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

Erik Grasaas, Sølvi Helseth, Liv Fegran, Jennifer Stinson, Milada Småstuen, Chitra Lalloo, Kristin Haraldstad, Erik Grasaas, Sølvi Helseth, Liv Fegran, Jennifer Stinson, Milada Småstuen, Chitra Lalloo, Kristin Haraldstad

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.

Keywords: Adolescent; Chronic pain; Mobile applications; Randomized controlled trial; Self-management.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram. *Completers answered all items in the postintervention questionnaire
Fig. 2
Fig. 2
Changes in symptoms since the beginning of the intervention

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