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Citation
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Corwin MD, Orchinik J, D'Alonzo B, Master C, Agarwal AK, Wiebe DJ. Neurology 2022; 98(Suppl 1): S7. |
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Abstract
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OBJECTIVE: To determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) following pediatric concussion.
BACKGROUND: Concussion is a common pediatric injury. Traditionally, outcome assessment has occurred at discrete points-in-time, days or weeks apart, relying on patient's subjective recall of symptoms and activity. EMA is a behavioral measurement approach that allows for reporting of real-time symptoms and behaviors in real-life settings. While feasible in adolescents, the ideal strategy to maximize responsiveness from the emergency department (ED) setting is unknown. DESIGN/METHODS: This was a randomized controlled trial of patients age 13-18 with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Patients were randomized to one of 4 incentive-based arms: 2 dynamic (loss-based and streak) and 2 flat-rate (monetary and electronic device). Through the ReCoUPS app, patients reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a FitBit (which was kept by the participant in the electronic device flat-rate arm). The primary outcome was proportion of prompts to which patients responded. Secondary outcomes included daily symptom change and time to symptom resolution.
RESULTS: Thirty participants were enrolled, median age 15.5 years, 60% female. Median proportion completed was 81% in the loss-based arm, 59% in the streak accrual arm, 50% in the FitBit-received arm, and 57% monetary flat rate arm. Retention was higher in the dynamic compared to the flat arms (68% v. 54%, p = 0.065). There was no significant difference between morning, afternoon, and evening symptoms. Sixty-four percent of participants had symptom resolution during the 3-week follow-up.
CONCLUSIONS: Dynamic incentivization showed higher rates of response to tri-daily symptom prompts compared with flat-fee incentivization. This data shows tracking concussed youth using EMA from ED is feasible using a dynamic incentivization strategy.
Language: en |