A Pilot Randomized Controlled Trial of the iCanCope Pain Self-management Application for Adolescents with Juvenile Idiopathic Arthritis

Chitra Lalloo ¹, Lauren Harris ², Amos Hundert ², Roberta Berard ³, Joseph Cafazzo ⁴, Mark Connelly ⁵, Brian Feldman ², Kristin Houghton ⁶, Adam Huber ⁷, Ronald Laxer ⁸, Nadia Luca ⁹, Heinrike Schmeling ¹⁰, Lynn Spiegel ¹¹, Lori Tucker ¹², Quynh Pham ⁴, Cleo Davies-Chalmers ¹³ and Jennifer Stinson¹⁴, ¹The Hospital for Sick Children, Toronto, Ontario, Canada, ²The Hospital for Sick Children, Toronto, Canada, ³Children's Hospital London Health Sciences Centre, London, Canada, ⁴University of Toronto, Toronto, Canada, ⁵Kansas City, ⁶University of British Columbia - Vancouver, Vancouver, Canada, ⁷IWK Health Centre & Dalhousie University, Halifax, Nova Scotia, Canada, ⁸The Hospital for Sick Children and University of Toronto, Toronto, Canada, ⁹University of Calgary, Calgary, Alberta, Canada, ¹⁰Alberta Children's Hospital/University of Calgary, Calgary, Alberta, Canada, ¹¹University of Toronto/Hospital for Sick Children, Thornhill, Canada, ¹²BC Children's Hospital, Vancouver, British Columbia, Canada, ¹³The Hospital for Sick Children, Toonto, Canada, ¹⁴University of Toronto & The Hospital for Sick Children, Toronto, Ontario, Canada

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: app, juvenile idiopathic arthritis (JIA), pain, RCT, Self-management

Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Friday, May 1, 2020

Title: Poster Session 2

Session Type: ACR Abstract Session

Session Time: 5:00PM-6:00PM

Background/Purpose: Pain is the most common symptom of Juvenile Idiopathic Arthritis (JIA), a chronic childhood illness that has potentially debilitating effects on health-related quality of life (HRQL). iCanCope is a smartphone-based program developed to provide accessible, evidence-based self-management support for adolescents with JIA pain. It was developed through a phased, user-centred approach that involved youth with JIA at every stage. iCanCope provides features of daily symptom tracking, goal-setting, pain coping skills, and social support. The purpose of this study was to evaluate feasibility and preliminary effectiveness of the iCanCope app in adolescents (aged 12-18 years) with JIA pain.

Methods: A 2-arm pilot randomized controlled trial (RCT) was used to evaluate the iCanCope app compared to a version with symptom tracking only. Adolescents who met the ACR classification criteria for JIA and experienced arthritis-related pain >3/10 in the past week were recruited from 3 Canadian paediatric rheumatology centres.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 (HRQL). 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%); “high” (76-100%). Linear mixed models were applied for preliminary effectiveness analyses as per intention-to-treat. ClinicalTrials.gov study identifier: NCT02764346.

Results: Adolescents (N=60) were recruited between June 2017 and April 2019. See Figure 1 for CONSORT diagram. 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. See Figure 2 for observed changes in pain intensity outcomes. There were no significant changes in activity limitations or HRQL.

Conclusion: The iCanCope pilot RCT was feasible to implement in a paediatric rheumatology setting. Both apps were deployed successfully, with high acceptability, and 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.

Disclosure: C. Lalloo, None; L. Harris, None; A. Hundert, None; R. Berard, None; J. Cafazzo, None; M. Connelly, None; B. Feldman, OPTUM, Pfizer, AB2-Bio, 1; K. Houghton, None; A. Huber, None; R. Laxer, None; N. Luca, None; H. Schmeling, None; L. Spiegel, None; L. Tucker, None; Q. Pham, None; C. Davies-Chalmers, None; J. Stinson, None.

To cite this abstract in AMA style:

Lalloo C, Harris L, Hundert A, Berard R, Cafazzo J, Connelly M, Feldman B, Houghton K, Huber A, Laxer R, Luca N, Schmeling H, Spiegel L, Tucker L, Pham Q, Davies-Chalmers C, Stinson J. A Pilot Randomized Controlled Trial of the iCanCope Pain Self-management Application for Adolescents with Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/a-pilot-randomized-controlled-trial-of-the-icancope-pain-self-management-application-for-adolescents-with-juvenile-idiopathic-arthritis/. Accessed .

« Back to 2020 Pediatric Rheumatology Symposium

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-pilot-randomized-controlled-trial-of-the-icancope-pain-self-management-application-for-adolescents-with-juvenile-idiopathic-arthritis/