Parental Engagement of a Prototype Electronic Diary in an Ambulatory Setting Following Adenotonsillectomy in Children: A Prospective Cohort Study

Adenotonsillectomy is performed in children on an outpatient basis, and pain is managed by parents. A pain diary would facilitate pain management in the ambulatory setting. Our objective was to evaluate the parental response rate and the compliance of a prototype electronic pain diary (e-diary) with cloud storage in children aged 2–12 years recovering from adenotonsillectomy and to compare the e-diary with a paper diary (p-diary). Parents recorded pain scores twice daily in a pain diary for 2 weeks post-operation. Parents were given the choice of an e-diary or p-diary with picture message. A total of 208 patients were recruited, of which 35 parents (16.8%) chose the e-diary. Most parents (98%) chose to be contacted by text message. Eighty-one families (47%) returned p-diaries to us by mail. However, the response rate increased to 77% and was similar to that of the e-diary (80%) when we included data texted to the research phone from 53 families. The proportion of diaries with Complete (e-diary:0.37 vs. p-diary:0.4) and Incomplete (e-diary:0.43 vs. p-diary:0.38) data entries were similar. E-diaries provide a means to follow patients in real time after discharge. Our findings suggest that a smartphone-based medical health application coupled with a cloud would meet the needs of families and health care providers alike.

Manual therapy associated with topical heat reduces pain and self-medication in patients with tension-type headache

ABSTRACT Tension-type headache (TTH) is a significant public health problem. The myofascial trigger points in the masticatory and cervical muscles are related to pain located in the temporomandibular joint, face, and cranium according to specific patterns. Thus, therapeutic procedures should be directed to myofascial trigger points rather than to the area of referred pain. For this purpose, the massage therapy combined with the topical heat can provide effective results due to the increase of the local microcirculation, improving tissue perfusion and promoting muscle relaxation. In this study we investigated the effects of manual therapy associated with topical heat therapy in TTH pain. This is a single-arm study composed of 13 participants with TTH (females), which were submitted to a three-month research protocol. In the first month , they filled out a pain diary and then they were evaluated. In the following month, the treatment protocol was applied (8 sessions of 45 minutes, twice a week, involving massage for skin desensitization, myofascial trigger point deactivation and stretching (friction massage) on masticatory and trapezius muscles after the topical heat). Then, in the third month (follow-up period), the participants were instructed to fill out the pain diary once again. We observed a significant decrease in pain intensity in TTH episodes, and medication intake after treatment and it keeps decreasing in follow-up. We conclude that the combination of manual therapy protocol and topical heat reduced pain and episodes related to TTH, and self-medication use in our sample.

Pain Diary in Bands Based on SBAR Communication Mode Application of Nursing Management in Patients with Postherpetic Neuralgia

Pain diary shows an important role in the pain management of patients with chronic cancer pain, but it has not been mentioned in the nursing management of Postherpetic neuralgia (PHN). This study explored the impact of pain diary on patients with postherpetic neuralgia during hospitalization. Patients with postherpetic neuralgia were randomly divided into a pain diary group and a control group. During the hospitalization, the diary group was instructed to record the pain diary, and the control group was given routine care. Evaluating VAS score of the patients for 10 days on admission, Thai Brief Pain questionnaire score during mid-hospitalization, and the amount and satisfaction of the patient's condition information collected upon discharge. On the third day after admission, the VAS score of the diary group was significantly lower than that of the control group. The Thai Brief Pain results showed that the pain diary group had better mood, sleep and enjoyment of life than the control group. The number of patient's condition information from the diary group was significantly more than the control group, the diary group had better satisfaction with nurses and doctors than the control group. The short-term pain diary should have a better role in PHN hospitalization.

Hey Google, Remind Me to Write in My Diary: Voice Assistants for Daily Pain Monitoring

Diaries can be important tools to document and communicate pain symptoms. Diary-based assessments can be prone to poor adherence and limitations with biased recall. One strategy to help adherence is to use voice assistant reminders. A sample of 15 community dwelling aging adults used the Google Assistant for reminders to complete pain self-management tasks. One task was a reminder created to write daily in a pain diary. Within the diary, participants could document a change in pain, pain severity, average and worst amount of pain, and pain relief. At follow-up, it was noted that participants adhered to writing most pain characteristics in the diaries, but there were times that each question was not answered. Participant’s pain characteristics varied, which could be a helpful assessment to communicate to health providers for pain management. This feasibility study is preliminary support that voice assistants may help with the daily pain diary completion.

Mobile Health Use Predicts Self-Efficacy and Self-Management in Adolescents with Sickle Cell Disease

Background: Sickle cell disease (SCD) is associated with medical challenges that often worsen for adolescents and young adults (AYA) when caregivers begin to transfer responsibility for care. Living with SCD requires self-management and self-efficacy and is a critical concern for AYA as they navigate complex medical systems. However, previous research indicates that AYA with SCD often lack the ability, confidence, and skills to manage their disease effectively. As most AYA with SCD are now "technology natives," mobile health (mHealth) holds considerable promise for assessing and changing behaviors to improve health outcomes. In a previous feasibility and acceptability study, AYA with SCD provided qualitative feedback that they would use mHealth (a co-designed mobile app) and that it was beneficial for tracking health behaviors. Thus, we integrated the mHealth app into a group intervention (SCThrive) and hypothesized that more engagement with the mHealth app would result in increased self-management and self-efficacy for AYA with SCD. Methods: Our analysis from a single-site, randomized control trial (NCT02851615) assessed data from only AYA in the treatment arm (N = 26) who received the SCThrive intervention and used the mHealth app. The sample included AYA with SCD aged 13 to 21 years (Mage = 16.7 years; 54% female; 46% HbSS genotype; all African American/Black) who received six-weekly group sessions (3 in-person, 3 online). All SCThrive participants were provided with the mobile app (iManage) on an iPad. The Transition Readiness Assessment Questionnaire (TRAQ-5) assessed self-management skills and the Patient Activation Measure (PAM-13) assessed self-efficacy at baseline and posttreatment. We also assessed engagement (logins), confidence and completion of self-management goals (e.g., exercising, take medications), pain diary entries, and mood symptoms recorded on the iManage app (see Figure 1). Results: Preliminary analyses indicated that most AYA with SCD logged on to the iManage app (Mlogins = 7.8, SD = 9.1, range = 1 - 45) and viewed their pain diary (Mviews = 5.7, SD = 9.1, range = 1 - 45) at least once a week. Eighty-eight percent of AYA saved a pain diary entry and the most commonly used strategies for managing pain episodes were resting (22%), drinking water (19%), and using distraction (8%). AYA viewed their self-management goals about once every 11 days (Mdays = 11.24, SD = 13, range = 0 - 57). All AYA created (Mgoals = 5.7, SD = .72, range = 4 - 7), but only 54% of AYA completed at least one self-management goal. Of the 149 self-management goals created by the entire sample, only 37 (25%) were recorded as completed. AYA with a confidence level of 7 or lower were least likely to complete their self-management goals (14%) (see Figure 2). Correlation analyses demonstrated that logging on to the iManage app more frequently was associated with completing more self-management goals (r = .38), documenting pain symptoms more frequently (r = .54), and lower mood ratings (r = .54). Primary analyses demonstrated that after controlling for scores at baseline, the number of logins to the iManage app (p = .08, η2 = .13) predicted self-efficacy (PAM-13) and (p = .05, η2 = .17) self-management skills (TRAQ-5). Completing more self-management goals on the iManage app did not predict scores on the PAM-13, but, surprisingly, predicted lower scores (less self-management) on the TRAQ-5 (p = .08, η2 = .14). Conclusion: Lessons learned from our study indicate that it can be challenging to maintain engagement in mHealth for AYA with SCD, but for those who do engage there are significant benefits related to self-management goals, documenting pain symptoms, and mood. Supporting hypotheses, engaging more with the iManage app was related to higher-reported self-efficacy and self-management skills. Some AYA engaged with the app infrequently and did not create or complete self-management goals; others were "super users" and logged into the app daily. Increasing the frequency of reminder messages, encouraging more interactions with peers, and tailoring the opportunity to earn incentives are potential modifications for future interventions. However, our findings indicate that a mHealth app can be effectively integrated into a clinical trial and is related to positive outcomes. Although there are challenges to address, mHealth has the potential to bring about changes in behavior and improve health in the SCD population. Disclosures No relevant conflicts of interest to declare.

Effects of upper cervical joints manipulation on the signs and symptoms of subjects with headache: a blind clinical trial.

There is a relationship between headaches and dysfunctions in the upper cervical spine, so joint manipulation in this region can be a useful tool for recovering tissue mobility and improving the related symptoms. Objectives: to evaluate the effect of 3 sessions of manipulation of the upper cervical spine on pain, cervical mobility, neck disability index (NDI) and the MIDAS questionnaire of subjects with headache. Methods: 13 subjects (28.1 ± 6.7 years) with headache participated. Initially, they filled in a pain diary for 4 weeks. After this period, NDI and MIDAS questionnaire were applied. Then, the cervical spine movements were measured with a tape measure, with the subject in the seated position. Subsequently, the intervention was performed (3 sessions with an interval of 7 days between them), with the subject positioned in the supine position and the global manipulation for the upper cervical spine was applied bilaterally. At the end of the intervention, subjects were re-evaluated for cervical mobility and for the NDI and MIDAS questionnaire. After that period, subjects answered the pain diary for another 4 weeks (follow up). The statistical analysis consisted of the KS normality test, followed by ANOVA test (and Tukey post hoc test) or paired Student's t test, with the level of significance set at 5%. Results: MIDAS questionnaire and NDI showed a significant improvement after the cervical mobility intervention. The pain parameters, assessed by the pain diary, were significantly reduced during the intervention and remained so in the follow up evaluation. Conclusion: the intervention was effective in reducing the signs and symptoms of subjects with headache.

VERIFICATION OF PAIN MEDICATION ADHERENCE IN OLDER ADULTS USING INTERACTIVE VOICE REMINDERS

Adherence to analgesics needs to be monitored to ensure optimal pain management and avert adverse events among older adults. mHealth reminders may encourage adherence behavior, but it is unclear if medication use ensues following the reminder. The purpose of this study was to trial the use of medication event monitoring to verify the initiation of scheduled pain medication after an mHealth reminder. Methods: N=15 adults 55 and older created Google Assistant reminders to take their scheduled pain medication and write in a pain diary. A sub sample of n= 5 participants used a Medication Event Monitoring System Cap with their scheduled pain medications over 4 weeks. Data were collected on demographics, pain severity, and medication adherence. Descriptive statistics were performed. Results: Five women with ages ranging from 56-80 years, reported pain in multiple body locations. Pain severity on average was rated at 4 and at its worst 7; with pain relief ranging from 50-90%. Adherence percentages ranged from 82% to 100%. The overall latency was M = 55 min, SD = 100 min. The average latencies varied among the 5 participants; the shortest average time was 17 minutes and the longest average time was 4.5 hours. Only 15% of pain medications were taken within 5 minutes and 64% within 30 minutes of the interactive voice assistant reminder. Conclusions: It is important to ensure a behavioral intervention promotes the desired outcome. Medication event monitoring systems may help to identify non adherent behaviors when using mHealth interventions to promote pain medication adherence.

Measurement of equivalence using a patient-reported daily pain diary across three smartphone devices

<p><strong>Background:</strong> Patient-reported outcomes play an essential role in evaluating the results of clinical trials. As technological advances are made throughout the industry, pharmaceutical sponsors’ ability to collect field-based patient data has greatly increased. Recently, many clinical trials are utilizing varying modes of data capture in order to enable maximum flexibility. Given the regulatory concern over the equivalence of mixed modes of administration, the need to research the use of varying devices is essential.</p><p class="abstract"><strong>Methods:</strong> This study reviewed three handheld smartphone devices for conceptual equivalence and conducted usability for standard questions used in a daily pain diary. Ten participants, 7 females 3 males; ages 27-70 years, diagnosed with chronic pain or fibromyalgia, completed the same pain diary on three different smartphone devices.</p><p class="abstract"><strong>Results:</strong> Overall, participants reported no differences between these three smartphone devices and found the presentation of the diary content to be similar, if not identical, on all three devices.</p><p class="abstract"><strong>Conclusions: </strong>Device type had no impact on the presentation of the diary content or participants’ understanding of the diary questions.</p>