Do mHealth interventions at the bedside work?—a pilot intervention for pediatric patients admitted with pain complaints

Kristin A. Kullgren, Christina Limke, Emily M. Fredericks, Terri Voepel-Lewis

Abstract

Background: Pediatric admissions for pain have been increasing, and pediatric consultation-liaison (CL) psychologists are frequently consulted to address pain coping for hospitalized youth. Many apps have been developed to target pain coping strategies, but no specific intervention has been developed to target pain coping using mobile health (mHealth) at the bedside. We describe an innovative, pilot, proof of concept mHealth intervention program using clinical apps to target pain coping strategies in youth referred for a pediatric psychology consult during their hospitalization.
Methods: Parent-child dyads (n=18, youth ages 7–19) completed measures assessing the child’s pain history, pain catastrophizing, and pain interference during their child’s inpatient admission. Participants were loaned a tablet and prescribed specific clinical apps as part of their psychology consult to target pain coping. Youth tracked the frequency and duration of clinical app use. At about 2 weeks post-discharge families (n=10) completed a satisfaction survey about their experience with the intervention and again completed the pain outcome measures administered at baseline.
Results: The clinical apps were used frequently during the hospitalization, primarily for relaxation. Youth who tracked their app use in the hospital were more likely to participate at Time 2. There was significant attrition from enrollment to Time 2. There were no changes in pain level from Time 1 to Time 2. Pain catastrophizing scores for youth decreased significantly at the follow-up interval. Most participants felt that the clinical apps helped with inpatient pain management and 70% continued to use the clinical apps after discharge. Parents universally would recommend the mHealth intervention to other families.
Conclusions: The feasibility of this proof of concept intervention is mixed. The intervention was acceptable to our CL team, we had no implementation issues, and there were high levels of acceptability and accessibility for patients. However, attrition from across time points presents a challenge to interpretation of results and highlights the difficulty in implementing such an intervention with a high acuity population. Further research is needed to better describe the impact of clinical apps use on post-discharge outcomes, but this mHealth pilot showed promise as an adjunct to standard inpatient CL interventions for pediatric pain.