Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial.

INTRODUCTION: Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. METHODS AND ANALYSIS: This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. ETHICS AND DISSEMINATION: This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. TRIAL REGISTRATION NUMBER: NCT03632343

The Impact of Menstrual Phase on Outcomes of Females with Concussion

This study examined the impact of menstrual phase, oral contraceptive use and post-menopausal status (collectively referred to as reproductive states) during time of injury on female post-concussion outcomes during the acute phase of recovery. A total of 83 female participants (ages 17 - 71) recruited from a concussion clinic at a rehabilitation hospital were included in the analysis. Personal health information and Rivermead Post-Concussion Questionnaire (RPCQ) scores were collected. Descriptive, bivariate regression and multivariable regression models were performed. The reproductive states were not associated with RPCQ scores during the first week of recovery; however, females taking oral contraceptives had significantly higher RPCQ scores two weeks post-injury. The other reproductive states do not appear related to RPCQ scores up to 2 weeks post injury. Being on birth control was independently associated with more symptomatology.M.Sc

Perceptions of technology experiences and development among family caregivers and technology researchers: qualitative study

Background: Caregiving is highly stressful and associated with poor mental and physical health. Technologies, including mobile and e-health applications, have been developed to address caregiver needs. Yet, there remains a paucity of research that examines the technology perceptions of informal caregivers, especially from a sex, gender and diversity perspective. Objective: To address this gap and inform the development of future caregiving technologies, this study aimed to (1) examine how family caregivers perceive the use of technology in assisting with their caregiving routines, (2) explore the sex, gender and diversity influences on these perceptions and (3) understand how these perceptions and needs are reflected within the current technology development process. Methods: Semi-structured interviews were conducted with 16 informal caregivers of individuals with a range of chronic medical conditions and eight technology researchers involved in caregiving technology projects. Results: Three main themes with subthemes were developed: the first main theme is Caregivers see a need for technology in their lives and consists of three subthemes: Caregiving is a challenging endeavor, Technology is multi-faceted, and Caregiver preferences mediate technology use. The second main theme is Relationships play a vital role in mediating technology uptake and comprises two subthemes: The caregiver-care recipient dynamic shapes technology perceptions, and Caregivers rely on external networks for technology information. Finally, the third main theme is Barriers are present in the use and adoption of technology and comprises two subthemes: Technology may not be compatible with personal values and abilities, and Technology that is not tailored towards caregivers lacks adoption. Conclusions: The findings bring to light the multi-faceted role technology can play in aiding caregiving, while at the same time drawing attention to the pitfalls and drawbacks of these technologies perceived by caregivers. Bringing in technology researchers to the study provides a more holistic understanding of technology in caregiving from its initial development to eventual uptake by caregivers