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

Authors

Chitra Lalloo, Hospital for Sick Children University of Toronto
Lauren R. Harris, Hospital for Sick Children University of Toronto
Amos S. Hundert, Hospital for Sick Children University of Toronto
Roberta Berard, London Health Sciences CentreFollow
Joseph Cafazzo, Institute of Health Policy, Management and Evaluation
Mark Connelly, Division of Developmental and Behavioural Health
Brian M. Feldman, Hospital for Sick Children University of Toronto
Kristin Houghton, BC​ Children​'​​s Hospital
Adam Huber, IWK Health Centre
Ronald M. Laxer, Hospital for Sick Children University of Toronto
Nadia Luca, Alberta Children's Hospital
Heinrike Schmeling, Alberta Children's Hospital
Lynn Spiegel, Hospital for Sick Children University of Toronto
Lori B. Tucker, BC​ Children​'​​s Hospital
Quynh Pham, Institute of Health Policy, Management and Evaluation
Cleo C. Davies-Chalmers, Hospital for Sick Children University of Toronto
Jennifer N. Stinson, Hospital for Sick Children University of Toronto

Document Type

Article

Publication Date

1-1-2021

Journal

Rheumatology (United Kingdom)

Volume

60

Issue

1

First Page

196

Last Page

206

URL with Digital Object Identifier

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.