The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial

Chitra Lalloo; Lauren R Harris; Amos S Hundert; Roberta Berard; Joseph Cafazzo; Mark Connelly; Brian M Feldman; Kristin Houghton; Adam Huber; Ronald M Laxer; Nadia Luca; Heinrike Schmeling; Lynn Spiegel; Lori B Tucker; Quynh Pham; Cleo C Davies-Chalmers; Jennifer N Stinson

doi:10.1093/rheumatology/keaa178

The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial

Rheumatology (Oxford). 2021 Jan 5;60(1):196-206. doi: 10.1093/rheumatology/keaa178.

Authors

Chitra Lalloo^{1

2}, Lauren R Harris¹, Amos S Hundert¹, Roberta Berard³, Joseph Cafazzo^{2

4}, Mark Connelly⁵, Brian M Feldman⁶, Kristin Houghton⁷, Adam Huber⁸, Ronald M Laxer⁶, Nadia Luca⁹, Heinrike Schmeling⁹, Lynn Spiegel⁶, Lori B Tucker⁷, Quynh Pham^{2

4}, Cleo C Davies-Chalmers¹, Jennifer N Stinson^{1

2

10}

Affiliations

¹ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.
² Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.
³ Division of Rheumatology, Children's Hospital London Health Sciences Centre, London, Ontario.
⁴ Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada.
⁵ Division of Developmental and Behavioural Health, Children's Mercy Kansas City, Kansas City, MO, USA.
⁶ Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario.
⁷ Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia.
⁸ Division of Rheumatology, IWK Health Centre, Halifax, Nova Scotia.
⁹ Section of Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta.
¹⁰ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.

PMID: 32613229
DOI: 10.1093/rheumatology/keaa178

Abstract

Objectives: To evaluate the feasibility and preliminary effectiveness of iCanCope with Pain (iCanCope), a smartphone-based pain self-management program, in adolescents with JIA. iCanCope featured symptom tracking, goal-setting, pain coping skills and social support.

Methods: A two-arm pilot randomized controlled trial was used to evaluate the iCanCope app compared with a version with symptom tracking only. Primary (feasibility) outcomes were: participant accrual/attrition rates, success of app deployment, acceptability and adherence. Secondary (preliminary effectiveness) outcomes were: pain intensity, pain-related activity limitations and health-related quality of life. Outcomes were assessed at baseline and 8 weeks. Adherence was defined as the proportion of completed symptom reports: 'low' (≤24%); 'low-moderate' (25-49%); 'high-moderate' (50-75%); or 'high' (76-100%). Linear mixed models were applied for preliminary effectiveness analyses as per intention-to-treat.

Results: Adolescents (N = 60) were recruited from three paediatric rheumatology centres. Rates of accrual and attrition were 82 and 13%, respectively. Both apps were deployed with high success (over 85%) and were rated as highly acceptable. Adherence was similar for both groups, with most participants demonstrating moderate-to-high adherence. Both groups exhibited a clinically meaningful reduction in pain intensity (≥1 point) that did not statistically differ between groups. There were no significant changes in activity limitations or health-related quality of life.

Conclusion: The iCanCope pilot randomized controlled trial was feasible to implement in a paediatric rheumatology setting. Both apps were deployed successfully, with high acceptability, and were associated with moderate-to-high adherence. Preliminary reductions in pain intensity warrant a future trial to evaluate effectiveness of iCanCope in improving health outcomes in adolescents with JIA.

Trial registration: ClinicalTrials.gov identifier: NCT02764346.

Keywords: juvenile idiopathic arthritis; pain; pilot randomized controlled trial; self-management; smartphone.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological*
Adolescent
Arthritis, Juvenile / therapy*
Feasibility Studies
Female
Humans
Male
Mobile Applications / statistics & numerical data*
Pain Management / methods*
Pain Measurement
Patient Compliance / statistics & numerical data
Patient Dropouts / statistics & numerical data
Pilot Projects
Quality of Life
Self-Management / methods*
Social Support
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02764346