Jointly Managing JIA Online: An Internet-based Psycho-educational Game for Children With JIA and Their Parents

Overview

Arthritis in children is a long-term illness and it can make a child's life very difficult. In children 8-11 years old, the child and their family work together to deal with the problems that arthritis can cause. Learning to cope with and manage the problems that come with arthritis can stop it from getting worse. It is important to create programs that teach children and families how to cope with and manage arthritis. This study will develop and test an online game that helps children learn how to better manage their arthritis. The goal of these studies is to test: (1) how easy to use and acceptable the online game is; and (2) if children who play the game feel less pain, have fewer limitations, and a better quality of life compared to children who do not play the game.

Full Title of Study: “Jointly Managing JIA Online: An Internet-based Psycho-educational Game for Children With Juvenile Idiopathic Arthritis (JIA) and Their Parents”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Investigator)
  • Study Primary Completion Date: March 2019

Interventions

  • Behavioral: Game
    • In addition to standard medical care, children in the experimental group will receive the Match-3 game. The game will be designed for short individual gameplay sessions (as little as a few seconds), once to three times a day, over the course of 8 weeks, involving no more than 15 minutes per day in anticipated screen time. There is no way to “lose” the game. Through a structured series of daily interactions, the player will learn strategies and develop decision-making abilities that will assist with management of their own JIA. The Match 3 concept (similar to the game, Bejeweled) will require the player to successfully match the treatment strategy to the JIA symptom.
  • Other: Usual Care
    • Children in usual care group receive standard medical care.

Arms, Groups and Cohorts

  • Experimental: Game
    • Access to the game.
  • Active Comparator: Usual Care
    • Control group.

Clinical Trial Outcome Measures

Primary Measures

  • Participant Accrual
    • Time Frame: 8 weeks
    • This will be centrally tracked by the clinical research project coordinator (CRPC).
  • Intervention Fidelity
    • Time Frame: 8 weeks
    • Any issues or difficulties encountered during implementation of the intervention, control strategy, or outcome measures will be tracked throughout the study by the CRPC. For example, issues from a technical standpoint (for example, game not downloading properly, participant requiring assistance using the technology) or logistics standpoint.
  • Acceptability and Satisfaction with Intervention
    • Time Frame: 8 weeks
    • Immediately post-trial children and parents in the intervention group will rate their acceptability of and satisfaction with the game and 10-15 English and 10-15 French children and one of their parents will take part in a brief qualitative interview.
  • Engagement with Intervention
    • Time Frame: 8 weeks
    • Analytics will be used to track patterns of website program usage (“number of interactions” [clicks]).
  • Dropout Rates
    • Time Frame: 8 weeks
    • This will be centrally tracked by the clinical research project coordinator (CRPC).

Secondary Measures

  • Pain
    • Time Frame: 8 weeks
    • Measured using the Standardized Universal Pain Evaluations for Rheumatology providers for children and youth (SUPERKIDZ). It consists of 4 domains: pain intensity and location (5 items), fatigue (1 item), pain interference/evaluative dimension (10 items), and affective/emotional dimension (4 items) for children ≥ 8 years (and parent proxy report for children 4-8 years). This measure takes 3 – 5 minutes to complete.
  • Pain-related Activity Limitations
    • Time Frame: 8 weeks
    • Measured using the Child Activity Limitations Interview (CALI-21). This is a 21-item self-report scale divided into (i) active (e.g. gym, sports) and (ii) routine (e.g., schoolwork, reading) activity subscales.
  • Health-related Quality of Life
    • Time Frame: 8 weeks
    • Measured using the Arthritis Pediatric Quality of Life Inventory (PedsQL). The PedsQL Arthritis Module is a 22-item self-report scale with five subscales: pain and hurt, daily activities, treatment, worry, and communication.
  • Self Efficacy
    • Time Frame: 8 weeks
    • Measured using the Children’s Arthritis Self-Efficacy Scale (CASE). The CASE is a disease specific 11-item self-report measure that is divided into three sub-scales: activity, symptom, and emotion. A 5-point Likert scale is used to rate responses to each item with 1 = “not at all sure” to 5 = “very sure” based on how confident the child is that they can manage disease effects.
  • JIA-specific Disease Knowledge
    • Time Frame: 8 weeks
    • Measured using the 24-item Medical Issues, Exercise, Pain and Social Support Questionnaire (MEPS). MEPS is made up of 4 sub scales (medical issues, exercise, pain, and social support). Items are rated on a 10-cm VAS with higher scores indicating greater disease knowledge.
  • Adherence
    • Time Frame: 8 weeks
    • Adherence to medical treatment will be assessed using the 34-item Child Adherence Report Questionnaire (CARQ) that assesses adherence to prescribed medications, exercises, and wearing of splints over the past 3 months. The CARQ was developed specifically for children with JIA and consists of three sections: (1) responsibility for treatment, (2) child’s ability to adhere to the three types of treatment, and (3) perceptions about helpfulness of therapies. Items in the last two sections are rated on 11-point numeric pain rating scale with higher scores indicating better adherence and perceived helpfulness of therapies.

Participating in This Clinical Trial

Inclusion Criteria

1. Age ≥ 8 and ≤ 11 years of age 2. Diagnosed with JIA (minimum 3 months) using International League of Associations for Rheumatology classification criteria96 3. Active disease 4. Child and primary parent/caregiver are able to speak and read English or French 5. Participants are willing and able to complete online measures Exclusion Criteria:

1. Cognitive impairments (as assessed by reviewing medical chart and consultation with the patient's rheumatologist) 2. Major co-morbid illnesses (e.g., medical [inflammatory bowel disease, cancer, diabetes] or psychiatric [depression, anxiety]) which may impact their ability to understand and use the game or complete outcome assessments (as determined by their rheumatologist). 3. Children currently participating in other Cognitive Behavioural Therapy (CBT) interventions 4. Usability testing participants

Gender Eligibility: All

Minimum Age: 8 Years

Maximum Age: 11 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • The Hospital for Sick Children
  • Collaborator
    • Provincial Health Services Authority
  • Provider of Information About this Clinical Study
    • Principal Investigator: Jennifer Stinson, Clinician Scientist/Clinical Nurse Specialist/NP – The Hospital for Sick Children

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