{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:09:44Z","timestamp":1789664984222,"version":"4.0.1"},"reference-count":55,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Alternative Funding Plan for the Academic Health Sciences Centres of Ontario (CHAMO)\u2019s Innovation Fund"},{"name":"University of Ottawa Brain and Mind Research Institute Team Grant"},{"name":"CHEO Research Institute Research Growth Award"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants aged 12 to 18 years were recruited from an emergency department within 48\u2005hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes\/day, at a minimum of 4 days\/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median\/max possible\u2009=\u20096.50\/9.00 [6.83,8.75]) and DTx was usable (median\/max possible\u2009=\u200970.00\/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median\/max possible\u2009=\u200927.00\/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median\/max possible\u2009=\u20093.92\/5.00 [3.38\u20134.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Results show 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 MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076241248296","type":"journal-article","created":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:33:57Z","timestamp":1714523637000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Acceptability, usability, and credibility of a mindfulness-based digital therapeutic for pediatric concussion: A mixed-method study"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2452-934X","authenticated-orcid":false,"given":"Veronik","family":"Sicard","sequence":"first","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiarah","family":"O\u2019Kane","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Brown","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Butterfield","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kardish","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Choi","sequence":"additional","affiliation":[{"name":"Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0069-2900","authenticated-orcid":false,"given":"Katherine","family":"Healey","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra M","family":"Smith","sequence":"additional","affiliation":[{"name":"School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Goldfield","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bechara J","family":"Saab","sequence":"additional","affiliation":[{"name":"Mobio Interactive, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Gray","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Goulet","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Anderson","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Mackie","sequence":"additional","affiliation":[{"name":"Essential Change, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Roth","sequence":"additional","affiliation":[{"name":"MBSR Junior, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Osmond","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Cairncross","sequence":"additional","affiliation":[{"name":"Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9e-Anne","family":"Ledoux","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"},{"name":"School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"bibr1-20552076241248296","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","volume":"51","author":"McCrory P","year":"2017","journal-title":"Br J Sports Med"},{"key":"bibr2-20552076241248296","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2018.3820","volume":"173","author":"Ledoux AA","year":"2019","journal-title":"JAMA Pediatr"},{"key":"bibr3-20552076241248296","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jpeds.2022.03.039","volume":"246","author":"Chadwick L","year":"2022","journal-title":"J Pediatr"},{"key":"bibr4-20552076241248296","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1001\/jama.2016.1203","volume":"315","author":"Zemek R","year":"2016","journal-title":"J Am Med Assoc"},{"key":"bibr5-20552076241248296","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2016.2900","volume":"170","author":"Novak Z","year":"2016","journal-title":"JAMA Pediatr"},{"key":"bibr6-20552076241248296","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1080\/02699052.2021.2008490","volume":"35","author":"Chrisman SPD","year":"2021","journal-title":"Brain Inj"},{"key":"bibr7-20552076241248296","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1136\/bjsports-2020-103548","volume":"55","author":"Gornall A","year":"2021","journal-title":"Br J Sports Med"},{"key":"bibr8-20552076241248296","doi-asserted-by":"crossref","first-page":"114542","DOI":"10.1016\/j.psychres.2022.114542","volume":"312","author":"Ziminski D","year":"2022","journal-title":"Psychiatry Res"},{"key":"bibr9-20552076241248296","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.1235","volume":"5","author":"Ledoux AA","year":"2022","journal-title":"JAMA Netw Open"},{"key":"bibr10-20552076241248296","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3109\/02699052.2014.974674","volume":"29","author":"Broshek DK","year":"2015","journal-title":"Brain Inj"},{"key":"bibr11-20552076241248296","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1089\/neu.2014.3600","volume":"32","author":"Silverberg ND","year":"2015","journal-title":"J Neurotrauma"},{"key":"bibr12-20552076241248296","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1136\/bjsports-2017-097729","volume":"51","author":"Iverson GL","year":"2017","journal-title":"Br J Sports Med"},{"key":"bibr13-20552076241248296","volume-title":"Wherever you go, there you are: mindfulness meditation in everyday life","author":"Kabat-Zinn J","year":"1994"},{"key":"bibr14-20552076241248296","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1136\/ebmental-2022-300464","volume":"25","author":"Dunning D","year":"2022","journal-title":"Evid Based Ment Health"},{"key":"bibr15-20552076241248296","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s12671-018-0998-9","volume":"10","author":"McKeering P","year":"2019","journal-title":"Mindfulness (N Y)"},{"key":"bibr16-20552076241248296","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2147\/PRBM.S157503","volume":"11","author":"Bazzano AN","year":"2018","journal-title":"Psychol Res Behav Manag"},{"key":"bibr17-20552076241248296","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1089\/acm.2009.0321","volume":"16","author":"Zeidan F","year":"2010","journal-title":"J Altern Complement Med"},{"key":"bibr18-20552076241248296","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.concog.2010.03.014","volume":"19","author":"Zeidan F","year":"2010","journal-title":"Conscious Cogn"},{"key":"bibr19-20552076241248296","doi-asserted-by":"crossref","DOI":"10.2196\/10844","volume":"6","author":"Walsh KM","year":"2019","journal-title":"JMIR Ment Health"},{"key":"bibr20-20552076241248296","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.cpr.2016.03.009","volume":"45","author":"Spijkerman MPJ","year":"2016","journal-title":"Clin Psychol Rev"},{"key":"bibr21-20552076241248296","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1007\/s12671-019-01163-1","volume":"10","author":"Howarth A","year":"2019","journal-title":"Mindfulness (N Y)"},{"key":"bibr22-20552076241248296","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/aphw.12244","volume":"13","author":"Acabchuk RL","year":"2021","journal-title":"Appl Psychol Health Well-Being"},{"key":"bibr23-20552076241248296","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/HTR.0b013e318250ebda","volume":"28","author":"Azulay J","year":"2013","journal-title":"J Head Trauma Rehabil"},{"key":"bibr24-20552076241248296","doi-asserted-by":"crossref","DOI":"10.17761\/2023-D-21-00074","volume":"33","author":"Devore E","year":"2023","journal-title":"Int J Yoga Ther"},{"key":"bibr25-20552076241248296","doi-asserted-by":"crossref","first-page":"7301205040p1","DOI":"10.5014\/ajot.2019.027672","volume":"73","author":"Paniccia M","year":"2019","journal-title":"Am J Occup Ther"},{"key":"bibr26-20552076241248296","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s12671-017-0761-7","volume":"9","author":"van Emmerik AAP","year":"2018","journal-title":"Mindfulness (N Y)"},{"key":"bibr27-20552076241248296","doi-asserted-by":"crossref","first-page":"840","DOI":"10.3389\/fneur.2019.00840","volume":"10","author":"Ellis MJ","year":"2019","journal-title":"Front Neurol"},{"key":"bibr28-20552076241248296","doi-asserted-by":"crossref","DOI":"10.2196\/16317","volume":"22","author":"Liverpool S","year":"2020","journal-title":"J Med Internet Res"},{"key":"bibr29-20552076241248296","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2020.103","volume":"6","author":"Edbrooke-Childs J","year":"2020","journal-title":"BJPsych Open"},{"key":"bibr30-20552076241248296","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/tmj.2013.0214","volume":"20","author":"Pramana G","year":"2014","journal-title":"Telemed E-Health"},{"key":"bibr31-20552076241248296","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1080\/13811118.2016.1182094","volume":"21","author":"McManama O\u2019Brien KH","year":"2017","journal-title":"Arch Suicide Res"},{"key":"bibr32-20552076241248296","doi-asserted-by":"crossref","DOI":"10.2196\/mental.4370","volume":"2","author":"Kenny R","year":"2015","journal-title":"JMIR Ment Health"},{"key":"bibr33-20552076241248296","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1099800418789777","volume":"21","author":"Lengacher CA","year":"2019","journal-title":"Biol Res Nurs"},{"key":"bibr34-20552076241248296","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s12671-020-01502-7","volume":"12","author":"Smith JL","year":"2021","journal-title":"Mindfulness (N Y)"},{"key":"bibr35-20552076241248296","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jad.2020.09.134","volume":"279","author":"G\u00e1l \u00c9","year":"2021","journal-title":"J Affect Disord"},{"key":"bibr36-20552076241248296","volume-title":"ICD-10: international statistical classification of diseases and related health problems: tenth revision","author":"World Health Organization","year":"2004","edition":"2"},{"key":"bibr37-20552076241248296","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"Harris PA","year":"2009","journal-title":"J Biomed Inform"},{"key":"bibr38-20552076241248296","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","volume":"95","author":"Harris PA","year":"2019","journal-title":"J Biomed Inform"},{"key":"bibr39-20552076241248296","doi-asserted-by":"crossref","DOI":"10.2196\/15178","volume":"9","author":"Subnis UB","year":"2020","journal-title":"JMIR Res Protoc"},{"key":"bibr40-20552076241248296","doi-asserted-by":"crossref","unstructured":"Chwyl B, Chung A, Amelara R, et al.\n                      SAPPHIRE: stochastically acquired photoplethysmogram for heart rate inference in realistic environments\n                      . 2016.","DOI":"10.1109\/ICIP.2016.7532554"},{"key":"bibr41-20552076241248296","doi-asserted-by":"crossref","first-page":"101929","DOI":"10.1016\/j.bspc.2020.101929","volume":"59","author":"Al-Jebrni AH","year":"2020","journal-title":"Biomed Signal Process Control"},{"key":"bibr42-20552076241248296","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0005-7916(00)00012-4","volume":"31","author":"Devilly GJ","year":"2000","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"bibr43-20552076241248296","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/0149-7189(79)90094-6","volume":"2","author":"Larsen DL","year":"1979","journal-title":"Eval Program Plann"},{"key":"bibr44-20552076241248296","first-page":"189","volume-title":"Usability evaluation in industry","author":"Brooke J","year":"1996"},{"key":"bibr45-20552076241248296","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1002\/jclp.22823","volume":"76","author":"G\u00f3mez Penedo JM","year":"2020","journal-title":"J Clin Psychol"},{"key":"bibr46-20552076241248296","unstructured":"Table 22-10-0115-01 Smartphone use and smartphone habits by gender and age group, inactive. https:\/\/doi.org\/10.25318\/2210011501-eng. 2022"},{"key":"bibr47-20552076241248296","unstructured":"Ofcom.\n                      Children and parents: media use and attitudes report 2020\/21\n                      . https:\/\/www.ofcom.org.uk\/research-and-data\/media-literacy-research\/childrens\/children-and-parents-media-use-and-attitudes-report-2021 (2022, accessed 12 October 2022)."},{"key":"bibr48-20552076241248296","unstructured":"Common Sense.\n                      The Common Sense Census: media use by tweens and teens\n                      . 2019."},{"key":"bibr49-20552076241248296","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/AJP.0b013e318164aa75","volume":"24","author":"Smeets RJEM","year":"2008","journal-title":"Clin J Pain"},{"key":"bibr50-20552076241248296","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0124258","volume":"10","author":"El Alaoui S","year":"2015","journal-title":"PloS One"},{"key":"bibr51-20552076241248296","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jad.2018.05.009","volume":"238","author":"Uebelacker LA","year":"2018","journal-title":"J Affect Disord"},{"key":"bibr52-20552076241248296","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1521\/ijct.2010.3.3.245","volume":"3","author":"Newman MG","year":"2010","journal-title":"Int J Cogn Ther"},{"key":"bibr53-20552076241248296","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5127\/jep.033712","volume":"5","author":"Thompson-Hollands J","year":"2014","journal-title":"J Exp Psychopathol"},{"key":"bibr54-20552076241248296","doi-asserted-by":"crossref","first-page":"850590","DOI":"10.3389\/fneur.2022.850590","volume":"13","author":"Sheldrake E","year":"2022","journal-title":"Front Neurol"},{"key":"bibr55-20552076241248296","doi-asserted-by":"crossref","DOI":"10.2196\/57226","volume":"13","author":"Ledoux AA","year":"2024","journal-title":"JMIR Res Protoc"}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076241248296","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076241248296","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076241248296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:50:59Z","timestamp":1777398659000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076241248296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":55,"alternative-id":["10.1177\/20552076241248296"],"URL":"https:\/\/doi.org\/10.1177\/20552076241248296","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"article-number":"20552076241248296"}}