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

Abstract

Background: Persistent pain in adolescence adversely afects 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 diferences 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-efcacy, pain self-efcacy, 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 difer between the 2 groups. No diferences 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 signifcant diferences in outcomes between groups. However, the large efect 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 fullscale randomized controlled trial to improve participant retention.