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BACKGROUND A third of adolescents experiencing a concussion will suffer from persistent post-concussion symptoms lasting a month or beyond. The ability to cope with concussion symptoms, regulate emotions, and manage stress is an important determinant of risk for prolonged symptoms. Early psychological interventions, such as mindfulness-based interventions, might improve concussion recovery. OBJECTIVE This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion. METHODS Participants aged 12-18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1 month post-concussion (persistent symptom cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10-15 min/day, at a minimum of 4 days/week. At 2 weeks post-concussion, participants completed a credibility questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability, and working alliance, as well as a semi-structured phone interview. RESULTS 10 participants completed the study outcomes, including 7 acute (5 females; median IQR age=14.73 13.94,16.94 years and 3 persistent symptom patients (2 females; median IQR age=17.62 17.48,17.86 years). Across cohorts, half-way through the intervention, the treatment expectation was moderate (median=6.00 3.58,7.75, maximum possible=9.00). Moreover, the intervention was perceived as credible (median=6.50 6.83,8.75, maximum possible=9.00). At 4 weeks, the DTx was considered usable (median=70.00 55.00,82.50, maximum possible=100.00). Participants rated their satisfaction with the DTx (median=27.00 24.50,29.50, maximum possible=32.00) and the working alliance with the digital mindfulness guides (median=3.92 3.38-4.33, maximum possible=5.00) as high. Four themes were identified from the qualitative data: 1) positive attributes (including accessibility, ease of use, perceived effectiveness, variety of features, and meditation guides); 2) negative attributes (technical issues that acted as a barrier to use, and sounds and lights that were triggering headaches); 3) ideas for modifications; and 4) technical issues. CONCLUSIONS Adolescents were very satisfied with a mindfulness-based intervention delivered via a smartphone app and considered it to be usable and credible. Results inform modifications to the DTx, instructions, and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx to decrease the risk of persistent symptoms and reduce the symptom burden following pediatric concussion. The present mixed-methods study and the iterative approach to intervention design we are using will ensure better translation and impact of interventions for adolescents with concussions.
Sicard et al. (Mon,) studied this question.