Although psychological treatments benefit youth with chronic pain, treatment is not accessible in most communities. Digital health
interventions offer promise for expanding access and reach to this population. Using a stepped-wedge cluster randomized trial
design, we evaluated effectiveness and implementation of a digital health delivered psychological intervention for pediatric chronic
pain. One hundred forty-three youth, aged 10 to 17 years, with chronic pain and a caregiver were recruited from 8 clinics in the
United States. Active intervention included access to the Web-based Management of Adolescent Pain (WebMAP) Mobile app and
the WebMAP parent web site to learn pain self-management skills. Effectiveness outcomes included pain intensity, disability, and
patient global impression of change, while Reach, Adoption, Implementation, and Maintenance were implementation outcomes.
Results showed that youth in both treatment conditions (WebMAP vs Usual Care) had similar changes over time in pain and
disability. Youth in the WebMAP condition perceived greater improvement (patient global impression of change) at post-treatment
and follow-up (d’s 5 0.54 and 0.44, P , 0.05) compared with youth receiving usual care. Use of the digital health intervention was
modest and variable; approximately 30% of youth and parents completed treatment. Greater engagement (number of completed
modules) was associated with significantly greater reductions in pain and disability from pre-treatment to follow-up (d’s520.57 and
20.38, P , 0.05). Parents, youth, and providers found treatment acceptable; providers had positive attitudes and demonstrated
referrals over a maintenance period. Further research is needed to understand how to enhance treatment engagement with digital
health interventions and optimize implementation.
