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There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404 to -$808 AUD) or an optional-guided format (ICER range: -$314 to -$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88 to $225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE This study examines the cost-effectiveness of an internet-delivered pain management program provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.
Blake F. Dear; Eyal Karin; Rhiannon Fogliati; Joanne Dudeney; Olav Nielssen; Amelia J. Scott; Milena Gandy; Madelyne A. Bisby; Andreea I. Heriseanu; Taylor Hathway; Lauren Staples; Nickolai Titov; Liz Schroeder. A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial. The Journal of Pain 2020, 22, 344 -358.
AMA StyleBlake F. Dear, Eyal Karin, Rhiannon Fogliati, Joanne Dudeney, Olav Nielssen, Amelia J. Scott, Milena Gandy, Madelyne A. Bisby, Andreea I. Heriseanu, Taylor Hathway, Lauren Staples, Nickolai Titov, Liz Schroeder. A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial. The Journal of Pain. 2020; 22 (3):344-358.
Chicago/Turabian StyleBlake F. Dear; Eyal Karin; Rhiannon Fogliati; Joanne Dudeney; Olav Nielssen; Amelia J. Scott; Milena Gandy; Madelyne A. Bisby; Andreea I. Heriseanu; Taylor Hathway; Lauren Staples; Nickolai Titov; Liz Schroeder. 2020. "A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial." The Journal of Pain 22, no. 3: 344-358.
Background Migraine is a common neurological problem associated with the highest burden amongst neurological conditions in terms of years lived with disability. Medications can be used as prophylaxis or rescue medicines, but are costly and not always effective. A range of psychological interventions have been developed to manage migraine. Objectives The objective was to evaluate the efficacy and adverse events of psychological therapies for the prevention of migraine in adults. Search methods We searched CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL from their inception until July 2018, and trials registries in the UK, USA, Australia and New Zealand for randomised controlled trials of any psychological intervention for adults with migraine. Selection criteria We included randomised controlled trials (RCTs) of a psychological therapy for people with chronic or episodic migraine, with or without aura. Interventions could be compared to another active treatment (psychological or medical), an attention‐placebo (e.g. supportive counselling) or other placebo, routine care, or waiting‐list control. We excluded studies where fewer than 15 participants completed each arm. Data collection and analysis We extracted study characteristics and outcome data at post‐treatment and the longest available follow‐up. We analysed intervention versus control comparisons for the primary outcome of migraine frequency. We measured migraine frequency using days with migraines or number of migraine attacks measured in the four weeks after treatment. In addition, we analysed the following secondary outcomes: responder rate (the proportion of participants with a 50% reduction in migraine frequency between the four weeks prior to and the four weeks after treatment); migraine intensity; migraine duration; migraine medication usage; mood; quality of life; migraine‐related disability; and proportion of participants reporting adverse events during the treatment. We included these variables, where available, at follow‐up, the timing of which varied between the studies. We used the GRADE approach to judge the quality of the evidence. Main results We found 21 RCTs including 2482 participants with migraine, and we extracted meta‐analytic data from 14 of these studies. The majority of studies recruited participants through advertisements, included participants with migraine according to the International Classification of Headache Disorders (ICHD) criteria and those with and without aura. Most intervention arms were a form of behavioural or cognitive‐behavioural therapy. The majority of comparator arms were no treatment, routine care or waiting list. Interventions varied from one 20‐minute session to 14 hours of intervention. No study had unequivocally low risk of bias; all had at least one domain at high risk of bias, and 20 had two to five domains at high risk. Reporting of randomisation procedures and allocation concealment were at high or unclear risk of bias. We downgraded the quality of evidence for outcomes to very low, due to very serious limitations in study quality and imprecision. Reporting in trials was poor; we found no preregistrations stipulating the outcomes, or demonstrating equivalent expectations between groups. Few studies reported our outcomes of interest, most only reported outcomes post treatment; follow‐up data were sparse. Post‐treatment effects We found no evidence of an effect of psychological interventions for migraine frequency in number of migraines or days with migraine (standardised mean difference (SMD) −0.02, 95% confidence interval (CI) −0.17 to 0.13; 4 studies, 681 participants; very low‐quality evidence). The responder rate (proportion of participants with migraine frequency reduction of more than 50%) was greater for those who received a psychological intervention compared to control: 101/186 participants (54%) with psychological therapy; 37/152 participants (24%) with control (risk ratio (RR) 2.21, 95% CI 1.63 to 2.98; 4 studies, 338 participants; very low‐quality evidence). We found no effect of psychological therapies on migraine intensity (SMD −0.13, 95% CI −0.28 to 0.02; 4 studies, 685 participants). There were no data for migraine duration (hours of migraine per day). There was no effect on migraine medication usage (SMD −0.06, 95% CI −0.35 to 0.24; 2 studies, 483 participants), mood (mean difference (MD) 0.08, 95% CI −0.33 to 0.49; 4 studies, 432 participants), quality of life (SMD −0.02, 95% CI −0.30 to 0.26; 4 studies, 565 participants), or migraine‐related disability (SMD −0.67, 95% CI −1.34 to 0.00; 6 studies, 952 participants). The proportion of participants reporting adverse events did not differ between those receiving psychological treatment (9/107; 8%) and control (30/101; 30%) (RR 0.16, 95% CI 0.00 to 7.85; 2 studies, 208 participants). Only two studies reported adverse events and so we were unable to draw any conclusions. We rated evidence from all studies as very low quality. Follow‐up Only four studies reported any follow‐up data. Follow‐ups ranged from four months following intervention to 11 months following intervention. There was no evidence of an effect on any outcomes at follow‐up (very low‐quality evidence). Authors' conclusions This review identified 21 studies of psychological interventions for the management of migraine. We did not find evidence that psychological interventions affected migraine frequency, a result based on four studies of primarily brief treatments. Those who received psychological interventions were twice as likely to be classified as responders in the short term, but this was based on very low‐quality evidence and there was no evidence of an effect of psychological intervention compared to control at follow‐up. There was no evidence of an effect...
Louise Sharpe; Joanne Dudeney; Amanda C De C Williams; Michael Nicholas; Ingrid McPhee; Andrew Baillie; Miriam Welgampola; Brian McGuire. Psychological therapies for the prevention of migraine in adults. Cochrane Database of Systematic Reviews 2019, 2019, CD012295 .
AMA StyleLouise Sharpe, Joanne Dudeney, Amanda C De C Williams, Michael Nicholas, Ingrid McPhee, Andrew Baillie, Miriam Welgampola, Brian McGuire. Psychological therapies for the prevention of migraine in adults. Cochrane Database of Systematic Reviews. 2019; 2019 (7):CD012295.
Chicago/Turabian StyleLouise Sharpe; Joanne Dudeney; Amanda C De C Williams; Michael Nicholas; Ingrid McPhee; Andrew Baillie; Miriam Welgampola; Brian McGuire. 2019. "Psychological therapies for the prevention of migraine in adults." Cochrane Database of Systematic Reviews 2019, no. 7: CD012295.
There has been growing interest in the potential of emerging internet-delivered psychological treatments for supporting the mental health needs of university students. However, no large-scale prospective effectiveness trials examining their real-world potential have been reported. The aim of the current study was to evaluate the acceptability and effectiveness of a brief, 5-week, internet-delivered and therapist-guided intervention for anxiety and depression, when delivered as part of routine care by a university counselling service. A large, prospective, single-group Phase-IV clinical trial. Students (n = 1326) engaging with the university counselling service were provided the opportunity to receive the intervention based on their preferences and identified needs. Students completed standardised measures of anxiety and depression at pre-treatment, each week of the intervention, post-treatment and 3-month follow-up. Over a 4 year period, 1081 students (10% of those presenting to the counselling service) participated in the intervention. Large clinical reductions in symptoms of both anxiety (% reduction = 41%; Cohen's d = 0.94) and depression (% reduction = 36%; Cohen's d = 0.81) were observed alongside high levels of acceptability. The intervention required relatively little counsellor time (M = 36.28 mins; SD = 20.56) per student, and symptom deterioration was observed in less than 5% of students. The findings of the current study are supportive of internet-delivered interventions provided as routine care to university students. Further research is needed to carefully explore whether these interventions could be used with a larger proportion of students presenting to counselling services, paying close attention to acceptability, engagement and clinical outcomes.
Blake F. Dear; Bareena Johnson; Ashwin Singh; Benjamin Wilkes; Tamara Brkic; Richa Gupta; Michael Jones; Steve Bailey; Joanne Dudeney; Milena Gandy; Rhiannon Fogliati; Nickolai Titov. Examining an internet-delivered intervention for anxiety and depression when delivered as a part of routine care for university students: A phase IV trial. Journal of Affective Disorders 2019, 256, 567 -577.
AMA StyleBlake F. Dear, Bareena Johnson, Ashwin Singh, Benjamin Wilkes, Tamara Brkic, Richa Gupta, Michael Jones, Steve Bailey, Joanne Dudeney, Milena Gandy, Rhiannon Fogliati, Nickolai Titov. Examining an internet-delivered intervention for anxiety and depression when delivered as a part of routine care for university students: A phase IV trial. Journal of Affective Disorders. 2019; 256 ():567-577.
Chicago/Turabian StyleBlake F. Dear; Bareena Johnson; Ashwin Singh; Benjamin Wilkes; Tamara Brkic; Richa Gupta; Michael Jones; Steve Bailey; Joanne Dudeney; Milena Gandy; Rhiannon Fogliati; Nickolai Titov. 2019. "Examining an internet-delivered intervention for anxiety and depression when delivered as a part of routine care for university students: A phase IV trial." Journal of Affective Disorders 256, no. : 567-577.
Background This is the first update of a review published in 2015, Issue 1. Chronic pain is common during childhood and adolescence and is associated with negative outcomes, such as increased severity of pain, reduced function, and low mood. Psychological therapies, traditionally delivered face‐to‐face with a therapist, are efficacious at reducing pain intensity and disability. To address barriers to treatment access, such as distance and cost of treatment, technology is being used to deliver these psychological therapies remotely. Therapies delivered remotely, such as via the Internet, computer‐based programmes, and smartphone applications, can be used to deliver treatment to children and adolescents with chronic pain. Objectives To determine the efficacy of psychological therapies delivered remotely compared to waiting list, treatment as usual, or active control treatments, for the management of chronic pain in children and adolescents. Search methods We searched four databases (CENTRAL, MEDLINE, Embase, and PsycINFO) from inception to May 2018 for randomised controlled trials (RCTs) of remotely‐delivered psychological interventions for children and adolescents with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries, reference sections, and citations of included studies for potential trials. Selection criteria We included RCTs that investigated the efficacy of a psychological therapy delivered remotely via technology in comparison to an active, treatment as usual, or waiting‐list control. We considered blended treatments, which used a combination of technology and up to 30% face‐to‐face interaction. Interventions had to be delivered primarily via technology to be included, and we excluded interventions delivered via telephone. We included studies that delivered interventions to children and adolescents (up to 18 years of age) with a chronic pain condition or where chronic pain was a primary symptom of their condition (e.g. juvenile arthritis). We included studies that reported 10 or more participants in each comparator arm, at each extraction point. Data collection and analysis We combined all psychological therapies in the analyses. We split pain conditions into headache and mixed (non‐headache) pain and analysed them separately. We extracted pain severity/intensity, disability, depression, anxiety, and adverse events as primary outcomes, and satisfaction with treatment as a secondary outcome. We considered outcomes at two time points: first immediately following the end of treatment (known as 'post‐treatment'), and second, any follow‐up time point post‐treatment between three and 12 months (known as 'follow‐up'). We assessed risk of bias and all outcomes for quality using the GRADE assessment. Main results We found 10 studies with 697 participants (an additional 4 studies with 326 participants since the previous review) that delivered treatment remotely; four studies investigated children with headache conditions, one study was with children with juvenile idiopathic arthritis, one included children with sickle cell disease, one included children with irritable bowel syndrome, and three studies included children with different chronic pain conditions (i.e. headache, recurrent abdominal pain, musculoskeletal pain). The average age of children receiving treatment was 13.17 years. We judged selection, detection, and reporting biases to be mostly low risk. However, we judged performance and attrition biases to be mostly unclear. Out of the 16 planned analyses, we were able to conduct 13 meta‐analyses. We downgraded outcomes for imprecision, indirectness of evidence, inconsistency of results, or because the analysis only included one study. Headache conditions For headache pain conditions, we found headache severity was reduced post‐treatment (risk ratio (RR) 2.02, 95% confidence interval (CI) 1.35 to 3.01); P < 0.001, number needed to treat to benefit (NNTB) = 5.36, 7 studies, 379 participants; very low‐quality evidence). No effect was found at follow‐up (very low‐quality evidence). There were no effects of psychological therapies delivered remotely for disability post‐treatment (standardised mean difference (SMD) ‐0.16, 95% CI ‐0.46 to 0.13; P = 0.28, 5 studies, 440 participants) or follow‐up (both very low‐quality evidence). Similarly, no effect was found for the outcomes of depression (SMD ‐0.04, 95% CI ‐0.15 to 0.23, P = 0.69, 4 studies, 422 participants) or anxiety (SMD ‐0.08, 95% CI ‐0.28 to 0.12; P = 0.45, 3 studies, 380 participants) at post‐treatment, or follow‐up (both very low‐quality evidence). Mixed chronic pain conditions We did not find any beneficial effects of psychological therapies for reducing pain intensity post‐treatment for mixed chronic pain conditions (SMD ‐0.90, 95% CI ‐1.95 to 0.16; P = 0.10, 5 studies, 501 participants) or at follow‐up. There were no beneficial effects of psychological therapies delivered remotely for disability post‐treatment (SMD ‐0.28, 95% CI ‐0.74 to 0.18; P = 0.24, 3 studies, 363 participants) and a lack of data at follow‐up meant no analysis could be run. We found no beneficial effects for the outcomes of depression (SMD 0.04, 95% CI ‐0.18 to 0.26; P = 0.73, 2 studies, 317 participants) and anxiety (SMD 0.53, 95% CI ‐0.63 to 1.68; P = 0.37, 2 studies, 370 participants) post‐treatment, however, we are cautious of our findings as we could only include two studies in the analyses. We could not conduct analyses at follow‐up. We judged the evidence for all outcomes to be very low quality. All conditions Across all chronic pain conditions, six...
Emma Fisher; Emily Law; Joanne Dudeney; Christopher Eccleston; Tonya M Palermo. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2019, 4, CD011118 .
AMA StyleEmma Fisher, Emily Law, Joanne Dudeney, Christopher Eccleston, Tonya M Palermo. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews. 2019; 4 (4):CD011118.
Chicago/Turabian StyleEmma Fisher; Emily Law; Joanne Dudeney; Christopher Eccleston; Tonya M Palermo. 2019. "Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents." Cochrane Database of Systematic Reviews 4, no. 4: CD011118.
Pain frequently co-occurs with elevated posttraumatic stress symptoms (PTSS); women are at elevated risk for their co-occurrence. PTSS and pain are associated with poor sleep quality; yet, little research has examined how sleep impacts their co-occurrence. The current study examines the indirect role of sleep on the relationship between PTSS and pain. A community sample of 182 women completed psychometrically-sound questionnaires assessing PTSS, sleep quality, pain characteristics, depression and anxiety symptoms, and anxiety sensitivity. We examined how sleep quality impacted associations among PTSS and pain intensity and pain interference, while controlling for key psychological factors. Greater PTSS was associated with worse pain interference, and poor sleep quality had a significant indirect effect on this relationship. Sleep may represent a modifiable behavioral mechanism that contributes to the mutual maintenance of PTSS and pain in women. Future research is needed to further clarify the role of sleep quality in their co-occurrence.
Rachel Aaron; Melanie Noel; Joanne Dudeney; Anna Wilson; Amy Holley; Tonya Palermo. The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women. Journal of Behavioral Medicine 2019, 42, 924 -933.
AMA StyleRachel Aaron, Melanie Noel, Joanne Dudeney, Anna Wilson, Amy Holley, Tonya Palermo. The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women. Journal of Behavioral Medicine. 2019; 42 (5):924-933.
Chicago/Turabian StyleRachel Aaron; Melanie Noel; Joanne Dudeney; Anna Wilson; Amy Holley; Tonya Palermo. 2019. "The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women." Journal of Behavioral Medicine 42, no. 5: 924-933.
Background: Assessing features of centralized pain may prove to be clinically meaningful in pediatric populations. However, we are currently limited by the lack of validated pediatric measures. Aim: We examined the psychometric properties of the Widespread Pain Index (WPI) and Symptom Severity (SS) scale to assess features of centralized pain in youth with painful conditions from three clinical samples: (1) musculoskeletal surgery, (2) headache, and (3) chronic pain. Methods: Participants were 240 youth aged 10 to 18 years (Mage = 14.8, SD = 1.9) who completed the WPI and SS scale. Subsets of participants also completed additional measures of pain region, pain intensity, quality of life, pain interference, and physical function. Results: Increased features of centralized pain by age were seen for the WPI (r = 0.27, P < 0.01) and SS scale (r = 0.29, P < 0.01). Expected differences in sex were seen for the WPI (sex: t132 = −3.62, P < 0.01) but not the SS scale (sex: t223 = −1.73, P = 0.09). Reliability for the SS scale was adequate (α = 0.70). Construct validity was demonstrated through relationships between the WPI and pain regions (r = 0.57, P < 0.01) and between the SS scale and quality of life (r = −0.59, P < 0.01) and pain interference (r = 0.56, P < 0.01). Criterion validity was demonstrated by differences on the WPI between the surgery sample and the headache and chronic pain samples (F2,237 = 17.55, P < 0.001). Comprehension of the SS scale items was problematic for some youth. Conclusions: The WPI showed adequate psychometric properties in youth; however, the SS scale may need to be modified. Our findings support the need to develop psychometrically sound instruments for comprehensive assessment of pain in pediatric samples.
Joanne Dudeney; Emily F. Law; Alagumeena Meyyappan; Tonya M. Palermo; Jennifer A. Rabbitts. Evaluating the psychometric properties of the Widespread Pain Index and the Symptom Severity Scale in youth with painful conditions. Canadian Journal of Pain 2019, 3, 137 -147.
AMA StyleJoanne Dudeney, Emily F. Law, Alagumeena Meyyappan, Tonya M. Palermo, Jennifer A. Rabbitts. Evaluating the psychometric properties of the Widespread Pain Index and the Symptom Severity Scale in youth with painful conditions. Canadian Journal of Pain. 2019; 3 (1):137-147.
Chicago/Turabian StyleJoanne Dudeney; Emily F. Law; Alagumeena Meyyappan; Tonya M. Palermo; Jennifer A. Rabbitts. 2019. "Evaluating the psychometric properties of the Widespread Pain Index and the Symptom Severity Scale in youth with painful conditions." Canadian Journal of Pain 3, no. 1: 137-147.
Jeannette M. Iskander; Joanne Dudeney; Jaclyn L. Papadakis; Laura Simons; Jessica Valenzuela; Wendy Ward; Christine Chambers; Eleanor Mackey. Evaluation of Society of Pediatric Psychology initiatives to support trainees in pediatric psychology. Clinical Practice in Pediatric Psychology 2018, 6, 313 -322.
AMA StyleJeannette M. Iskander, Joanne Dudeney, Jaclyn L. Papadakis, Laura Simons, Jessica Valenzuela, Wendy Ward, Christine Chambers, Eleanor Mackey. Evaluation of Society of Pediatric Psychology initiatives to support trainees in pediatric psychology. Clinical Practice in Pediatric Psychology. 2018; 6 (4):313-322.
Chicago/Turabian StyleJeannette M. Iskander; Joanne Dudeney; Jaclyn L. Papadakis; Laura Simons; Jessica Valenzuela; Wendy Ward; Christine Chambers; Eleanor Mackey. 2018. "Evaluation of Society of Pediatric Psychology initiatives to support trainees in pediatric psychology." Clinical Practice in Pediatric Psychology 6, no. 4: 313-322.
Chronic and recurrent pain is defined as pain that persists or recurs for longer than 3 months. Chronic pain is common in childhood, impacting at least one in four youth. The etiology of chronic pain is best understood within a biopsychosocial framework, which emphasizes the intersection of biological processes, psychological factors, and social/environmental influences in both the onset and maintenance of chronic pain. Children and adolescents with chronic pain can experience disability of physical function, psychological distress, family conflict, and difficulties in school and social functioning. Given the degree of potential physical and psychosocial consequences, assessment and treatment of pediatric chronic pain typically involves an interprofessional team including physicians, psychologists, and physical/occupational therapists who specialize in pediatric pain medicine. In this chapter, we use a biopsychosocial framework to describe the evaluation and treatment of chronic pain in childhood. Implications for interprofessional care and future directions are also discussed.
Joanne Dudeney; Emily F. Law. Chronic and Recurrent Pain. Handbook of Pediatric Behavioral Healthcare 2018, 125 -136.
AMA StyleJoanne Dudeney, Emily F. Law. Chronic and Recurrent Pain. Handbook of Pediatric Behavioral Healthcare. 2018; ():125-136.
Chicago/Turabian StyleJoanne Dudeney; Emily F. Law. 2018. "Chronic and Recurrent Pain." Handbook of Pediatric Behavioral Healthcare , no. : 125-136.
Introduction Approximately 5–8% of children report severe chronic pain and disability. Although evidence supports pain-self management as effective for reducing pain and disability, most youth do not have access to psychological intervention. Our prior studies demonstrate that an existing internet-delivered pain self-management program (WebMAP) can reduce barriers to care, is feasible, acceptable, and is effective in reducing pain-related disability in youth with chronic pain. The current trial seeks to: 1) determine the effectiveness of a mobile app version of WebMAP for improving patient pain-related outcomes, and 2) evaluate a novel implementation strategy to maximize the public health impact of the intervention including the determination of adoption, reach, and sustainability of WebMAP in specialty clinics serving children with chronic pain in the United States. Methods This hybrid effectiveness-implementation cluster randomized controlled trial employs a stepped wedge design in which the WebMAP mobile intervention is sequentially implemented in 8 specialty pain clinics following a usual care period. This trial aims to enroll a minimum of 120 youth (ages 10–17) who have chronic pain. Outcome analyses will determine effectiveness of treatment on adolescent pain-related outcomes as well as public health impact via reach, adoption, implementation, and maintenance. Conclusions This trial examines an innovative approach to evaluate a technology-delivered pain self-management program for youth with chronic pain. Findings are expected to yield a strategic approach for delivering a digital pain management program for youth with chronic pain that can be sustained in clinical settings. Clinical Trial Registration #: NCT03332563
Tonya M. Palermo; Rocio de la Vega; Joanne Dudeney; Caitlin Murray; Emily Law. Mobile health intervention for self-management of adolescent chronic pain (WebMAP mobile): Protocol for a hybrid effectiveness-implementation cluster randomized controlled trial. Contemporary Clinical Trials 2018, 74, 55 -60.
AMA StyleTonya M. Palermo, Rocio de la Vega, Joanne Dudeney, Caitlin Murray, Emily Law. Mobile health intervention for self-management of adolescent chronic pain (WebMAP mobile): Protocol for a hybrid effectiveness-implementation cluster randomized controlled trial. Contemporary Clinical Trials. 2018; 74 ():55-60.
Chicago/Turabian StyleTonya M. Palermo; Rocio de la Vega; Joanne Dudeney; Caitlin Murray; Emily Law. 2018. "Mobile health intervention for self-management of adolescent chronic pain (WebMAP mobile): Protocol for a hybrid effectiveness-implementation cluster randomized controlled trial." Contemporary Clinical Trials 74, no. : 55-60.
Background This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009, 2012 and 2014. Chronic pain, defined as pain that recurs or persists for more than three months, is common in childhood. Chronic pain can affect nearly every aspect of daily life and is associated with disability, anxiety, and depressive symptoms. Objectives The aim of this review was to update the published evidence on the efficacy of psychological treatments for chronic and recurrent pain in children and adolescents. The primary objective of this updated review was to determine any effect of psychological therapy on the clinical outcomes of pain intensity and disability for chronic and recurrent pain in children and adolescents compared with active treatment, waiting‐list, or treatment‐as‐usual care. The secondary objective was to examine the impact of psychological therapies on children's depressive symptoms and anxiety symptoms, and determine adverse events. Search methods Searches were undertaken of CENTRAL, MEDLINE, MEDLINE in Process, Embase, and PsycINFO databases. We searched for further RCTs in the references of all identified studies, meta‐analyses, and reviews, and trial registry databases. The most recent search was conducted in May 2018. Selection criteria RCTs with at least 10 participants in each arm post‐treatment comparing psychological therapies with active treatment, treatment‐as‐usual, or waiting‐list control for children or adolescents with recurrent or chronic pain were eligible for inclusion. We excluded trials conducted remotely via the Internet. Data collection and analysis We analysed included studies and we assessed quality of outcomes. We combined all treatments into one class named 'psychological treatments'. We separated the trials by the number of participants that were included in each arm; trials with > 20 participants per arm versus trials with < 20 participants per arm. We split pain conditions into headache and mixed chronic pain conditions. We assessed the impact of both conditions on four outcomes: pain, disability, depression, and anxiety. We extracted data at two time points; post‐treatment (immediately or the earliest data available following end of treatment) and at follow‐up (between three and 12 months post‐treatment). Main results We identified 10 new studies (an additional 869 participants) in the updated search. The review thus included a total of 47 studies, with 2884 children and adolescents completing treatment (mean age 12.65 years, SD 2.21 years). Twenty‐three studies addressed treatments for headache (including migraine); 10 for abdominal pain; two studies treated participants with either a primary diagnosis of abdominal pain or irritable bowel syndrome, two studies treated adolescents with fibromyalgia, two studies included adolescents with temporomandibular disorders, three were for the treatment of pain associated with sickle cell disease, and two studies treated adolescents with inflammatory bowel disease. Finally, three studies included adolescents with mixed pain conditions. Overall, we judged the included studies to be at unclear or high risk of bias. Children with headache pain We found that psychological therapies reduced pain frequency post‐treatment for children and adolescents with headaches (risk ratio (RR) 2.35, 95% confidence interval (CI) 1.67 to 3.30, P < 0.01, number needed to treat for an additional beneficial outcome (NNTB) = 2.86), but these effects were not maintained at follow‐up. We did not find a beneficial effect of psychological therapies on reducing disability in young people post‐treatment (SMD ‐0.26, 95% CI ‐0.56 to 0.03), but we did find a beneficial effect in a small number of studies at follow‐up (SMD ‐0.34, 95% CI ‐0.54 to ‐0.15). We found no beneficial effect of psychological interventions on depression or anxiety symptoms. Children with mixed pain conditions We found that psychological therapies reduced pain intensity post‐treatment for children and adolescents with mixed pain conditions (SMD ‐0.43, 95% CI ‐0.67 to ‐0.19, P < 0.01), but these effects were not maintained at follow‐up. We did find beneficial effects of psychological therapies on reducing disability for young people with mixed pain conditions post‐treatment (SMD ‐0.34, 95% CI ‐0.54 to ‐0.15) and at follow‐up (SMD ‐0.27, 95% CI ‐0.49 to ‐0.06). We found no beneficial effect of psychological interventions on depression symptoms. In contrast, we found a beneficial effect on anxiety at post‐treatment in children with mixed pain conditions (SMD ‐0.16, 95% CI ‐0.29 to ‐0.03), but this was not maintained at follow‐up. Across all pain conditions, we found that adverse events were reported in seven trials, of which two studies reported adverse events that were study‐related. Quality of evidence We found the quality of evidence for all outcomes to be low or very low, mostly downgraded for unexplained heterogeneity, limitations in study design, imprecise and sparse data, or suspicion of publication bias. This means our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect, or we have very little confidence in the effect estimate; or the true effect is likely to be substantially different from the estimate of effect. Authors' conclusions Psychological treatments delivered predominantly face‐to‐face might be effective for reducing pain outcomes for children and adolescents with headache or other chronic pain conditions post‐treatment. However, there were no effects at follow‐up. Psychological therapies were also beneficial for reducing disability in children with mixed chronic pain...
Emma Fisher; Emily Law; Joanne Dudeney; Tonya M Palermo; Gavin Stewart; Christopher Eccleston. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2018, 9, CD003968 .
AMA StyleEmma Fisher, Emily Law, Joanne Dudeney, Tonya M Palermo, Gavin Stewart, Christopher Eccleston. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews. 2018; 9 (9):CD003968.
Chicago/Turabian StyleEmma Fisher; Emily Law; Joanne Dudeney; Tonya M Palermo; Gavin Stewart; Christopher Eccleston. 2018. "Psychological therapies for the management of chronic and recurrent pain in children and adolescents." Cochrane Database of Systematic Reviews 9, no. 9: CD003968.
Objective This study aimed to evaluate feasibility and acceptability of a hybrid cognitive‐behavioral therapy intervention for adolescents with co‐occurring migraine and insomnia. Background Many youth with chronic migraine have co‐occurring insomnia. Little research has been conducted to evaluate behavioral treatments for insomnia in youth with migraine. Design and Methods We conducted a single‐arm pilot trial to evaluate the feasibility and acceptability of delivering cognitive‐behavioral therapy for insomnia to 21 youth (mean age 15.5, standard deviation 1.6) with co‐occurring chronic migraine and insomnia. Adolescents completed up to 6 individual treatment sessions over 6 to 12 weeks, and 1 booster session 1 month later. Assessments included a prospective 7‐day headache and sleep diary, and self‐report measures of insomnia, sleep quality, sleep habits, and activity limitations at pre‐treatment, immediate post‐treatment, and 3‐month follow‐up. Results Adolescents demonstrated good treatment adherence and families rated the intervention as highly acceptable. Preliminary analyses indicated improvements from pre‐treatment to post‐treatment in primary outcomes of headache days (M = 4.7, SD = 2.1 vs M = 2.8, SD = 2.7) and insomnia symptoms (M = 16.9, SD = 5.2 vs M = 9.5, SD = 6.2), which were maintained at 3‐month follow‐up (M = 2.7, SD = 2.8; M = 9.3, SD = 5.0, respectively). We also found improvements in secondary outcomes of pain‐related activity limitations as well as sleep quality, sleep hygiene, and sleep patterns. Conclusions These preliminary data indicate that hybrid cognitive‐behavioral therapy is feasible and acceptable for youth with co‐occurring chronic migraine and insomnia. Future randomized controlled trials are needed to test treatment efficacy on migraine, sleep, and functional outcomes. ClinicalTrials.gov Identifier: NCT03137147.
Emily F. Law; See Wan Tham; Rachel V. Aaron; Joanne Dudeney; Tonya M. Palermo. Hybrid Cognitive-Behavioral Therapy Intervention for Adolescents With Co-Occurring Migraine and Insomnia: A Single-Arm Pilot Trial. Headache: The Journal of Head and Face Pain 2018, 58, 1060 -1073.
AMA StyleEmily F. Law, See Wan Tham, Rachel V. Aaron, Joanne Dudeney, Tonya M. Palermo. Hybrid Cognitive-Behavioral Therapy Intervention for Adolescents With Co-Occurring Migraine and Insomnia: A Single-Arm Pilot Trial. Headache: The Journal of Head and Face Pain. 2018; 58 (7):1060-1073.
Chicago/Turabian StyleEmily F. Law; See Wan Tham; Rachel V. Aaron; Joanne Dudeney; Tonya M. Palermo. 2018. "Hybrid Cognitive-Behavioral Therapy Intervention for Adolescents With Co-Occurring Migraine and Insomnia: A Single-Arm Pilot Trial." Headache: The Journal of Head and Face Pain 58, no. 7: 1060-1073.
Pain is a clinical hallmark of sickle cell disease (SCD), and is rarely optimally managed. Cognitive-behavioral therapy (CBT) for pain has been effectively delivered through the Internet in other pediatric populations. We tested feasibility and acceptability of an Internet-delivered CBT intervention in 25 adolescents with SCD (64% female, mean age=14.8 y) and their parents randomized to Internet CBT (n=15) or Internet Pain Education (n=10). Participants completed pretreatment/posttreatment measures. Eight dyads completed semistructured interviews to evaluate treatment acceptability. Feasibility indicators included recruitment and participation rates, engagement and adherence to intervention, and completion of outcome measures. In total, 87 referrals were received from 9 study sites; our recruitment rate was 60% from those families approached for screening. Among participants, high levels of initial intervention engagement (>90%), and adherence (>70%) were demonstrated. Most participants completed posttreatment outcome and diary measures (>75%). Retention at posttreatment was 80%. High treatment acceptability was reported in interviews. Our findings suggest that Internet-delivered CBT for SCD pain is feasible and acceptable to adolescents with SCD and their parents. Engagement and adherence were good. Next steps are to modify recruitment plans to enhance enrollment and determine efficacy of Internet CBT for SCD pain in a large multisite randomized controlled trial.
Tonya M. Palermo; Joanne Dudeney; James P. Santanelli; Alexie Carletti; William T. Zempsky. Feasibility and Acceptability of Internet-delivered Cognitive Behavioral Therapy for Chronic Pain in Adolescents With Sickle Cell Disease and Their Parents. Journal of Pediatric Hematology/Oncology 2018, 40, 122 -127.
AMA StyleTonya M. Palermo, Joanne Dudeney, James P. Santanelli, Alexie Carletti, William T. Zempsky. Feasibility and Acceptability of Internet-delivered Cognitive Behavioral Therapy for Chronic Pain in Adolescents With Sickle Cell Disease and Their Parents. Journal of Pediatric Hematology/Oncology. 2018; 40 (2):122-127.
Chicago/Turabian StyleTonya M. Palermo; Joanne Dudeney; James P. Santanelli; Alexie Carletti; William T. Zempsky. 2018. "Feasibility and Acceptability of Internet-delivered Cognitive Behavioral Therapy for Chronic Pain in Adolescents With Sickle Cell Disease and Their Parents." Journal of Pediatric Hematology/Oncology 40, no. 2: 122-127.
The experience of paediatric asthma is associated with increased stress and emotional difficulties for both the child and family. The current study aimed to qualitatively explore parents’ views of their child's asthma experience, from initial diagnosis onwards, to enhance our understanding of how families emotionally adjust and adapt to the diagnosis and management of asthma. Semi-structured interviews were conducted with 17 parents of children (
Joanne Dudeney; Louise Sharpe; Caroline Hunt. Understanding the Impact of Paediatric Asthma on Families: Development of a Theoretical Model. Behaviour Change 2017, 34, 253 -266.
AMA StyleJoanne Dudeney, Louise Sharpe, Caroline Hunt. Understanding the Impact of Paediatric Asthma on Families: Development of a Theoretical Model. Behaviour Change. 2017; 34 (4):253-266.
Chicago/Turabian StyleJoanne Dudeney; Louise Sharpe; Caroline Hunt. 2017. "Understanding the Impact of Paediatric Asthma on Families: Development of a Theoretical Model." Behaviour Change 34, no. 4: 253-266.
Anxiety disorders are highly prevalent in children with asthma yet very little is known about the parenting factors that may underlie this relationship. The aim of the current study was to examine observed parenting behaviours - involvement and negativity - associated with asthma and anxiety in children using the tangram task and the Five Minute Speech Sample (FMSS). Eighty-nine parent-child dyads were included across four groups of children (8-13 years old): asthma and anxiety, anxiety only, asthma only and healthy controls. Overall, results from both tasks showed that parenting behaviours of children with and without asthma did not differ significantly. Results from a subcomponent of the FMSS indicated that parents of children with asthma were more overprotective, or self-sacrificing, or non-objective than parents of children without asthma, and this difference was greater in the non-anxious groups. The results suggest that some parenting strategies developed for parents of children with anxiety may be useful for parents of children with asthma and anxiety (e.g. strategies targeting involvement), however, others may not be necessary (e.g. those targeting negativity).
Gemma Sicouri; Louise Sharpe; Jennie Hudson; Joanne Dudeney; Adam Jaffe; Hiran Selvadurai; Caroline Hunt. Parent-child interactions in children with asthma and anxiety. Behaviour Research and Therapy 2017, 97, 242 -251.
AMA StyleGemma Sicouri, Louise Sharpe, Jennie Hudson, Joanne Dudeney, Adam Jaffe, Hiran Selvadurai, Caroline Hunt. Parent-child interactions in children with asthma and anxiety. Behaviour Research and Therapy. 2017; 97 ():242-251.
Chicago/Turabian StyleGemma Sicouri; Louise Sharpe; Jennie Hudson; Joanne Dudeney; Adam Jaffe; Hiran Selvadurai; Caroline Hunt. 2017. "Parent-child interactions in children with asthma and anxiety." Behaviour Research and Therapy 97, no. : 242-251.
Anxiety often presents comorbidly with asthma in youth under 18; however, prevalence rates are unclear. The aim of this review was to provide an up-to-date analysis of the literature investigating the prevalence of anxiety disorders, and comparisons of anxiety disorders and symptomatology in youth with asthma, compared to those without. A systematic search was conducted using the databases PsycINFO, MEDLINE, EMBASE, and CINAHL. The search process produced 15 studies (n = 7443) reporting data on youth with asthma and anxiety disorders, 11 studies (n = 10 332) reporting data on youth with and without asthma and anxiety disorders, and 28 studies (n = 5848) reporting data on youth with and without asthma and anxiety symptomatology. Youth with asthma had an anxiety disorder prevalence rate of 22.7%. Youth with asthma also had a greater number of anxiety disorders, compared to those without asthma (d = 0.37, 95%CI: 0.24-0.50, P < 0.001), and higher levels of anxiety symptomatology than youth without asthma (d = 0.29, 95%CI: 0.19-0.39, P < 0.001). Youth with asthma display a prevalence rate for anxiety disorders that is more than three times higher than the prevalence in healthy youth. For the specific anxiety disorders investigated, elevated prevalence rates for youth with asthma were also found. Future research needs to focus on the factors that mediate or predict the development and maintenance of anxiety in youth with asthma and the development of clinically efficacious treatments.
Joanne Dudeney; Louise Sharpe; Adam Jaffe; Emma B. Jones; Caroline Hunt. Anxiety in youth with asthma: A meta-analysis. Pediatric Pulmonology 2017, 52, 1121 -1129.
AMA StyleJoanne Dudeney, Louise Sharpe, Adam Jaffe, Emma B. Jones, Caroline Hunt. Anxiety in youth with asthma: A meta-analysis. Pediatric Pulmonology. 2017; 52 (9):1121-1129.
Chicago/Turabian StyleJoanne Dudeney; Louise Sharpe; Adam Jaffe; Emma B. Jones; Caroline Hunt. 2017. "Anxiety in youth with asthma: A meta-analysis." Pediatric Pulmonology 52, no. 9: 1121-1129.
Decades of research have emphasized the role that coercive and ineffective discipline plays in shaping child and adolescent conduct problems, yet an emerging body of evidence has suggested that parents' emotion socialization behaviors (ESBs) (e.g., reactions to emotions, discussion of emotions, and emotion coaching) may also be implicated. This meta-analysis examined concurrent and longitudinal associations between parental ESBs and conduct problems, and tested for moderators of these associations. A systematic search identified 49 studies for which data on concurrent associations between ESBs and conduct problems were available ( n = 6270), and 14 studies reporting on prospective associations ( n = 1899). Parental ESBs were found to be significantly associated with concurrent ( r = − 0.08) and prospective ( r = − 0.11) conduct problems, in the order of small effect sizes. Key findings of moderator analyses were that ESBs were more strongly associated with conduct problems at younger ages and when ESBs were focused on the socialization of negative rather than positive emotions. Findings support the integration of ESBs into family-based models of antisocial behavior, and have the potential to inform the design of parent training interventions for the prevention and treatment of child conduct problems.
Ameika M. Johnson; David J. Hawes; Nancy Eisenberg; Jane Kohlhoff; Joanne Dudeney. Emotion socialization and child conduct problems: A comprehensive review and meta-analysis. Clinical Psychology Review 2017, 54, 65 -80.
AMA StyleAmeika M. Johnson, David J. Hawes, Nancy Eisenberg, Jane Kohlhoff, Joanne Dudeney. Emotion socialization and child conduct problems: A comprehensive review and meta-analysis. Clinical Psychology Review. 2017; 54 ():65-80.
Chicago/Turabian StyleAmeika M. Johnson; David J. Hawes; Nancy Eisenberg; Jane Kohlhoff; Joanne Dudeney. 2017. "Emotion socialization and child conduct problems: A comprehensive review and meta-analysis." Clinical Psychology Review 54, no. : 65-80.
Anxiety disorders occur at an increased rate in children with asthma; however, there is only a small evidence base to support specific psychological treatments for these children. The current study evaluated the efficacy of a pilot cognitive behavioural treatment (CBT) group intervention for children with asthma and a comorbid anxiety disorder in a case series design. Five children (aged 8–11 years old) with asthma and a comorbid anxiety disorder and their mothers took part in eight 1-hour group treatment sessions. Primary outcomes measures were anxiety diagnosis and asthma-related quality of life. Secondary outcome measures were asthma symptom control and parent quality of life associated with caring for a child with asthma. Three of the participants no longer met diagnostic criteria for an anxiety disorder following treatment and three different participants reported a reliable improvement in asthma-related quality of life. Two participants reported a reliable improvement in asthma symptom control. Three mothers reported an improvement in caregiver quality of life. The findings provide preliminary proof of concept evidence for the efficacy of a CBT intervention for children with asthma and clinical anxiety.
Gemma Sicouri; Louise Sharpe; Jennie Hudson; Joanne Dudeney; Adam Jaffe; Caroline Hunt. A Case Series Evaluation of a Pilot Group Cognitive Behavioural Treatment for Children With Asthma and Anxiety. Behaviour Change 2017, 34, 35 -47.
AMA StyleGemma Sicouri, Louise Sharpe, Jennie Hudson, Joanne Dudeney, Adam Jaffe, Caroline Hunt. A Case Series Evaluation of a Pilot Group Cognitive Behavioural Treatment for Children With Asthma and Anxiety. Behaviour Change. 2017; 34 (1):35-47.
Chicago/Turabian StyleGemma Sicouri; Louise Sharpe; Jennie Hudson; Joanne Dudeney; Adam Jaffe; Caroline Hunt. 2017. "A Case Series Evaluation of a Pilot Group Cognitive Behavioural Treatment for Children With Asthma and Anxiety." Behaviour Change 34, no. 1: 35-47.
Anxiety disorders are highly prevalent in children with asthma yet very little is known about the cognitive and parent factors that may underpin this relationship. The present study investigated interpretation biases in children with asthma and anxiety and their parents, and whether parent-child discussions influenced children's interpretations. Eighty-nine parent-child dyads were included across four groups: children with asthma and anxiety, children with anxiety only, children with asthma only and healthy children (aged between 8 and 13 years old). Interpretation bias was assessed using ambiguous scenarios. Children with anxiety showed an interpretation bias in the general threat scenarios, whereas children with asthma showed an interpretation bias in the asthma threat scenarios. Parental predictions of their child's responses showed similar results. Parent-child discussions increased avoidance for children with anxiety and no asthma across all scenarios, but only for children with asthma and anxiety in the asthma threat scenarios. The results provide partial support for a cognitive theory of asthma and anxiety in children and suggest that parents play a role in influencing children's thinking styles. Treatment programs could thus aim to target and modify interpretation biases in children with anxiety, and include parents as part of treatment.
Gemma Sicouri; Louise Sharpe; Jennie Hudson; Jo Dudeney; Adam Jaffe; Hiran Selvadurai; Sarah Lorimer; Caroline Hunt. Threat interpretation and parental influences for children with asthma and anxiety. Behaviour Research and Therapy 2017, 89, 14 -23.
AMA StyleGemma Sicouri, Louise Sharpe, Jennie Hudson, Jo Dudeney, Adam Jaffe, Hiran Selvadurai, Sarah Lorimer, Caroline Hunt. Threat interpretation and parental influences for children with asthma and anxiety. Behaviour Research and Therapy. 2017; 89 ():14-23.
Chicago/Turabian StyleGemma Sicouri; Louise Sharpe; Jennie Hudson; Jo Dudeney; Adam Jaffe; Hiran Selvadurai; Sarah Lorimer; Caroline Hunt. 2017. "Threat interpretation and parental influences for children with asthma and anxiety." Behaviour Research and Therapy 89, no. : 14-23.
Children with asthma have a high prevalence of anxiety disorders, however, very little is known about the mechanisms that confer vulnerability for anxiety in this population. This study investigated whether children with asthma and anxiety disorders display attentional biases towards threatening stimuli, similar to what has been seen in children with anxiety disorders more generally. We also examined the relationships between attentional biases and anxiety symptomatology and asthma control for children with asthma. Ninety-three children, aged 8-13, took part in the study and were recruited into one of four conditions (asthma/anxiety, asthma, anxiety, control). Asthma was medically confirmed and anxiety was assessed through clinical interview. We used self- and parent-report questionnaires to measure child asthma (ATAQ) and anxiety (SCAS, CASI) variables. Participants completed a visual dot-probe task designed to measure attentional bias towards two types of stimuli: asthma related words and general threat words, as well as tasks to assess reading ability and attentional control. Results showed that attentional biases did not differ between the groups, although children with anxiety disorders displayed poorer attentional control. A significant correlation was found between poor asthma control and an attentional bias of asthma stimuli. While we found no evidence that anxiety disorders in children with asthma were associated with threat- or asthma-related attentional biases, preliminary evidence suggested that children with poor asthma control displayed biases towards asthma-specific stimuli. Future research is needed to explore whether these attentional biases are adaptive.
Joanne Dudeney; Louise Sharpe; Gemma Sicouri; Sarah Lorimer; Hiran Selvadurai; Caroline Hunt; Blake F. Dear; Adam Jaffe. Attentional Bias in Children with Asthma with and without Anxiety Disorders. Journal of Abnormal Child Psychology 2017, 45, 1635 -1646.
AMA StyleJoanne Dudeney, Louise Sharpe, Gemma Sicouri, Sarah Lorimer, Hiran Selvadurai, Caroline Hunt, Blake F. Dear, Adam Jaffe. Attentional Bias in Children with Asthma with and without Anxiety Disorders. Journal of Abnormal Child Psychology. 2017; 45 (8):1635-1646.
Chicago/Turabian StyleJoanne Dudeney; Louise Sharpe; Gemma Sicouri; Sarah Lorimer; Hiran Selvadurai; Caroline Hunt; Blake F. Dear; Adam Jaffe. 2017. "Attentional Bias in Children with Asthma with and without Anxiety Disorders." Journal of Abnormal Child Psychology 45, no. 8: 1635-1646.
This is the protocol for a review and there is no . The objectives are as follows:To assess beneficial and adverse effects of psychological treatment versus active alternative treatment or no treatment in adults with migraine, using methods that allow comparison with reviews of psychological interventions for other painful conditions.
Louise Sharpe; Amanda C De C Williams; Paul R Martin; Michael Nicholas; Miriam Welgampola; Ingrid McPhee; Andrew Baillie; Joanne Dudeney; Brian McGuire. Psychological therapies for the prevention of migraine in adults. Cochrane Database of Systematic Reviews 2016, 1 .
AMA StyleLouise Sharpe, Amanda C De C Williams, Paul R Martin, Michael Nicholas, Miriam Welgampola, Ingrid McPhee, Andrew Baillie, Joanne Dudeney, Brian McGuire. Psychological therapies for the prevention of migraine in adults. Cochrane Database of Systematic Reviews. 2016; ():1.
Chicago/Turabian StyleLouise Sharpe; Amanda C De C Williams; Paul R Martin; Michael Nicholas; Miriam Welgampola; Ingrid McPhee; Andrew Baillie; Joanne Dudeney; Brian McGuire. 2016. "Psychological therapies for the prevention of migraine in adults." Cochrane Database of Systematic Reviews , no. : 1.