scores: 1-Rolling over in bed 2- Sitting up from lying down 3- Sitting down and standing up from a chair 4- Moving from sitting to standing (transfers)5- Walking 6- Climbing stairs	Assessed up to 4 weeks after surgery
Gabapentin use	Secondary outcomes include whether or not patients took Gabapentin.	From surgery date until up to four weeks after surgery
Postoperative opioid use at home	Secondary outcomes include postoperative opioid use via a calendar with instructions upon discharge to document opioid use at home.	From discharge until up to four weeks after surgery

Collaborators and Investigators

• Sponsor: Columbia University

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): September 15, 2027
• Study Completion (Estimated): June 30, 2028

Study Registration Dates

• First Submitted: June 2, 2026
• First Submitted That Met QC Criteria: June 2, 2026
• First Posted (Actual): June 8, 2026

Study Record Updates

• Last Update Posted (Actual): June 8, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Posterior spinal fusion; Integrative therapy
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Mental Disorders; Postoperative Complications; Pathologic Processes; Signs and Symptoms, Digestive; Vomiting; Nausea; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Anxiety Disorders; Postoperative Nausea and Vomiting
• Other Study ID Numbers: ACYY0676

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No