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.

项目摘要/摘要 尽管年轻人中轻度创伤性脑损伤（MTBI）或脑震荡的发生率很高，但没有 可用的标准化循证治疗，缺乏检查早期治疗的试验 方法。因此，迫切需要制定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，游戏化的移动学习 MTBI青年的环境（GMLE）促进实时症状自我管理和自我效能感 传统，间歇性的医学随访是不可能的。青年是emedicine的理想目标 方法是因为它们存在持续症状，技术能力以及与独立的风险 提高个人功效。尽管成功地将自我管理原则应用于几个慢性 条件，目前尚无旨在促进主动解决问题和自我的计划的报告 MTBI青年的管理。作为原型，我们将使用我们最近开发的基于Web的程序，自我 管理活动调节和放松培训（SMART），该培训整合了实时自我监控 具有旨在提高自我效能的模块的症状和活动（来自基于患者网络的入口） 通过心理教育和培训解决问题/以问题为中心的应对策略。在第一阶段， 我们将结合先前工作的反馈和协作设计团队的投入，以改变 原始的智能原型变成gmle。计划的修改包括基于化身的教学剂 充当虚拟教练和数字徽章，激励完成。遵循可用性测试和迭代 改进，在第二阶段，我们将进行一项飞行员随机对照试验，涉及100名年轻人 MTBI，11至18岁的MTBI及其父母评估安全性和可行性，并估算对应对和 与通常的护理相比，心理功能。结果将在每周的间隔进行评估 通过在线链接遵循基线的一个月时间范围。我们假设接受聪明的参与者将 报告对该计划的高可用性和满意度，并且没有不利影响。我们进一步假设 智能干预小组的参与者将报告更高的积极应对水平，更大的自我效能感， 福祉感，生活质量和苦难程度较低，而受到平常护理的感觉。探索性 分析将随着时间的推移研究后脑震荡症状解决方案的群体差异。鉴于缺乏 基于证据的干预措施以促进小儿MTBI后自我管理和恢复，这项研究 针对关键的社会和科学问题。这项研究的发现将为随后的大规模试验提供信息 这最终可能会改变小儿MTBI的管理。