Agil udvikling af en digital eksponeringsbehandling til unge med kroniske muskel- og skeletsmerter
23. juni 2026 opdateret af: Lauren Harrison, Stanford University
Dette projekt foreslår systematisk at udvikle og evaluere gennemførligheden og den foreløbige effektivitet af en digitalt leveret, graderet eksponeringsbehandling til unge med kroniske muskuloskeletale smerter ved at anvende et sekventielt replikeret og randomiseret enkelt-tilfælde eksperimentelt design (SCED). SCED giver mulighed for nøje at evaluere behandlingens effektivitet på individuelt niveau.
Udviklingen af iGET Living vil være baseret på en række korte iterationer med alfa-testning (Mål 1) på et lille udvalg af unge med kroniske smerter (N = 15) og deres forældre (N = 15). For mål 1 vil deltagerne deltage i tre, to timers fokusgrupper (en om ugen i løbet af tre uger), hvilket resulterer i 6 timers deltagelse i alt pr. deltager for mål 1.
Mål 2 vil involvere en stikprøve (N = 20 unge, N = 20 forældre) af naive slutbrugere. Deltagerne vil blive tilmeldt i en basisperiode, der spænder fra 7-25 dage (gjort for at understøtte SCED-metoden), hvorefter de vil blive tilmeldt online-interventionsprogrammet, der varer 6 uger. Patienter vil blive kontaktet 3 måneder efter udskrivelse fra behandling (uge 22 af indskrivningen) og vil gennemføre selvrapporterende resultatmål på dette tidspunkt.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
108
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
California
-
Menlo Park, California, Forenede Stater, 94025
- Pediatric Pain Management Clinic
-
-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
10 år til 17 år (Barn, Voksen)
Tager imod sunde frivillige
Ingen
Beskrivelse
Inklusionskriterier:
- Ungdom i alderen 10-17
- Har diagnosen kronisk muskuloskeletale smerte (>3 måneder)
- Har moderat til høj smerteinterferens (PROMIS Smerteinterferens ≥ 61)
- engelsk læsefærdige
- Har adgang til computer, smartphone eller tablet med internetforbindelse
Ekskluderingskriterier:
- Betydelig kognitiv svækkelse (f.eks. hjerneskade)
- Væsentlige medicinske eller psykiatriske problemer, der ville forstyrre behandlingen
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Graderet eksponeringsintervention
For mål 2 vil unge med kroniske smerter blive tilmeldt et enkelt-arms gennemførlighedsforsøg, der undersøger accept, gennemførlighed og foreløbig effektivitet af en ny, digitalt leveret, graderet eksponeringsbehandling.
|
Graderet eksponering er en teoridrevet, individuelt skræddersyet og dokumenteret adfærdsintervention for personer med kronisk smerte rettet mod smerterelateret svækkelse ved at udsætte patienter for tidligere frygtede og undgåede aktiviteter.
|
|
Ingen indgriben: User centered development
For Aim 1, participants engaged with the prototypes of the intervention and provided feedback.
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Assessment of Acceptability of Treatment Content - Likert Scale (Aim 1)
Tidsramme: One day
|
Participant-rated acceptability measured on 5-point Likert scale.
Range 0-4 (higher scores indicate more acceptable).
Questionnaire will be administered to youth with chronic pain and their parents.
|
One day
|
|
Participant Satisfaction With the Intervention (Aim 2)
Tidsramme: 10 weeks (assessed at discharge)
|
Treatment satisfaction at the end of treatment will be evaluated by examining mean satisfaction scores on an adapted version of the Pain Service Satisfaction Test (PSST, McCracken et al., 1997).
The PSST consists of 23 items rated on a 5-point Likert Scale (0 = not at all satisfied to 4 = very satisfied) and assesses the patient and parent's experience of the intervention.
Scores range from 0-92.
A score greater than/equal to 40 of 60 (satisfied to very satisfied) will indicate high levels of satisfaction with the intervention content.
Caregivers were not assessed for this Outcome Measure.
|
10 weeks (assessed at discharge)
|
|
Percentage of Participants Dropped Out of Intervention (Aim 2)
Tidsramme: 10 weeks (Completed at discharge)
|
As a measure of treatment adherence, we will calculate the percentage of participants who drop out or withdraw from the intervention prior to completion of the intervention.
|
10 weeks (Completed at discharge)
|
|
Expectations for Treatment (Aim 2)
Tidsramme: Assessed seven days after starting the intervention (7 days post-baseline)
|
To assess expectations for treatment effectiveness, participants completed the Credibility/Effectiveness Questionnaire (CEQ; Borkovec & Nau, 1972) after engaging with iGET Living for one week.
The CEQ consists of six items rated on a 0 (not at all) to 10 (very much) Likert scale and assesses expectations related to the effects of the intervention across two subscales: Credibility (e.g., "How confident would you be recommending iGET Living to a friend with the same problems?")
and Expectancy (e.g., "By the end of iGET Living, how much do you think your functioning will improve?").
Credibility is calculated by summing items 1-3 and Expectancy by summing items 4-6.
Possible range of scores for each subscale is 0-30, with higher scores reflecting greater perceived credibility and expectancy.
|
Assessed seven days after starting the intervention (7 days post-baseline)
|
|
Functional Disability (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Functional disability will be assessed using the Functional Disability Inventory (FDI, Walker & Greene, 1991), a 15-item self-report measure of perceived difficulty in performing activities in school, home, physical, and social contexts.
Items are rated on a 5-point Likert scale ranging from 0 (no trouble) to 4 (impossible).
Scores from all the Items are summed to create a total score (range 0-60), with higher scores indicating greater disability.
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Child Fear of Pain (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Fear of Pain Questionnaire, Child Report, Short Form (FOPQ-C-SF, Heathcote et al., 2020) is a 10-item self-report measure that assesses pain-related fear and avoidance of activities.
Items are rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree).
Scores from all the Items are summed to create a total score ranging from 0 - 40.
Higher scores indicate higher levels of pain-related fear and avoidance (worst outcome).
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Parental Fear of Pain (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
The Parent Fear of Pain Questionnaire (PFOPQ, Simons et al., 2015) assesses parent's fear associated with their child's pain experiences.
The PFOPQ contains 23 items assessed on a 5-point Likert scale (0 = "strongly disagree" to 4 "strongly agree").
Items are summed to create a total score (0-92), with higher scores indicated greater parent fear associated with their child's pain.
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Child Pain Catastrophizing (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
The Pain Catastrophizing Scale -Child Version (PCS-C, Crombez et al., 2003) assesses negative cognitions associated with pain.
The PCS-C is comprised of 13-items rated on a 5-point Likert scale (0= "not at all true" to 4 "very true").
A total score (0-52) is obtained by summing all items.
Higher scores indicate higher levels of catastrophic thinking.
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Parent Pain Catastrophizing (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Pain Catastrophizing Scale-Parent Version (PCS-P, Goubert et al., 2006) assesses parents' negative cognitions associated with their child's pain.
It is comprised of 13 items rated on a 5-point Likert scale (0 = "not true at all" to 4 = "very true").
A total score (0-52) is derived by summing items, with higher scores indicating higher levels of catastrophic thinking.
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Child Pain Acceptance (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Child report on the Chronic Pain Acceptance Questionnaire for Adolescents-short form (CPAQ-A8, Gauntlett-Gilbert et al., 2018) will be used to assess pain acceptance in the child.
The CPAQ-A8 is an 8-item measure consisting of two subscales: Activity Engagement (4 items) and Pain Willingness (4 items).
Items are rated on a 5-point Likert scale ranging from 0 (Never True) to 4 (Always True) and yield a total score for each subscale ranging from 0-16.
Higher scores indicate greater Activity Engagement and greater Pain Willingness (positive outcome) .
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Parent Psychological Flexibility (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
The Parent Psychological Flexibility Questionnaire (PPFQ-10, Timmers et al., 2019) is a 10-item parent self-report questionnaire assessing a parent's ability to accept their own distress and respond adaptively and flexibly to their child's pain.
Items are rated on a 5-point Likert scale (0= " never true" to 4 = "always true") and are summed to create a total score, ranging from 0 - 40.
Higher scores indicate greater parent psychological flexibility (positive outcome).
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
|
Parent Responses to Childs Pain (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Adult Responses to Children's Symptoms (ARCS, Claar et al., 2010) assesses parents' behavioral responses to children's pain behaviors.
The Protect subscale (13 items) will be utilized in this study.
The Protect scale refers to protective parental behavior, such as giving the child special attention and limiting the child's normal activities and responsibilities.
All items are rated on a 5-point Likert scale (0 = "never" to 4 "always"), and are averaged to create a total score ranging from 0-4.
Higher scores indicating greater use of protective behavioral responses to their child's pain (worst outcome).
|
Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Lauren E Harrison, PhD, Stanford University
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol. 1991 Feb;16(1):39-58. doi: 10.1093/jpepsy/16.1.39.
- Crombez G, Bijttebier P, Eccleston C, Mascagni T, Mertens G, Goubert L, Verstraeten K. The child version of the pain catastrophizing scale (PCS-C): a preliminary validation. Pain. 2003 Aug;104(3):639-646. doi: 10.1016/S0304-3959(03)00121-0.
- Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317-332. doi: 10.1016/S0304-3959(99)00242-0.
- Groenewald CB, Essner BS, Wright D, Fesinmeyer MD, Palermo TM. The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain. 2014 Sep;15(9):925-33. doi: 10.1016/j.jpain.2014.06.002. Epub 2014 Jun 19.
- Huguet A, Miro J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008 Mar;9(3):226-36. doi: 10.1016/j.jpain.2007.10.015. Epub 2007 Dec 21.
- King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011 Dec;152(12):2729-2738. doi: 10.1016/j.pain.2011.07.016.
- Goubert L, Eccleston C, Vervoort T, Jordan A, Crombez G. Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation. Pain. 2006 Aug;123(3):254-263. doi: 10.1016/j.pain.2006.02.035. Epub 2006 Apr 27.
- Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016 Aug;157(8):1588-1589. doi: 10.1097/j.pain.0000000000000574. No abstract available.
- Wilson K, Bell C, Wilson L, Witteman H. Agile research to complement agile development: a proposal for an mHealth research lifecycle. NPJ Digit Med. 2018 Sep 13;1:46. doi: 10.1038/s41746-018-0053-1. eCollection 2018.
- Murray CB, Groenewald CB, de la Vega R, Palermo TM. Long-term impact of adolescent chronic pain on young adult educational, vocational, and social outcomes. Pain. 2020 Feb;161(2):439-445. doi: 10.1097/j.pain.0000000000001732.
- Groenewald CB, Patel KV, Rabbitts JA, Palermo TM. Correlates and motivations of prescription opioid use among adolescents 12 to 17 years of age in the United States. Pain. 2020 Apr;161(4):742-748. doi: 10.1097/j.pain.0000000000001775.
- Peng P, Stinson JN, Choiniere M, Dion D, Intrater H, Lefort S, Lynch M, Ong M, Rashiq S, Tkachuk G, Veillette Y; STOPPAIN Investigators Group. Dedicated multidisciplinary pain management centres for children in Canada: the current status. Can J Anaesth. 2007 Dec;54(12):985-91. doi: 10.1007/BF03016632.
- Eccleston C, Blyth FM, Dear BF, Fisher EA, Keefe FJ, Lynch ME, Palermo TM, Reid MC, Williams ACC. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. Pain. 2020 May;161(5):889-893. doi: 10.1097/j.pain.0000000000001885. No abstract available.
- Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain. 2002 Jul-Aug;18(4):251-61. doi: 10.1097/00002508-200207000-00006.
- Simons LE, Harrison LE, O'Brien SF, Heirich MS, Loecher N, Boothroyd DB, Vlaeyen JWS, Wicksell RK, Schofield D, Hood KK, Orendurff M, Chan S, Lyons S. Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design. Contemp Clin Trials Commun. 2019 Sep 10;16:100448. doi: 10.1016/j.conctc.2019.100448. eCollection 2019 Dec.
- Simons LE, Sieberg CB, Carpino E, Logan D, Berde C. The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain. J Pain. 2011 Jun;12(6):677-86. doi: 10.1016/j.jpain.2010.12.008. Epub 2011 Feb 26.
- Simons LE, Smith A, Kaczynski K, Basch M. Living in fear of your child's pain: the Parent Fear of Pain Questionnaire. Pain. 2015 Apr;156(4):694-702. doi: 10.1097/j.pain.0000000000000100.
- Claar RL, Guite JW, Kaczynski KJ, Logan DE. Factor structure of the Adult Responses to Children's Symptoms: validation in children and adolescents with diverse chronic pain conditions. Clin J Pain. 2010 Jun;26(5):410-7. doi: 10.1097/AJP.0b013e3181cf5706.
- Timmers I, Simons LE, Hernandez JM, McCracken LM, Wallace DP. Parent psychological flexibility in the context of pediatric pain: Brief assessment and associations with parent behaviour and child functioning. Eur J Pain. 2019 Aug;23(7):1340-1350. doi: 10.1002/ejp.1403. Epub 2019 May 14.
- Gauntlett-Gilbert J, Alamire B, Duggan GB. Pain Acceptance in Adolescents: Development of a Short Form of the CPAQ-A. J Pediatr Psychol. 2019 May 1;44(4):453-462. doi: 10.1093/jpepsy/jsy090.
- Palermo T. Remote management of pediatric pain. Encyclopedia of Pain 2nd Edition New York: Springer 2013:3389-93
- Borkovec TD, & Nau, S. D. . Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychology 1972;3:257-60
- Simons LE, Vlaeyen JWS, Declercq L, Smith AM, Beebe J, Hogan M, Li E, Kronman CA, Mahmud F, Corey JR, Sieberg CB, Ploski C. Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design. Pain. 2020 Mar;161(3):520-531. doi: 10.1097/j.pain.0000000000001735.
- McCracken LM, Klock PA, Mingay DJ, Asbury JK, Sinclair DM. Assessment of satisfaction with treatment for chronic pain. J Pain Symptom Manage. 1997 Nov;14(5):292-9. doi: 10.1016/s0885-3924(97)00225-x.
- Harrison LE, Webster SN, Van Orden AR, Choate E, Jehl N, Stinson J, Wicksell RK, Bonnert M, Lalouni M, Darnall BD, Simons LE. Agile development of a digital exposure treatment for youth with chronic musculoskeletal pain: protocol of a user-centred design approach and examination of feasibility and preliminary efficacy. BMJ Open. 2022 Sep 15;12(9):e065997. doi: 10.1136/bmjopen-2022-065997.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Faktiske)
2. maj 2022
Primær færdiggørelse (Faktiske)
13. maj 2025
Studieafslutning (Faktiske)
1. oktober 2025
Datoer for studieregistrering
Først indsendt
4. oktober 2021
Først indsendt, der opfyldte QC-kriterier
4. oktober 2021
Først opslået (Faktiske)
15. oktober 2021
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
22. juli 2026
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
23. juni 2026
Sidst verificeret
1. juni 2026
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 53323
- 1K23AR079608-01 (U.S. NIH-bevilling/kontrakt)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
INGEN
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Ingen
Studerer et amerikansk FDA-reguleret enhedsprodukt
Ingen
produkt fremstillet i og eksporteret fra U.S.A.
Ingen
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .