Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth

Anna Hilyard,1,2 Julia Kingsley,1 David Sommerfield,1,3,4 Susan Taylor,1,5 Natasha Bear,6 Noula Gibson7,8 1Complex Pain Service, Perth Children’s Hospital, Perth, Western Australia, Australia; 2Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia; 3Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia; 4Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; 5School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 6Department of Child Research, Child Adolescent Health Service, Perth, Western Australia, Australia; 7Physiotherapy Department, Perth Children’s Hospital, Perth, Western Australia, Australia; 8School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, AustraliaCorrespondence: Anna HilyardComplex Pain Service, Perth Children’s Hospital, Locked Bag 2010, Nedlands, Western Australia 6909, AustraliaTel +6186456 4341Email anna.hilyard@health.wa.gov.auPurpose: Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care.Patients and Methods: Parent–adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11– 17) had experienced primary pain for > 3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention.Results: Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5– 9 and Hybrid-PIPP median 8.5, range 5– 10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported.Conclusion: The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications.Registration: ANZTR(ACTRN2614000489695).Keywords: videoconferencing, telemedicine, interdisciplinary pain management, hybrid treatment, allied health, pediatric pain management