Novel eMedicine Self-Management Program for Youth with Mild Traumatic Brain Injury

针对轻度创伤性脑损伤青少年的新型电子医疗自我管理计划

• 批准号: 9387018
• 负责人: Lynn Babcock
• 金额: $ 21.37万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-21 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9387018
• 关键词: Accelerometer; Accident and Emergency department; Acute; Address; Adopted; Adverse effects; Adverse event; Affect; Age; Aptitude; Area; Brain Concussion; Brain Injuries; Caring; Childhood; Chronic; Clinical; Clinical Management; Cognitive; Control Groups; Coupling; Data; Development; Distress; Early treatment; Education; Educational Intervention; Effectiveness; Emergency Medicine; Evidence based intervention; Evidence based treatment; Family; Fatigue; Feedback; Future; Goals; Headache; Impairment; Incentives; Incidence; Individual; Informal Social Control; Injury; Intervention; Learning; Learning Module; Link; Measures; Medical; Modeling; Modification; Monitor; Morbidity - disease rate; Nature; Neurobehavioral Manifestations; Online Systems; Outcome; Parents; Participant; Patient Self-Report; Patients; Pattern; Pharmacology; Phase; Post-Concussion Syndrome; Problem Solving; Process; Psychology; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Regulation; Rehabilitation therapy; Relaxation Therapy; Reporting; Resolution; Risk; Safety; Science; Self Assessment; Self Efficacy; Self Management; Standardization; Structure; Symptoms; Technology; Teenagers; Testing; Time; Training; Training Programs; Variant; Work; Youth; acronyms; base; chronic pain; coping; design; digital; eHealth; educational atmosphere; emotional symptom; evidence base; experience; flexibility; follow-up; group intervention; high risk; improved; improved outcome; innovation; mild traumatic brain injury; novel; pedagogy; persistent symptom; physical symptom; programs; prototype; psychoeducation; psychologic; psychological distress; psychosocial; safety and feasibility; satisfaction; social; stress management; symptom management; symptom self management; therapy design; treatment as usual; usability; virtual

Project Summary/Abstract Despite the high incidence of mild traumatic brain injury (mTBI) or concussion in youth, there are no standardized evidence-based treatments available and there is a dearth of trials examining early treatment approaches. Consequently, there is a critical need to develop highly usable management strategies to support recovery. To address this need, we propose to develop and assess an innovative, gamified mobile learning environment (GMLE) for youth with mTBI to promote real-time symptom self-management and self-efficacy that is not possible with traditional, intermittent medical follow-up. Youth are the ideal targets for an eMedicine approach due to their risk of persistent symptoms, aptitude for technology, and advancing independence with increasing personal efficacy. Despite successful application of self-management principles to several chronic conditions, there are no current reports of a program designed to facilitate active problem solving and self- management in youth with mTBI. As a prototype, we will use our recently developed web-based program, Self- Management Activity-regulation and Relaxation Training (SMART), which integrates real-time self-monitoring of symptoms and activities (from patient web-based entry) with modules designed to increase self-efficacy through psychoeducation and training in problem solving/problem-focused coping strategies. In the first phase, we will incorporate feedback from prior work and input from a collaborative design team to transform the original SMART prototype into a GMLE. Planned modifications include an avatar-based pedagogical agent to act as a virtual coach and digital badging to incentivize completion. Following usability testing and iterative refinements, in the second phase, we will conduct a pilot randomized controlled trial involving 100 youth with mTBI, ages 11 to 18, and their parents to assess safety and feasibility, and estimate effects on coping and psychological functioning as compared to usual care. Outcomes will be assessed at weekly intervals over a month timeframe following baseline via online links. We hypothesize that participants receiving SMART will report high usability and satisfaction with the program and no adverse effects. We further hypothesize that participants in the SMART intervention group will report higher levels of active coping, greater self-efficacy, sense of well-being, and quality of life and lower levels of distress than those receiving usual care. Exploratory analyses will examine group differences in post-concussive symptom resolution over time. Given the lack of evidence-based interventions to promote self-management and recovery following pediatric mTBI, this study targets a critical social and scientific concern. Findings from this study will inform subsequent larger scale trials that could ultimately transform management of pediatric mTBI.

项目概要/摘要 尽管青少年轻度创伤性脑损伤 (mTBI) 或脑震荡的发生率很高，但目前还没有 现有标准化的循证治疗，但缺乏检查早期治疗的试验 接近。因此，迫切需要开发高度可用的管理策略来支持 恢复。为了满足这一需求，我们建议开发和评估创新的游戏化移动学习 为患有 mTBI 的青少年提供的环境 (GMLE)，以促进实时症状自我管理和自我效能 传统的、间歇性的医疗随访是不可能做到这一点的。青少年是电子医疗的理想目标 方法，因为他们存在持续症状的风险、技术能力以及提高独立性 提高个人效能。尽管自我管理原则成功应用于几种慢性病 在条件允许的情况下，目前还没有关于旨在促进积极解决问题和自我解决的计划的报告。 青年 mTBI 的管理。作为原型，我们将使用我们最近开发的基于网络的程序 Self- 管理活动调节和放松训练（SMART），集成实时自我监控 症状和活动（来自患者基于网络的条目）以及旨在提高自我效能的模块 通过心理教育和解决问题/以问题为中心的应对策略的培训。在第一阶段， 我们将结合之前工作的反馈和协作设计团队的意见来改变 将原始 SMART 原型转化为 GMLE。计划的修改包括基于化身的教学代理 充当虚拟教练和数字徽章来激励完成任务。遵循可用性测试和迭代 细化后，在第二阶段，我们将进行一项试点随机对照试验，涉及 100 名患有以下疾病的青少年： mTBI，年龄 11 至 18 岁及其父母，评估安全性和可行性，并估计对应对和治疗的影响 与常规护理相比的心理功能。将在一段时间内每周评估一次结果 通过在线链接遵循基线的一个月时间范围。我们假设接受 SMART 的参与者会 报告该程序具有很高的可用性和满意度，并且没有不良影响。我们进一步假设 SMART 干预组的参与者将报告更高水平的积极应对、更高的自我效能、 与接受常规护理的人相比，他们的幸福感和生活质量更高，痛苦程度也更低。探索性 分析将检查随着时间的推移脑震荡后症状缓解的群体差异。鉴于缺乏 这项研究旨在促进儿科 mTBI 后的自我管理和康复的循证干预措施 针对关键的社会和科学问题。这项研究的结果将为后续更大规模的试验提供信息 这最终可能会改变儿科 mTBI 的管理。