229: Treatment engagement in a digital psychological intervention for adolescent spinal surgery

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Psychology, Digital Health Technologies , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Chronic postsurgical pain impacts nearly 1/3 of adolescents 6-12 months after spinal fusion surgery, and can affect long-term functioning and quality of life. We evaluated the effectiveness of digital cognitive-behavioral therapy (CBT) (SurgeryPal) versus digital education (ED) delivered at two phases (pre-operative, post-operative) to reduce acute and chronic pain in adolescents undergoing spine surgery. Our primary trial findings demonstrated that groups receiving CBT compared to ED had lower pain interference, depression, and improved sleep at follow-up. The aim of this secondary analysis is to assess participant engagement with the digital interventions, perceived treatment acceptability, and association with perioperative treatment outcomes.

Methods: 430 adolescents (72% female) aged 12-18 years scheduled to undergo spinal fusion surgery and their parents were recruited from 34 US hospitals, and randomized to digital treatment programs delivered (via app and website) before and after surgery using a factorial design. This secondary analysis focuses on treatment engagement metrics and the Treatment Evaluation Inventory (TEI) to assess treatment acceptability completed by youth and parents. Linear regressions controlling for demographics were used to assess relationships between variables. Open response questions asking participants to comment on aspects of the program they liked and disliked were analyzed using content analysis and inductively coded.

Results: Mean TEI scores for adolescent and parent participants indicated strong treatment acceptability across all treatment arms. Engagement was moderate with 68% of adolescents completing all 3 modules before surgery and 69% post-surgery. However, the education arm had a higher rate of completion. Regressions demonstrated significant relationships between TEI scores and pain intensity at 3 months (B=-.034, p=.011) and 6 months (B=-.031, p=.005), and depression at 6 months (B=-.203, p=.004) post-surgery in adolescents. While control participants valued the program’s brevity, some found it generic; CBT participants reported improved coping skills and reduced anxiety despite the desire for more interactive, family-centered features.

Conclusions: Adolescent and parent participants displayed strong engagement and high acceptability toward the digital intervention programs, with higher completion rates in the less demanding education arm compared to the CBT intervention. Significant relationships between treatment acceptability ratings and postoperative pain and health outcomes highlight the importance of aligning intervention design with patient preferences to maximize clinical efficacy. Ultimately, these digital programs represent a promising and acceptable approach to improving the recovery trajectory following adolescent spinal fusion surgery.

References: Hochreuter J, Dreher T, Hasler C-C, Canonica S, Locher C, Held U, Rabbitts J and Koechlin H. Longitudinal Resilience and Risk Factors in Pediatric Postoperative Pain (LORRIS): Protocol for a Prospective Longitudinal Swiss University Children’s Hospitals-Based Study. BMJ open 2024;14:e080174.

Kelley ML, Heffer RW, Gresham FM, Elliott SN. Development of a modified treatment evaluation inventory. J Psychopathol Behav Assess. 1989;11(3):235-247. doi:10.1007/BF00960495

Ocay DD, Li MM, Ingelmo P, Ouellet JA, Pagé MG and Ferland CE. Predicting acute postoperative pain trajectories and long‐term outcomes of adolescents after spinal fusion surgery. Pain Research and Management 2020;2020:9874739.

Rabbitts JA, Zhou C, de la Vega R, Aalfs H, Murray CB, Palermo TM. A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial. Trials. 2021;22(1):506. doi:10.1186/s13063-021-05421-3

Presenting Author: Ryan D Parsons
Submitting Author: Ryan Parsons

Senior Author: Tonya M Palermo

IASP 2026 Global Year theme of Neuropathic Pain: No

• Homer Aalfs - Seattle Children’s Research Institute
• Chuan Zhou - Seattle Children’s Research Institute
• Jennifer Rabbitts - Stanford University
• Patricia Dionicio - Stanford University
• Tonya M Palermo - Seattle Children’s Research Institute; University of Washington