title: Sleep Outcomes in Youth With Chronic Pain Participating in a Randomized Controlled Trial of Online Cognitive-Behavioral Therapy for Pain Management Trajectories of change during a randomized controlled trial of internet-delivered psychological treatment for adolescent chronic pain: how does change in pain and function relate? Implementation and preliminary effectiveness of a real‐time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Multi-modal distraction. Using technology to combat pain in young children with burn injuries. iPeer2Peer program: a pilot feasibility study in adolescents with chronic pain Interactive Health Communication Applications for people with chronic disease. Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial. Automated parent-training for preschooler immunization pain relief: a randomized controlled trial. An Internet-based Self-management Program with Telephone Support for Adolescents with Arthritis: A Pilot Randomized Controlled Trial Promising insights into the health related quality of life for children with severe obesity Online psychological treatment for pediatric recurrent pain: a randomized evaluation. The iPeer2Peer Program: a pilot randomized controlled trial in adolescents with Juvenile Idiopathic Arthritis Evaluating treatment participation in an internet-based behavioral intervention for pediatric chronic pain. Use of handheld wireless technology for a home-based sickle cell pain management protocol. Neonatal procedural pain can be assessed by computer software that has good sensitivity and specificity to detect facial movements A comparison between prospective Internet-based and paper diary recordings of headache among adolescents in the general population Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial Comparing patient and parent recall of 90-day and 30-day migraine disability using elements of the PedMIDAS and an Internet headache diary Electronic momentary assessment of weather changes as a trigger of headaches in children. A Prospective Randomized Controlled Trial of Nonpharmacological Pain Management During Intravenous Cannulation in a Pediatric Emergency Department Brief report: Web-based management of adolescent chronic pain: development and usability testing of an online family cognitive behavioral therapy program. Changes in Coping, Pain, and Activity After Cognitive-Behavioral Training: A Randomized Clinical Trial for Pediatric Sickle Cell Disease Using Smartphones Play and heal: randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns. A novel technology approach to pain management in children with burns: A prospective randomized controlled trial. Internet-Delivered Cognitive Behavior Therapy for Adolescents With Irritable Bowel Syndrome: A Randomized Controlled Trial Pain-QuILT: Assessing Clinical Feasibility of a Web-based Tool for the Visual Self-Report of Pain in an Interdisciplinary Pediatric Chronic Pain Clinic Pain buddy: A novel use of m-health in the management of children's cancer pain
abstract: Sleep disturbances are commonly reported in youth with chronic pain . We examined whether online cognitive-behavioral therapy ( CBT ) for pain management would impact youth 's sleep . Subjective sleep quality and actigraphic sleep were evaluated in 33 youth ( M = 14.8 years ; 70 % female ) with chronic pain participating in a larger r and omized controlled trial of online-CBT . The Internet treatment condition ( n = 17 ) received 8–10 weeks of online-CBT + st and ard care , and the wait-list control condition ( n = 16 ) continued with st and ard care . Although pain improved with online-CBT , no changes were observed in sleep outcomes . Shorter pretreatment sleep duration was associated with less improvement in posttreatment functioning . Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain Abstract Although pain and function improve at immediate posttreatment for youth receiving cognitive behavioral therapy for chronic pain , limited data are available to underst and changes that youth make during psychological treatment . We sought to characterize distinct trajectory patterns of change in pain and function to underst and the temporal association of these changes during internet-delivered cognitive behavioral therapy ( CBT ) . Weekly repeated assessment s of pain and function were conducted during 8 weeks of treatment among 135 adolescents , aged 11 to 17 years , with chronic pain who were r and omized to the cognitive behavioral intervention arm of an ongoing trial of internet-delivered CBT ( Web-based management of adolescent pain ; Web-MAP2 ) . Using r and om-effects growth mixture models , we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear and quadratic effects . Trajectories of change showed that some patients ' pain and functional disability were improving , others worsened or changed minimally . Paired t tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period . There was no support for improvements in either pain or function to precede changes in the other domain . Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles . This may lead to the development of intervention strategies that can both more effectively target children 's pain and function during treatment and lead to sustained changes after treatment BACKGROUND Pain in adolescents with cancer ( 12 - 18 years ) is common and negatively impacts health-related quality of life ( HRQL ) . The Pain Squad+ smartphone app , which provides adolescents with real-time pain self-management support , was developed to address this issue . This study evaluated the implementation of the app to inform a future r and omized controlled trial ( RCT ) and obtain treatment effect estimates for pain intensity , pain interference , HRQL , and self-efficacy . PROCEDURE A one-group baseline/post study design with 40 adolescents recruited from two pediatric tertiary care centers was used . Baseline question naires were completed and adolescents used the app at least twice daily for 28 days , receiving algorithm-informed self-management advice depending on their reported pain . A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care . Post study question naires were completed . Descriptive analyses , with exploratory inferential testing conducted on health outcome data , were used to address study aims . RESULTS Most ( 40/52 ; 77 % ) eligible adolescents participated . Two participants withdrew participation . Intervention fidelity was impacted by technical difficulties ( occurring for 15 % of participants ) and a prolonged time for nurse contact in the event of sustained pain . Adherence to pain reporting was 68.8 ± 38.1 % . Outcome measure completion rates were high and the intervention was acceptable to participants . Trends in improvements in pain intensity , pain interference , and HRQL were significant , with effect sizes of 0.23 - 0.67 . CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer . A multicenter RCT will be undertaken to examine app effectiveness Background Many promising technological innovations in health and social care are characterized by nonadoption or ab and onment by individuals or by failed attempts to scale up locally , spread distantly , or sustain the innovation long term at the organization or system level . Objective Our objective was to produce an evidence -based , theory-informed , and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program . Methods The study had 2 parallel components : ( 1 ) secondary research ( hermeneutic systematic review ) to identify key domains , and ( 2 ) empirical case studies of technology implementation to explore , test , and refine these domains . We studied 6 technology-supported programs — video outpatient consultations , global positioning system tracking for cognitive impairment , pendant alarm services , remote biomarker monitoring for heart failure , care organizing software , and integrated case management via data sharing — using longitudinal ethnography and action research for up to 3 years across more than 20 organizations . Data were collected at micro level ( individual technology users ) , meso level ( organizational processes and systems ) , and macro level ( national policy and wider context ) . Analysis and synthesis was aided by sociotechnically informed theories of individual , organizational , and system change . The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback . Results The literature review identified 28 previous technology implementation frameworks , of which 14 had taken a dynamic systems approach ( including 2 integrative review s of previous work ) . Our empirical data set consisted of over 400 hours of ethnographic observation , 165 semistructured interviews , and 200 documents . The final nonadoption , ab and onment , scale-up , spread , and sustainability ( NASSS ) framework included questions in 7 domains : the condition or illness , the technology , the value proposition , the adopter system ( comprising professional staff , patient , and lay caregivers ) , the organization(s ) , the wider ( institutional and societal ) context , and the interaction and mutual adaptation between all these domains over time . Our empirical case studies raised a variety of challenges across all 7 domains , each classified as simple ( straightforward , predictable , few components ) , complicated ( multiple interacting components or issues ) , or complex ( dynamic , unpredictable , not easily disaggregated into constituent components ) . Programs characterized by complicatedness proved difficult but not impossible to implement . Those characterized by complexity in multiple NASSS domains rarely , if ever , became mainstreamed . The framework showed promise when applied ( both prospect ively and retrospectively ) to other programs . Conclusions Subject to further empirical testing , NASSS could be applied across a range of technological innovations in health and social care . It has several potential uses : ( 1 ) to inform the design of a new technology ; ( 2 ) to identify technological solutions that ( perhaps despite policy or industry enthusiasm ) have a limited chance of achieving large-scale , sustained adoption ; ( 3 ) to plan the implementation , scale-up , or rollout of a technology program ; and ( 4 ) to explain and learn from program failures BACKGROUND The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocol s despite ongoing acknowledgement of its role . Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain , as exemplified by the development of multi-modal distraction ( MMD ) . This easy to use , h and held interactive device uses customized programs design ed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes . AIM ( 1 ) To investigate if either MMD procedural preparation ( MMD-PP ) or distraction ( MMD-D ) has a greater impact on child pain reduction compared to st and ard distraction ( SD ) or h and held video game distraction ( VG ) , ( 2 ) to underst and the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups , and lastly , ( 3 ) to assess the efficacy of distraction techniques over three dressing change procedures . METHODS A prospect i ve r and omised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic . Eighty participants were recruited and studied over their first three dressing changes .  Pain was assessed using vali date d child report , caregiver report , nursing observation and physiological measures . RESULTS MMD-D and MMD-PP were both shown to significantly relieve reported pain ( p < or=0.05 ) and reduce the time taken for dressings ( p < or=0.05 ) compared to SD and VG . The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes . CONCLUSIONS The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to st and ard practice s or h and held video games . This device has the potential to improve clinic efficiency with reductions in treatment lengths Abstract Adolescents with chronic pain are often socially isolated , having never met others with chronic pain , and often feel misunderstood by healthy peers . Adolescence is a sensitive period for developing one 's sense of self and autonomy , which often occurs in the context of peer relationships . This developmental process is disrupted in adolescents when their chronic pain interferes with their social interactions . Peer mentoring is proposed as a developmentally timely intervention . The aim of this study is to develop and test the feasibility , acceptability , and impact of the iPeer2Peer program . The iPeer2Peer program is a tailored peer mentorship program that provides modeling and reinforcement by peers ( trained young adults with chronic pain aged 18 - 25 years who have learned to successfully manage their pain ) . This program aim ed to enhance self-management of chronic pain in adolescents through 10 Skype video calls over the course of 8 weeks . A pilot r and omized controlled trial design using waitlist controls was used in an adolescent chronic pain sample . Twenty-eight adolescents aged 14.8 ± 1.6 years ( 93 % female ) completed the trial ( intervention : n = 12 ; control n = 16 ) . Three adolescents completed the intervention after completing their participation in the control arm . The iPeer2Peer program was feasible and acceptable , provided the adolescents were given more time to complete all 10 calls . When compared with controls , adolescents who completed the iPeer2Peer program had significant improvement in self-management skills and their coping efforts were more successful . The iPeer2Peer program is a promising peer mentoring intervention that complements st and ard care for adolescents with chronic pain BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition ABSTRACT Cognitive – behavioral therapy ( CBT ) interventions show promise for decreasing chronic pain in youth . However , the availability of CBT is limited by many factors including distance to major treatment centers and expense . This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet‐delivered family CBT intervention .  Participants included 48 children , aged 11–17 years , with chronic headache , abdominal , or musculoskeletal pain and associated functional disability , and their parents . Children were r and omly assigned to a wait‐list control group or an Internet treatment group . Primary treatment outcomes were pain intensity ratings ( 0–10 NRS ) and activity limitations on the Child Activity Limitations Interview , both completed via an online daily diary . In addition to their medical care , the Internet treatment group completed 8 weeks of online modules including relaxation training , cognitive strategies , parent operant techniques , communication strategies , and sleep and activity interventions . Youth r and omized to the wait‐list control group continued with the current medical care only . Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post‐treatment for the Internet treatment group and these effects were maintained at the three‐month follow‐up . Rate of clinical ly significant improvement in pain was also greater for the Internet treatment group than for the wait‐list control group . There were no significant group differences in parental protectiveness or child depressive symptoms post‐treatment . Internet treatment was rated as acceptable by all children and parents . Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain In children , the pain and anxiety associated with acute burn dressing changes can be severe , with drug treatment alone frequently proving to be inadequate . Virtual reality ( VR ) systems have been successfully trialled in limited numbers of adult and paediatric burn patients .  Augmented reality ( AR ) differs from VR in that it overlays virtual images onto the physical world , instead of creating a complete virtual world . This prospect i ve r and omised controlled trial investigated the use of AR as an adjunct to analgesia and sedation in children with acute burns . Forty-two children ( 30 male and 12 female ) , with an age range of 3 - 14 years ( median age 9 years ) and a total burn surface area ranging from 1 to 16 % were r and omised into a treatment ( AR ) arm and a control ( basic cognitive therapy ) arm after administration of analgesia and /or sedation .  Pain scores , pulse rates ( PR ) , respiratory rates ( RR ) and oxygen saturations ( SaO2 ) were recorded pre-procedurally , at 10 min intervals and post-procedurally . Parents were also asked to grade their child 's overall pain score for the dressing change . Mean pain scores were significantly lower ( p=0.0060 ) in the AR group compared to the control group , as were parental pain assessment scores ( p=0.015 ) . Respiratory and pulse rates showed significant changes over time within groups , however , these were not significantly different between the two study groups . Oxygen saturation did not differ significantly over time or between the two study groups . This trial shows that augmented reality is a useful adjunct to pharmacological analgesia OBJECTIVE To examine a computerized parent training program , " Bear Essentials , " to improve parents ' knowledge and coaching to help relieve preschoolers ' immunization distress . METHOD In a r and omized controlled trial , 90 parent-child dyads received  Bear Essentials parent training plus distraction , distraction only , or control . Outcomes were parent knowledge , parent and child behavior , and child pain . RESULTS Bear Essentials result ed in improved knowledge of the effects of parents ' reassurance , provision of information , and apologizing on children 's procedural distress . Trained parents also engaged in less reassurance and more distraction and encouragement of deep breathing . Children in Bear Essentials engaged in more distraction and deep breathing than children in other groups . There were no effects on measures of child distress or pain . CONCLUSIONS Results suggest that the interactive computer training program impacted parent knowledge , parent behavior , and child behavior as hypothesized , but modifications will be necessary to have more robust outcomes on child procedural distress Objective . To determine the feasibility of a 12-week Internet-based self-management program of disease-specific information , self-management strategies , and social support with telephone support for youth with juvenile idiopathic arthritis ( JIA ) and their parents , aim ed at reducing physical and emotional symptoms and improving health-related quality of life ( HRQOL ) . Methods . A nonblind pilot r and omized controlled trial ( NCT01011179 ) was conducted to test the feasibility of the “ Teens Taking Charge : Managing Arthritis Online ” Internet intervention  across 4 tertiary-level centers in Canada . Participants were 46 adolescents with JIA , ages 12 to 18 years , and 1 parent for each participant , who were r and omized to the control arm ( n = 24 ) or the Internet intervention ( n = 22 ) . Results . The 2 groups were comparable on demographic and disease-related variables and treatment expectation at baseline . Attrition rates were 18.1 % and 20.8 % , respectively , from experimental and control groups . Ninety-one percent of participants r and omized to the experimental group completed all 12 online modules and weekly phone calls with a coach in an average of 14.7 weeks ( SD 2.1 ) . The control group completed 90 % of weekly attention-control phone calls . The Internet treatment was rated as acceptable by all youth and their parents . In posttreatment the experimental group had significantly higher knowledge ( p < 0.001 , effect size 1.32 ) and lower average weekly pain intensity ( p = 0.03 , effect size 0.78 ) . There were no significant group differences in HRQOL , self-efficacy , adherence , and stress posttreatment . Conclusion . Findings support the feasibility ( acceptability , compliance , and user satisfaction ) and initial efficacy of Internet delivery of a self-management program for improving disease-specific knowledge and reducing pain in youth with JIA Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents . The Patient Reported Outcomes Measurement Information System ( PROMIS ) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents . The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity . Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index ( BMI ) greater than the 85th percentile in a design to establish known-group validity . The children completed the  depressive symptoms , anxiety , anger , peer relationships , pain interference , fatigue , upper extremity , and mobility PROMIS domains utilizing a computer interface . PROMIS domains and individual items were administered in r and om order and included a total of 95 items . Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile . Results 136 participants were recruited and had all necessary clinical data for analysis . Of the 136 participants , 5 % ended the survey early result ing in missing domain scores at the end of survey administration . In multivariate analysis , patients with BMI ≥ 99th percentile had worse scores for depressive symptoms , anger , fatigue , and mobility ( p < 0.05 ) . Parent-reported exercise was associated with better scores for depressive symptoms , anxiety , and fatigue ( p < 0.05 ) . Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting . In the 5 % with missing domain scores , the missing scores were consistently found in the domains administered last , suggesting the length of the assessment is important . The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity . We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life OBJECTIVE To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain . METHODS Forty-seven participants ( 9 - 16 years of age ) were r and omly assigned to either an Internet-based treatment or a st and ard medical care waitlist . Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail . At 1- and 3-month follow-ups , participants were assessed on the outcome variables of pain and quality of life . A 50 % reduction in diary pain scores was considered clinical ly significant . RESULTS Significant between-group differences were found : 71 and 72 % of the treatment group achieved clinical ly significant improvement at the 1- and 3-month follow-ups , respectively , whereas only 19 and 14 % of the control group achieved the criterion . No significant differences were found on the quality of life variable . CONCLUSIONS Distance methods have considerable potential for making effective treatments more accessible with lower associated costs Background Adolescents with Juvenile Idiopathic Arthritis ( JIA ) are at risk for physical , emotional , social and role challenges that negatively impact quality of life .  Peer mentoring has been shown to improve positive health behaviours in adolescents with chronic disease while simultaneously providing social support . The objectives of this paper are to examine the feasibility and acceptability of an online peer mentoring program ( iPeer2Peer Program ) for adolescents with JIA . Methods The iPeer2Peer program was examined using a waitlist pilot r and omized control trial ( RCT ) . Participants were r and omly allocated to the intervention or wait-list control group via a secure , web-based r and omization service . Health care providers and investigators were blinded to participant group allocation . Trained peer mentors ( 16–25 years ; successfully managing their JIA ) were matched to participants ( 12–18 years ; diagnosed with JIA ) r and omized to the intervention group to provide peer support and education for effective self-management of JIA . Participant-mentor pairings connected ten times over 8 weeks using Skype video calls . Primary outcomes focused on implementation ( i.e. measures of feasibility and acceptability ) . Secondary outcomes focused on effectiveness ( i.e. measures of self-management , self-efficacy , pain , social support and quality of life ) . Results Thirty adolescents ( mean age 14.3 ± 1.7 years , 97 % female ) completed the RCT ( intervention n = 16 , control n = 14 ) . Primary outcomes : One third ( 32 % ) of adolescents approached agreed to participate , completed baseline measures and were r and omized . Half of pairings completed ten calls within 8 weeks . Average call length was twice the required amount with call lengths of 44.72 ± 15.76 min . Participants reported satisfaction with the program and all reported that they would recommend it to their peers . Participants ’ mean engagement level with the program was 8.53/10 ( range = 7–10 ) . Secondary outcomes : Participants who completed the iPeer2Peer Program demonstrated improvements in their perceived ability to manage JIA ( p < 0.04 ) , compared to controls . No adverse events were reported . Conclusion The iPeer2Peer Program is a promising intervention that improves acceptability of self-management and peer support treatments for adolescents with JIA . By using the Internet to connect mentors to adolescents with JIA it may also improve accessibility to these re sources . Findings will be used to adapt the program and refine the methodology for a full-scale RCT .Trial registration Clinical Trials.gov Identifier : NCT01986400 . Registered November 11 , 2013 OBJECTIVE Little is known about how participation in internet-based behavioral interventions influences outcomes in youth with health conditions . This study describes participation in an online behavioral pain management intervention for families of adolescents with chronic pain . METHODS 26 adolescent-parent dyads were r and omized to the intervention arm of a controlled trial evaluating a cognitive-behavioral pain intervention . Participation was measured by the number of logins , messages , completion of interactive fields , and behavioral assignments . Associations between content of messages from participants and treatment outcomes were evaluated . RESULTS Most participants ( 92.3 % ) logged in and completed assignments . Over half of participants initiated messages to the online coach . A greater number of messages sent by adolescents containing rapport or treatment content predicted positive treatment outcomes . CONCLUSIONS Most families actively participated in the intervention . Interaction with an online coach may increase the benefit of this Internet behavioral pain management treatment program for adolescents PURPOSE To evaluate use of a h and held electronic wireless device to implement a pain management protocol for participants with sickle cell disease ( SCD ) . METHODS Participants were 19 patients with SCD aged 9 - 20 who experienced vaso-occlusive pain . A single-session training on the use of cognitive-behavioral coping skills was followed by instruction on how to practice these skills and monitor daily pain experience using the device .  Daily pain experience and practice of coping skills were collected for the 8-week intervention period using wireless technology . RESULTS High rates of participation , daily diary completion and consumer satisfaction support the use of h and held wireless devices to implement this protocol . A comparison of the rates of self and device-recorded skills practice provides important information about the use of electronic monitoring for behavioral interventions . CONCLUSION Wireless data transfer technology has significant potential to become a practical method to improve symptom monitoring and communication between patients and providers The difficulty in assessing  pain during the neonatal period is one of the main obstacles for appropriate analgesia in intensive care units . The aim of this study was to develop and vali date computer software to monitor  neonatal facial movements of pain in real time Aim The aim of this article was to develop and apply an Internet-based headache diary ( i-diary ) for adolescents and compare it with a paper-diary ( p-diary ) regarding adherence , user acceptability and recorded headache activity . Methods In a cross-sectional school-based study , a representative sample of 488 adolescents aged 12–18 years were r and omly allocated by cluster sampling to record for three weeks in i-diaries or p-diaries their headache intensity , disability , and use of acute medication . Results A significantly ( p = 0.008 ) higher proportion of adolescents in the i-diary group used the diary  at least once during the 21-day period ( 86 % vs 76 % for the p-diary ) . However , the p-diary group completed a significantly ( p < 0.001 ) higher number of diary days ( 20.8 vs 15.0 days for the i-diary ) . The response rate for the i-diary-group was largely evenly distributed over the study period ; conversely , approximately two-thirds of the adolescents using the p-diary responded on all 21 days , whereas one-fourth did not respond at all . The two diary types were rated as equal in easiness to remember ( p = 0.25 ) , but the i-diaries were more bothersome to use ( p = 0.029 ) . Conclusion Although p-diary users completed a higher proportion of diary days , i-diaries provided more reliable and credible estimates of headache parameters because of better real-time assessment Abstract Internet-delivered interventions are emerging as a strategy to address barriers to care for individuals with chronic pain . This is the first large multicenter r and omized controlled trial of Internet-delivered cognitive-behavioral therapy ( CBT ) for pediatric chronic pain . Participants included were 273 adolescents ( 205 females and 68 males ) , aged 11 to 17 years with mixed chronic pain conditions and their parents , who were r and omly assigned in a parallel-group design to Internet-delivered CBT ( n = 138 ) or Internet-delivered Education ( n = 135 ) . Assessment s were completed before treatment , immediately after treatment , and at 6-month follow-up . All data collection and procedures took place online . The primary analysis used linear growth models . Results demonstrated significantly greater reduction on the primary outcome of activity limitations from baseline to 6-month follow-up for Internet CBT compared with Internet education ( b = −1.13 , P = 0.03 ) . On secondary outcomes , significant beneficial effects of Internet CBT were found on sleep quality ( b = 0.14 , P = 0.04 ) , on reducing parent miscarried helping ( b = −2.66 , P = 0.007 ) and protective behaviors ( b = −0.19 , P = 0.001 ) , and on treatment satisfaction ( P values < 0.05 ) . On exploratory outcomes , benefits of Internet CBT were found for parent-perceived impact ( ie , reductions in depression , anxiety , self-blame about their adolescent 's pain , and improvement in parent behavioral responses to pain ) . In conclusion , our Internet-delivered CBT intervention produced a number of beneficial effects on adolescent and parent outcomes , and could ultimately lead to wide dissemination of evidence -based psychological pain treatment for youth and their families Aim The aim of this article is to compare 90-day and 30-day recall of Pediatric Migraine Disability Assessment ( PedMIDAS ) elements and headache frequency against daily entries from an Internet headache diary among pediatric patients and their parents . Methods In a prospect i ve cohort study , patients aged 10–18 years with episodic migraine or probable migraine completed a 90-day Internet-based headache diary that incorporated PedMIDAS questions . Following the 90-day diary period , patients and parents completed modified PedMIDAS instruments to assess 90-day and 30-day recall . Intraclass correlation coefficients ( ICC ) were calculated to measure recall reliability . The Kruskal-Wallis and Jonckheere-Terpstra tests were used to explore recall accuracy as it relates to each participant ’s self-reported confidence in recall and to patient age . Results Fifty-two subjects completed 90 consecutive diary entries . Comparing 30-day to 90-day recall of PedMIDAS elements , ICC scores improved by 26.2 % ( patients ) and 17.5 % ( parents ) . Patients had better recall than their parents for all study measures . Self-reported confidence in recall and patient age had limited and inconsistent effects on recall accuracy . Conclusion The optimal recall interval to assess migraine disability must balance recall accuracy with generalizability across a range of headache frequencies . When compared to daily diary entries , recall accuracy of PedMIDAS elements and headache frequency improves at 30 days compared to 90 days . Parent report of migraine disability should not be used as a replacement for patient report BACKGROUND Variables that are thought to precipitate migraine or tension-type headache episodes in children hitherto have only been studied using retrospective reports . As such , there is little empirical evidence to support the actual predictive association between presumed headache triggers and actual headache occurrence in children . OBJECTIVE The present study sought to determine if fluctuations in weather , a commonly reported headache trigger in children , predict increased likelihood of headache occurrence when evaluated using rigorous prospect i ve methodology ( " electronic momentary assessment ") . METHODS Twenty-five children ( 21 girls , 4 boys ) between the ages of 8 - 17 years attending a new patient neurology clinic appointment and having a diagnosis of chronic migraine , chronic tension-type , or episodic migraine headache ( with or without aura ) participated in the study . Children completed baseline measures on headache characteristics , presumed headache triggers , and mood and subsequently were trained in the use of electronic diaries to record information on headaches . Children then completed thrice daily diaries on h and held computers for a 2-week time period ( 42 assessment s per child ) while data on weather variables ( temperature , dew point temperature , barometric pressure , humidity , precipitation , and sunlight )  in the child 's geographic location were recorded each time a diary was completed . Data were analyzed using multilevel models . RESULTS Of the weather variables , relative humidity and presence of precipitation were significantly predictive of new headache onset , with nearly a 3-fold increase in probability of headache occurrence during times of precipitation or elevated humidity in the child 's area , b = 0.38 , t(821 ) = 2.10 , P = .04 , and b = 0.02 , t(821 ) = 2.81 , P = .01 , respectively . These associations remained after accounting for fluctuations in mood , and associations were not significantly stronger in children who at baseline thought that weather was a headache trigger for them . Changes in temperature , dew point temperature , barometric pressure , and sunlight were not significantly predictive of new headache episode occurrence in this sample . CONCLUSIONS Results of the present study lend some support to the belief commonly held by children with recurrent headaches that weather changes may contribute to headache onset . Although electronic momentary assessment methodology was found to be feasible in this population and to have the potential to identify specific headache triggers for children , it remains to be determined how best ( or even whether ) to incorporate this information into treatment recommendations Objectives  Intravenous ( IV ) cannulation  is commonly performed in pediatric emergency departments ( EDs ) . The busy ED environment is often not conducive to conventional nonpharmacological pain management . This study assessed the use of Ditto ( Diversionary Therapy Technologies , Brisbane , Australia ) , a h and held electronic device which provides procedural preparation and distraction , as a means of managing pain and distress during IV cannulation performed in the pediatric ED . Methods A r and omized controlled trial with 98 participants , aged 3 to 12 years , was conducted in a pediatric ED . Participants were recruited and r and omized into 5 intervention groups as follows : ( 1 ) St and ard Distraction , ( 2 ) PlayStation Portable Distraction , ( 3 ) Ditto Distraction , ( 4 ) Ditto Procedural Preparation , and ( 5 ) Ditto Preparation and Distraction .  Children 's pain and distress levels were assessed via self-reports and observational reports by caregivers and nursing staff across the following 3 time points : ( 1 ) before , ( 2 ) during , and ( 3 ) after IV cannulation . Results Caregivers and nursing staff reported significantly reduced pain and distress levels in children accessing the combined preparation and distraction Ditto protocol , as compared to st and ard distraction ( P ⩽ 0.01 ) . This intervention also saw the greatest reduction in pain and distress as reported by the child . Conclusions Caregiver reports indicate that using the combined Ditto protocol was most effective in reducing children 's pain experiences while undergoing IV cannulation in the ED . The use of Ditto offers a promising opportunity to negotiate barriers to the provision of nonpharmacological approaches encountered in the busy ED environment , and provide nonpharmacological pain-management interventions in pediatric EDs OBJECTIVES This study evaluates the usability and feasibility of a Web-based intervention ( Web-MAP ) to deliver cognitive behavioral therapy ( CBT ) to adolescents with chronic pain and their parents . METHODS The Web site was evaluated in two stages . In stage one , recovered adolescents and parents ( n = 5 dyads ) , who had completed office-based CBT through a pediatric pain management clinic , completed ratings of Web site content , usability , appearance , and theme . In stage two , treatment-seeking adolescents and their parents ( n = 6 dyads ) completed the full-length Web program . Program usage data were obtained to assess interaction with the Web site . RESULTS Participants rated moderate to strong acceptability of the program . Usage data indicated that participants interacted with the site and used communication features . CONCLUSIONS Feedback from usability testing provided important information in the process of design ing a feasible Web-based treatment for adolescents with chronic pain for use in a r and omized controlled trial Objectives : We examined the outcomes of a cognitive-behavioral therapy ( CBT ) intervention for pain in pediatric sickle cell disease ( SCD ) using smartphones as a novel delivery method . Material s and Methods : Forty-six children with SCD received CBT coping skills training using a r and omized , waitlist control design . The intervention involved a single session of CBT training and home-based practice using smartphones for 8 weeks . Pre-post question naires between the r and omized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Question naire . Daily diaries completed by the full sample during the treatment period were used to assess whether CBT skill use was related to reductions in next-day pain intensity and increases in same-day functional activity . Results : The pre-post group comparison suggested that the youth increased active psychological coping attempts with the intervention . Daily diary data indicated that when children used CBT skills on days with higher pain , there were reductions in next-day pain intensity . There was no such association between skill use and functional activity . Discussion : CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD ; however , additions to the study protocol s are recommended in future studies . Advantages and caveats of using smartphones are also discussed BACKGROUND The relationships between pain , stress and anxiety , and their effect on burn wound re-epithelialization have not been well explored to- date . The aim of this study was to investigate the effect of the Ditto ™ ( a h and -held electronic medical device providing procedural preparation and distraction ) intervention on re-epithelialization rates in acute pediatric burns . METHODS / DESIGN From August 2011 to August 2012 , children ( 4 - 12 years ) with an acute burn presenting to the Royal Children 's Hospital , Brisbane , Australia fulfilled the study requirements and were r and omized to [ 1 ] Ditto ™ intervention or [ 2 ] st and ard practice .  Burn re-epithelialization , pain intensity , anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization . RESULTS One hundred and seventeen children were r and omized and 75 children were analyzed ( n=40 st and ard group ; n=35 Ditto ™ group ) . Inability to predict wound management result ed in 42 participants no longer meeting the eligibility criteria . Wounds in the Ditto ™ intervention group re-epithelialized faster than the st and ard practice group ( -2.14 days ( CI : -4.38 to 0.10 ) , p-value=0.061 ) , and significantly faster when analyses were adjusted for mean burn depth ( -2.26 days ( CI : -4.48 to -0.04 ) , p-value=0.046 ) . Following procedural preparation at the first change of dressing , the Ditto ™ group reported lower pain intensity scores ( -0.64 ( CI : -1.28 , 0.01 ) p=0.052 ) and lower anxiety ratings ( -1.79 ( CI : -3.59 , 0.01 ) p=0.051 ) . At the second and third dressing removals average pain ( FPS-R and FLACC ) and anxiety scores ( VAS-A ) were at least one point lower when Ditto ™ intervention was received . CONCLUSIONS The Ditto ™ procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures BACKGROUND Non-pharmacological approaches to supporting young children through painful medical procedures are an essential component of burn pain management protocol s. New technology developed from collaborations between healthcare professionals and IT teams can enhance the preparation and distraction approaches used with children . This study follows on from previous studies using such technology , and aim to determine whether levels of pain and distress using a combined preparation and distraction content can be further reduced , and offer more efficient clinical outcomes . METHODS Forty children ( 3 - 10 years ) undergoing acute burn care procedures were r and omized to two groups : ( 1 ) St and ard Distraction ( SD ) Group and ( 2 ) Multi Modal Distraction ( MMD ) Group ( combined protocol of procedural preparation and distraction ) . Pain intensity and child distress were measured prior to and during the procedure . Clinical utility end points were also included ; length of treatment , days to healing and adverse pain events . RESULTS A combined MMD protocol significantly reduced pain intensity ( p<0.001 ) and distress scores ( p<0.001 ) when compared to SD . Length of treatment ( p<0.05 ) , days to healing and the number of pain adverse events were also reduced ( p<0.05 ) with the use of the MMD protocol . CONCLUSIONS A combined MMD protocol reduces the pain experiences for young children during burn care procedures . When compared with a previous MMD trial , outcomes reiterated the use of procedural preparation as an essential component of non-pharmacological approaches . In addition to minimizing pain and distress , this innovative technology reduced treatment length and pain adverse events , and may have an impact on reducing days to healing , providing evidence of clinical efficacy and utility Objectives : Few treatments have been able to effectively manage pediatric irritable bowel syndrome ( IBS ) . Internet-delivered cognitive behavior therapy ( Internet-CBT ) based on exposure for abdominal symptoms is effective for adult IBS . The objective of this study was to evaluate the efficacy of Internet-CBT based on behavioral exposure for adolescents with IBS . Methods : Adolescents with IBS fulfilling the Rome III criteria were r and omized to either  Internet-CBT  or a wait-list control . The Internet-CBT was a 10-week intervention where the main component was exposure to IBS symptoms by reduction of avoidance of abdominal symptoms and instead stepwise provocation of symptoms . The primary outcome was total score on Gastrointestinal Symptoms Rating Scale for IBS ( GSRS-IBS ) . Secondary outcomes included adolescent- and parent-rated quality of life and parent-rated gastrointestinal symptoms . Difference between groups was assessed from pretreatment to posttreatment and the Internet-CBT group was also evaluated at 6 months after treatment completion . Results : A total of 101 adolescents with IBS ( 13–17 years of age ) were included in this study . Dropout rates were low ( 6 % ) and all r and omized patients were included in intent-to-treat analyses based on mixed effects models . Analyses showed a significant larger pretreatment to posttreatment change on the primary outcome GSRS-IBS ( B=−6.42 , P=0.006 , effect size Cohen ’s d=0.45 , 95 % confidence interval ( 0.12 , 0.77 ) ) and on almost all secondary outcomes for the Internet-CBT group compared with the control group . After 6 months , the results were stable or significantly improved . Conclusions : Internet-CBT based on exposure exercises for adolescents with IBS can effectively improve gastrointestinal symptoms and quality of life Objectives : To evaluate clinical feasibility of the Pain-QuILT ( previously known as the Iconic Pain Assessment Tool ) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team . The Pain-QuILT ( PQ ) , a web-based tool that records the visual self-report of sensory pain in the form of time-stamped records , was directly compared with st and ard interview questions that were transformed to a paper-based tool . Methods : Qualitative , semi-structured interviews were used to refine the PQ . Adolescents with chronic pain aged 12 to 18 years used the PQ and comparator tool ( r and omized order ) to self-report pain before a scheduled clinic appointment , and then took part in a semi-structured interview . The health team used these pain reports ( PQ and comparator ) during patient appointments , and later participated in focus group interviews . Interview audio recordings were transcribed verbatim and underwent a simple line-by-line content analysis to identify key concepts . Results : A total of 17 adolescents and 9 health team members completed the study . All adolescents felt that the PQ was easy to use and underst and . The median time required for completion of the PQ and comparator tool was 3.3 and 3.6 minutes , respectively . Overall , 15/17 ( 88 % ) of adolescents preferred the PQ to self-report their pain versus the comparator . The health team indicated that the PQ was a clinical ly useful tool and identified minor barriers to implementation . Discussion : Consultations with adolescents and their health team indicate that the PQ is a clinical ly feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain BACKGROUND Over 12,000 children are diagnosed with cancer every year in the United States . In addition to symptoms associated with their disease , children undergoing chemotherapy  frequently experience significant pain , which is unfortunately often undertreated . The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting . The current study describes the development and initial evaluation of a tablet-based program , Pain Buddy , aim ed to enhance pain management and foster improved quality of life in children ages 8 - 18 years undergoing cancer treatment . METHODS An animated avatar-based tablet application was developed using state-of-the-art software . Key aspects of Pain Buddy include daily pain and symptom diaries completed by children , remote monitoring of symptoms by uploading patient 's data through internet to a cloud server , cognitive and behavioral skills training , interactive three-dimensional avatars that guide children through the program , and an incentive system to motivate engagement . Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy . RESULTS Children were highly satisfied with the program . Pain and appetite disturbances were most frequently endorsed . Symptom trigger alerts to outside providers were largely related to clinical ly significant pain . Children infrequently used analgesics , and reported using some non-pharmacological pain management strategies . CONCLUSION Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment . Results from the current study will inform future improvements to Pain Buddy , in preparation for a r and omized controlled trial to assess the efficacy of this innovative treatment
target: Conclusion : Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste .
background: Abstract Introduction : Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties , efficacy , and effectiveness .
  Although considerable re sources are spent on developing and evaluating these tools with the aim of increasing access to care , current evidence suggests they are not made available to end users , reducing their impact and creating potential research waste .