The purpose of this study is to understand if cognitive behavioral therapy can feasibly be provided to groups of adults with cerebral palsy and chronic pain via virtual group therapy sessions.
Many adults with cerebral palsy have chronic pain that interferes with daily activities, but evidence regarding pain treatments for adults with cerebral palsy is limited. In other chronic pain patient populations, behavioral therapies such as cognitive behavioral therapy for chronic pain (CBT-CP) are a key component of evidence-based pain management. This study will assess challenges, implementation barriers, and preliminary efficacy of CBT-CP administered in a virtual group setting for adults with CP to design larger trials to definitively estimate treatment efficacy. This study will invite 40 adult participants with CP and chronic pain that impacts their life to participate in a trial of CBT-CP. CBT-CP involves weekly group-therapy sessions for 12 weeks. Participants are oriented to CBT and set individualized goals (sessions #1-3) before focusing on cognitive and behavior skill building including physical activity, pacing, relaxation training, and cognitive restructuring (#4-10) then focusing on maintenance and discharge planning (#11-12). Participants will complete surveys every 3 months over a period of 12 months (a total of five surveys before and after CBT-CP). Participants will also continue to receive their usual medical care throughout. All enrolled participants will receive the CBT intervention. Participants will be randomly assigned to receive CBT either upon enrollment (group 1; CBT\_now) or after a three month delay (group 2; CBT\_later). This study will be conducted at the Kennedy Krieger Institute in Baltimore, Maryland, USA. Group CBT-CP will be conducted virtually via Zoom. 40 individuals with cerebral palsy who meet all inclusion/exclusion criteria will be recruited in two waves (one in early 2025 and one in early 2026). Participants must be at least 18 years old, able to make informed medical decision for themselves, and must endorse the ability and willingness to participate in all assessment and group sessions regardless of randomization outcome. Participants must also either live in Maryland, or be able to travel to Maryland on a weekly basis for the group therapy sessions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
14
CBT-CP consists of skill-based therapy sessions completed weekly for 12 weeks. Participants are oriented to CBT and set individualized goals (sessions #1-3) before focusing on cognitive and behavior skill building including physical activity, pacing, relaxation training, and cognitive restructuring (#4-10) then focusing on maintenance and discharge planning (#11-12). It will be completed in Maryland in an online real-time audio/video virtual group therapy format.
Kennedy Krieger Institute
Baltimore, Maryland, United States
Data collection achieved (feasibility assessment)
We will examine the rate of survey completion for each survey (0 = survey incomplete, 1 = survey complete). Higher scores indicate a better outcome (greater feasibility of recruiting adults with CP and chronic pain and retaining their engagement to complete this clinical trial over a period of 12 months).
Time frame: Five assessments (at enrollment and at 3, 6, 9, and 12 months post-enrollment)
Therapy attendance
Therapists will track frequency of group therapy attendance (present/absent) for each participant throughout the 12 week intervention. We will assess the rate of treatment adherence by looking at the number of sessions attended by each participant over the course of the intervention, as well as at a cohort level
Time frame: Weekly x 12 weeks during therapy administration
Patient Global Impressions of Change
These questions ask about how participants feel now, compared to before the intervention. Responses are recorded on a 7-point scale ranging 1 being "very much worse" to 7 being "very much improved"; higher scores represent better outcomes.
Time frame: Four assessments (at 3, 6, 9, and 12 months post-enrollment)
Change in Pain Catastrophizing Scale score
The Pain Catastrophizing Scale assesses specific patterns of pain-related thoughts. Responses are recorded on a 5-point scale, with 1 being "Not at all" and 5 being "All the time". Higher scores represent worse outcomes.
Time frame: Will be assessed at baseline (prior to randomization) as well as every 3 months throughout the 12 month study timeframe for each cohort
Change in Pain Self-Efficacy-4 Score
This 4-item questionnaire assesses an individual's confidence in their ability to complete various activities despite the presence of pain. Responses are recorded on a 7-point scale, with 1 being "Not at all confident" and 7 being "Completely confident". Higher scores represent better outcomes.
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Time frame: Will be assessed at baseline (prior to randomization) as well as every 3 months throughout the 12 month study timeframe for each cohort
Changes in Brief Pain Inventory Pain Interference Subtest scores
This survey asks how much pain is interfering with various activities. Responses are recorded on a 10-point scale, with 1 being "Does not interfere" and 7 being "Completely interferes". Higher scores represent worse outcomes. We will examine 1) improvement in the activity that saw the greatest pain-related impairment at baseline and 2) average improvement across all activities listed.
Time frame: Will be assessed at baseline (prior to randomization) as well as every 3 months throughout the 12 month study timeframe for each cohort
Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity 3a T-score
These questions ask about pain levels over the previous 7 days. Responses are recorded on a 5-point scale, with 1 being "had no pain" and 5 being "very severe"; higher scores represent worse outcomes.
Time frame: Will be assessed at baseline (prior to randomization) as well as every 3 months throughout the 12 month study timeframe for each cohort
Changes in Patient Health Questionnaire-4 (PHQ-4)
This 4-item questionnaire asks about symptoms of anxiety and depression in the last 14 days. Responses are recorded 4-point scale, with 0 being "not at all" and 4 being "nearly every day"; higher scores represent worse outcomes. We will examine changes in anxiety symptom scores and in depression symptom scores.
Time frame: Will be assessed at baseline (prior to randomization) as well as every 3 months throughout the 12 month study timeframe for each cohort