Smidig utvikling av en digital eksponeringsbehandling for ungdom med kroniske muskel- og skjelettsmerter
23. juni 2026 oppdatert av: Lauren Harrison, Stanford University
Dette prosjektet foreslår å systematisk utvikle og evaluere gjennomførbarheten og den foreløpige effektiviteten av en digitalt levert, gradert eksponeringsbehandling for ungdom med kroniske muskel-skjelettsmerter, ved å bruke et sekvensielt replikert og randomisert enkelttilfelle eksperimentelt design (SCED). SCED gir muligheten til å grundig evaluere behandlingseffektiviteten på individnivå.
Utviklingen av iGET Living vil være basert på en rekke korte iterasjoner, med alfatesting (Mål 1) på et lite utvalg av ungdommer med kroniske smerter (N = 15) og deres foreldre (N = 15). For mål 1 vil deltakerne delta i tre, to timers fokusgrupper (en per uke i løpet av tre uker), noe som resulterer i totalt 6 timer med deltakelse per deltaker for mål 1.
Mål 2 vil involvere et utvalg (N = 20 ungdommer, N = 20 foreldre) av naive sluttbrukere. Deltakerne vil bli registrert i en baseline-periode som varierer fra 7-25 dager (gjort for å støtte SCED-metodikk), hvoretter de vil bli registrert i det elektroniske intervensjonsprogrammet, som varer i 6 uker. Pasienter vil bli kontaktet 3 måneder etter utskrivning fra behandling (uke 22 av innskrivning) og vil fullføre egenrapportering av utfallsmål på dette tidspunktet.
Studieoversikt
Status
Fullført
Intervensjon / Behandling
Studietype
Intervensjonell
Registrering (Faktiske)
108
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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California
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Menlo Park, California, Forente stater, 94025
- Pediatric Pain Management Clinic
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Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
10 år til 17 år (Barn, Voksen)
Tar imot friske frivillige
Nei
Beskrivelse
Inklusjonskriterier:
- Ungdom i alderen 10-17
- Har diagnosen kronisk muskel- og skjelettsmerter (>3 måneder)
- Har moderat til høy smerteinterferens (PROMIS Pain Interference ≥ 61)
- engelskkunnskaper
- Ha tilgang til datamaskin, smarttelefon eller nettbrett med internettforbindelse
Ekskluderingskriterier:
- Betydelig kognitiv svikt (f.eks. hjerneskade)
- Betydelige medisinske eller psykiatriske problemer som kan forstyrre behandlingen
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Gradert eksponeringsintervensjon
For mål 2 vil ungdom med kroniske smerter bli registrert i en enarms mulighetsstudie som undersøker aksept, gjennomførbarhet og foreløpig effektivitet av en ny, digitalt levert, gradert eksponeringsbehandling.
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Gradert eksponering er en teoridrevet, individuelt skreddersydd og bevisbasert atferdsintervensjon for personer med kronisk smerte rettet mot smerterelatert svekkelse ved å utsette pasienter for tidligere fryktede og unngåtte aktiviteter.
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Ingen inngripen: User centered development
For Aim 1, participants engaged with the prototypes of the intervention and provided feedback.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Assessment of Acceptability of Treatment Content - Likert Scale (Aim 1)
Tidsramme: One day
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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.
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One day
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Participant Satisfaction With the Intervention (Aim 2)
Tidsramme: 10 weeks (assessed at discharge)
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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.
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10 weeks (assessed at discharge)
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Percentage of Participants Dropped Out of Intervention (Aim 2)
Tidsramme: 10 weeks (Completed at discharge)
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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.
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10 weeks (Completed at discharge)
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Expectations for Treatment (Aim 2)
Tidsramme: Assessed seven days after starting the intervention (7 days post-baseline)
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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.
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Assessed seven days after starting the intervention (7 days post-baseline)
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Functional Disability (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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.
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Child Fear of Pain (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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).
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Parental Fear of Pain (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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.
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Child Pain Catastrophizing (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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.
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Parent Pain Catastrophizing (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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.
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Child Pain Acceptance (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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) .
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Parent Psychological Flexibility (Aim 2)
Tidsramme: Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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).
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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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)
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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).
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Baseline (Day 7), Discharge (10 weeks post-baseline), and 3-month follow-up (12 weeks post-discharge)
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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Lauren E Harrison, PhD, Stanford University
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- 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.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Faktiske)
2. mai 2022
Primær fullføring (Faktiske)
13. mai 2025
Studiet fullført (Faktiske)
1. oktober 2025
Datoer for studieregistrering
Først innsendt
4. oktober 2021
Først innsendt som oppfylte QC-kriteriene
4. oktober 2021
Først lagt ut (Faktiske)
15. oktober 2021
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
22. juli 2026
Siste oppdatering sendt inn som oppfylte QC-kriteriene
23. juni 2026
Sist bekreftet
1. juni 2026
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 53323
- 1K23AR079608-01 (U.S. NIH-stipend/kontrakt)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
NEI
Legemiddel- og utstyrsinformasjon, studiedokumenter
Studerer et amerikansk FDA-regulert medikamentprodukt
Nei
Studerer et amerikansk FDA-regulert enhetsprodukt
Nei
produkt produsert i og eksportert fra USA
Nei
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