medwireNews: A smartphone-based pain self-management program – iCanCope with Pain (iCanCope) – warrants further investigation in adolescents with juvenile idiopathic arthritis (JIA) following a successful pilot trial, researchers report.
Users of the app experienced clinically meaningful reductions in pain intensity following 8 weeks of use and rated it as having a high degree of acceptability, according to Chitra Lalloo (The Hospital for Sick Children, Toronto, Ontario, Canada) and co-investigators.
Lalloo and team designed the pilot trial to assess the feasibility and preliminary effectiveness of iCanCope, which includes symptom tracking and goal-setting features, a library with information on disease education and pain coping strategies, and a social support section that allows users to interact with each other.
The trial included 60 adolescents aged 12–18 years (median 15 years) with JIA who were randomly assigned to use iCanCope or a scaled-back version that only included the symptom tracking feature for 8 weeks.
The app was successfully installed and logged into by 86% of participants in the intervention group and 100% of those in the control group, with respective mean acceptability scores of 34.7 and 34.6 out of 40.
The mean number of completed daily check-ins, which were used to calculate adherence, was 29.6 for intervention participants and 29.0 for control participants, out of a possible 55.
Adherence rates were classed as low (≤24%) for 12% of individuals using the full version of iCanCope, low-moderate (25–49%) for 32%, high-moderate (50–75%) for 36%, and high (76–100%) for 20%. The corresponding rates among people using the control version of the app were 10%, 35%, 35%, and 21%.
Both groups reported improvements in pain intensity from baseline to week 8, with those in the intervention group having a 1.73-point reduction on a scale that ranged from 0 (no pain) to 10 (most pain possible) and those in the control group having a 1.09-point reduction.
Both changes “exceed the minimal clinically important difference [of 1 point] for adolescents with persistent pain,” Lalloo and team remark.
However, “[t]here were no significant changes in pain-related activity limitations or health-related quality of life,” the authors note. They also point out that there was no significant between-group difference in the degree of pain intensity improvement.
Writing in Rheumatology, they say that future versions of iCanCope will be designed to boost engagement with the library, goal setting, and community features, which were used by less than half of participants.
Lalloo et al also believe that further work is needed “to explore how symptom tracking alone may confer benefit to JIA patients.”
They suggest that “the acts of symptom tracking and viewing of historical trends may have prompted users to reflect on their behaviours and make adjustments in their daily life (e.g. prioritizing sleep).”
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Rheumatol 2020; doi:10.1093/rheumatology/keaa178