Efficacy of Web-based Pain Self-management for Adolescents With Juvenile Idiopathic Arthritis

There is a critical gap in the contemporary treatment of Juvenile Idiopathic Arthritis (JIA)
wherein a majority of adolescent patients still experience ongoing pain and reduced
health-related quality of life even with advances in medical management of the disease.
Despite the pervasiveness of this problem, most adolescents receive no training in the
strategies that can help empower them to reduce pain and disability. The Internet offers a
unique opportunity to reach adolescents with JIA and provide the training in pain
self-management strategies that otherwise may not occur due to treatment access and resource
obstacles. The objective of this research study is to conduct a definitive test of an
investigator-developed online coping skills training program for English- and
Spanish-speaking adolescents with JIA. Based on data from the investigators' preliminary
work, the central hypothesis is that use of an online coping skills training program will
produce superior improvements in pain and health-related quality of life outcomes for
adolescents with JIA relative to outcomes attained with reviewing extant online educational
information about JIA and receiving additional attention to coping efforts (control
condition). Specific aims for the proposed work include (a) determining the extent to which
an online coping skills training program for adolescents with JIA produces improvements in
key health outcomes that currently do not optimally respond to only contemporary medical
management (pain and health-related quality of life); and (b) determining predictors of
change in pain and health-related quality of life indices in adolescents with JIA and
establishing the extent to which online coping skills training influences health outcomes
via these predictors. An exploratory aim is to determine the acceptability and preliminary
efficacy of online coping skills training within a subgroup of Hispanic adolescents with
JIA. These aims will be achieved through the approach of using a multi-center randomized
controlled trial in which a sample of 360 consenting English- and Spanish-speaking
adolescents aged 12-18 years with JIA will be enrolled and randomized into one of two
groups: (a) an experimental group consisting of a 12-week interactive online multi-component
treatment protocol including targeted disease education, training in empirically supported
cognitive-behavioral coping skills, and social support augmented by monthly telephone
contact with a nurse; or (b) a control group consisting of 12 weeks of guided access to
extant online resources for disease education and additional attention to own best efforts
at managing JIA via monthly telephone contact with a nurse. Outcome data will be collected
from both groups prior to treatment, immediately following the intervention, and at 6- and
12-month follow-up assessments. Successful completion of this project is expected to
establish to what extent and how an innovative online self-management program produces
change in clinically relevant health outcomes in both English- and Spanish-speaking
adolescents with JIA. The proposed study therefore can be expected to have a significant
positive impact in the healthcare of teens with JIA and in identifying treatment targets for
other youth self-management interventions.

Inclusion Criteria:

- 12-18 years of age (inclusive)

- diagnosed with JIA by a pediatric rheumatologist

- able to speak and read English and/or Spanish

- able to complete online measures

- reporting pain in at least one joint over the past 6 months

Exclusion Criteria:

- have another chronic medical condition that adversely impacts pain and/or
health-related quality of life (e.g., inflammatory bowel disease, fibromyalgia,
cancer, genetic disorder, pervasive developmental disorder, diabetes)

- have a significant cognitive impairment or illiteracy that would prevent
understanding of the intervention and outcome measures

- currently in psychotherapy