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Jarlman E, Hägglund G, Alriksson-Schmidt AI. Foot and lower leg pain in children and adults with cerebral palsy: a population-based register study on 5,122 individuals. BMC Musculoskelet Disord 2024; 25:391. [PMID: 38762469 PMCID: PMC11102238 DOI: 10.1186/s12891-024-07486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Pain is common in individuals with cerebral palsy (CP) and the most reported pain site is the foot/lower leg. We analyzed the prevalence of pain in the foot/lower leg and the associations with age, sex, gross motor function, and clinical findings in individuals with CP. METHOD This was a cross-sectional register-study, based on data reported to the Swedish Cerebral Palsy Follow-up Program (CPUP). All participants in CPUP, four years-of-age or older, were included. Pearson chi-square tests and logistic regression were used to analyze the prevalence and degree of pain in the foot/lower leg. RESULTS In total, 5,122 individuals were included from the CPUP database: 58% were males and 66% were under 18 years-of-age. Overall, 1,077 (21%) reported pain in the foot/lower leg. The odds ratios (ORs) of pain were higher in females (OR 1.31, 95% confidence interval (CI) 1.13-1.53), individuals who could ambulate (Gross Motor Function Classification System Level I (OR 1.84, CI 1.32-2.57) and II (OR 2.01, CI 1.46-2.79) compared to level V), and in individuals with decreased range of motion of the ankle (dorsiflexion 1-10 degrees (OR 1.43, CI 1.13-1.83) and ≤ 0 degrees (OR 1.46, CI 1.10-1.93) compared to ≥ 20 degrees). With increasing age the OR of pain increased (OR 1.02, CI 1.01-1.03) as well as the reported pain intensity (p < 0.001). CONCLUSIONS Pain in the foot and lower leg appears to be a significant problem in individuals with CP, particularly in those who walk. As with pain in general in this population, both pain intensity and frequency increase with age. The odds of pain in the foot and lower leg were increased in individuals with limited dorsiflexion of the ankle. Given the cross-sectional design causality cannot be inferred and it is unknown if pain causes decreased range of motion of the ankle or if decreased range of motion causes pain. Further research is needed on causal pathways and importantly on prevention.
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Affiliation(s)
- Ebba Jarlman
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
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Guízar-Sánchez C, Hernández-Díaz C, Guízar-Sánchez D, Meza-Sánchez AV, Torres-Serrano A, Camacho Cruz ME, Ventura-Ríos L. Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:512. [PMID: 37349815 DOI: 10.1186/s12891-023-06610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.
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Affiliation(s)
- Claudia Guízar-Sánchez
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | | | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, México, Av. Universidad 3004, Col. Copilco Universidad, Alcaldía Coyoacán, Cd. Universitaria.
| | - Ana Victoria Meza-Sánchez
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán., Ciudad de México, México
| | - Alejandra Torres-Serrano
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - María Elena Camacho Cruz
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - Lucio Ventura-Ríos
- Rheumatology Department, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, México
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Aydın Aİ, Özyazıcıoğlu N. Assessment of postoperative pain in children with computer assisted facial expression analysis. J Pediatr Nurs 2023; 71:60-65. [PMID: 37004311 DOI: 10.1016/j.pedn.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The present study was conducted to evaluate the use of computer-aided facial expression analysis to assess postoperative pain in children. DESIGN AND METHODS This was a methodological observational study. The study population consisted of patients in the age group of 7-18 years who underwent surgery in the pediatric surgery clinic of a university hospital. The study sample consisted of 83 children who agreed to participate and met the sample selection criteria. Data were collected by the researcher using the Wong Baker Faces pain rating scale and Visual Analog Scale. Data were collected from the child, mother, nurse, and one external observer. Facial action units associated with pain were used for machine estimation. OpenFace was used to analyze the child's facial action units and Python was used for machine learning algorithms. The intraclass correlation coefficient was used for statistical analysis of the data. RESULTS The pain score predicted by the machine and the pain score assessments of the child, mother, nurse, and observer were compared. The pain assessment closest to the self-reported pain score by the child was in the order of machine prediction, mother, and nurse. CONCLUSIONS The machine learning method used in pain assessment in children performed well in estimating pain severity.It can code facial expressions of children's pain and reliably measure pain-related facial action units from video recordings. APPLICATION TO PRACTICE The machine learning method for facial expression analysis assessed in this study can potentially be used as a scalable, standard, and valid pain assessment method for nurses in clinical practice.
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Affiliation(s)
- Ayla İrem Aydın
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, 16000 Bursa, Turkey.
| | - Nurcan Özyazıcıoğlu
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, 16000 Bursa, Turkey.
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Zhou H, Albrecht MA, Roberts PA, Porter P, Della PR. Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression. Pain Rep 2022; 7:e1029. [PMID: 36168394 PMCID: PMC9509055 DOI: 10.1097/pr9.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Accurate assessment of pediatric pain remains a challenge, especially for children who are preverbal or unable to communicate because of their health condition or a language barrier. A 2008 meta-analysis of 12 studies found a moderate correlation between 3 dyads (child-caregiver, child-nurse, and caregiver-nurse). We updated this meta-analysis, adding papers published up to August 8, 2021, and that included intraclass correlation/weighted kappa statistics (ICC/WK) in addition to standard correlation. Forty studies (4,628 children) were included. Meta-analysis showed moderate pain rating consistency between child and caregiver (ICC/WK = 0.51 [0.39-0.63], correlation = 0.59 [0.52-0.65], combined = 0.55 [0.48-0.62]), and weaker consistency between child and health care provider (HCP) (ICC/WK = 0.38 [0.19-0.58], correlation = 0.49 [0.34-0.55], combined = 0.45; 95% confidence interval 0.34-0.55), and between caregiver and HCP (ICC/WK = 0.27 [-0.06 to 0.61], correlation = 0.49 [0.32 to 0.59], combined = 0.41; 95% confidence interval 0.22-0.59). There was significant heterogeneity across studies for all analyses. Metaregression revealed that recent years of publication, the pain assessment tool used by caregivers (eg, Numerical Rating Scale, Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale), and surgically related pain were each associated with greater consistency in pain ratings between child and caregiver. Pain caused by surgery was also associated with improved rating consistency between the child and HCP. This updated meta-analysis warrants pediatric pain assessment researchers to apply a comprehensive pain assessment scale Patient-Reported Outcomes Measurement Information System to acknowledge psychological and psychosocial influence on pain ratings.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Perth Children's Hospital, Nedlands, WA, Australia.,Curtin School of Nursing, Curtin University, Bentley, WA, Australia
| | | | - Pam A Roberts
- Curtin School of Nursing, Curtin University, Bentley, WA, Australia
| | - Paul Porter
- Pediatrician, Joondalup Health Campus, Joondalup, WA, Australia
| | - Phillip R Della
- Curtin School of Nursing, Curtin University, Perth, Western Australia
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Özcan F, Ünsal Delialioğlu S, Özel S, Demir Y. Perception of pain in patients with adolescent cerebral palsy: self report or parent's report. Somatosens Mot Res 2022; 39:91-96. [PMID: 34881687 DOI: 10.1080/08990220.2021.2014805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare mothers' report on children's pain with patients' own reports and to explore the prevalence, intensity, localisation and the effect of pain on daily living activities of adolescents with CP. MATERIALS AND METHODS A total of 75 adolescent with CP (34 females and 41 males) and their mothers were included in this cross-sectional study. Demographical and clinical characteristics were recorded. The adolescent and the mother independently completed the pain questionnaire in a face-to-face interview administrated by a physiatrist. RESULTS The prevalance of pain in the previous week was 28% by self report and was 40% by mothers' report. No significant difference was determined between mother's report and self report (p = 0.121). There was no significant difference in the prevalence of pain, pain intensity, and the effect of pain on activities of daily living according to Gross Motor Functional Classification System levels and CP types in terms of mothers' report and self report. CONCLUSIONS Pain is a common condition in adolescents with CP and it affects quality of life negatively. While the self-report of pain is ideal, parent's reports in various situations is important for the assessment of pain.
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Affiliation(s)
- Fatma Özcan
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | - Sumru Özel
- Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Yasin Demir
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Guard A, Konz M, Smith RO, Engel JM, Keating T. The development of an iPad application for the pain assessment of individuals with developmental disabilities and complex communication needs. Assist Technol 2021; 33:178-189. [PMID: 31169462 DOI: 10.1080/10400435.2019.1612797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aims: Develop a new pain assessment for youth with communication challenges. The Guard-Putzer Pain Assessment Domains (gPAD) mobile application (app) was designed and tested as a universally accessible way for youth, ages 7-12 years, with a developmental disability (DD) to express their pain experiences through self-report. Methods: A two-phase process developed the design for an app, created an interactive prototype, and tested its face validity and user interface. This work included a comprehensive scoping review of current assessments and pain apps as well as a survey to obtain descriptive data on the clinical practicality of the gPAD to guide the app design. Additionally, 15 therapists reviewed the gPAD assessment. Results: Thirteen respondents (87%) agreed to the statement that they would use the gPAD for this population. School-based practitioners seemed to highlight the most significant needs for the app. Conclusions: Advancement of this app could mainstream the assessment of pain in youth with DD, and other potential populations.
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Affiliation(s)
- Alyssa Guard
- Occupational Therapy, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Michelle Konz
- Occupational Therapy, University of Wisconsin-Milwaukee, Oshkosh, Wisconsin, USA
| | - Roger O Smith
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joyce M Engel
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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7
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Nelson JA, Boyer ER. Perceived Limitations of Walking in Individuals With Cerebral Palsy. Phys Ther 2021; 101:6184953. [PMID: 33764475 DOI: 10.1093/ptj/pzab102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Impairments associated with cerebral palsy (CP) can affect gait quality and limit activity and participation. The purpose of this study was to quantify (1) which of 6 factors (pain, weakness, endurance, mental ability, safety concerns, balance) were perceived to limit walking ability the most in individuals with CP and (2) whether age or Gross Motor Function Classification System (GMFCS) level is related to that perception. METHODS This cross-sectional study queried data from a gait laboratory database. Perceived walking limitation was quantified using a 5-point Likert scale ("never" to "all of the time"). Included were 1566 children and adults (mean age = 10.9 y [SD = 6.8]; range = 3.0-72.1 y) with CP (GMFCS level I: 502; II: 564; III: 433; IV: 67). RESULTS Patients or caregivers perceived balance to limit walking ability to the greatest extent, followed by endurance, weakness, safety, mental ability, and pain. Balance was perceived to always limit walking ability in 8%, 22%, 30%, and 34% of individuals in GMFCS levels I through IV, respectively. Endurance was perceived to always limit walking ability in 5%, 13%, 13%, and 27% of individuals in GMFCS levels I through IV, respectively. There were minor differences in the perceived extent of limitation caused by the factors by GMFCS level. Only weak associations between age and pain, mental ability, safety, and balance were observed (Spearman rho = -0.13 to 0.24). CONCLUSION Patients or caregivers perceived decreased balance and endurance to most strongly limit walking ability. Efforts should be made to clinically track how both perceived and objective measures of these limiting factors change with age and intervention. IMPACT Following a patient- and family-centered care model, therapy that places greater emphasis on balance and cardiovascular endurance may have the greatest effect on walking ability for individuals with CP. Future research should quantify which therapeutic, surgical, and pharmacologic interventions minimize these impairments and optimize activity and participation. LAY SUMMARY Balance and endurance are perceived to be the greatest factors limiting walking in people with CP. If you have CP, your physical therapist might emphasize balance and cardiovascular endurance to improve your walking ability.
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Affiliation(s)
- Jennifer A Nelson
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA
| | - Elizabeth R Boyer
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA.,Department of Orthopedic Surgery, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
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8
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Hägglund G, Burman-Rimstedt A, Czuba T, Alriksson-Schmidt AI. Self-versus Proxy-Reported Pain in Children with Cerebral Palsy: A Population-Based Registry Study of 3783 Children. J Prim Care Community Health 2021; 11:2150132720911523. [PMID: 32172660 PMCID: PMC7074487 DOI: 10.1177/2150132720911523] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: To assess how the prevalence of pain in a population-based sample of children and adolescents with cerebral palsy (CP) differ based on self- or proxy reporting. Methods: This cross-sectional registry study included 3783 children (58% boys), 1 to 18 years old, enrolled in the Swedish follow-up program for CP. Logistic regression was used to regress source of reporting (self or proxy) on the presence of general pain adjusted for age, sex, Gross Motor Function Classification System (GMFCS), and Communication Function Classification System (CFCS) levels, including marginal effects between source of reporting and adjusted covariates. Results: The pain item was self-reported in 45%, proxy-reported in 51%, and information was missing in 3%. Pain was reported in 44% of those who self-reported and in 41% of those who proxy-reported (P = .04). The logistic regression showed that the average marginal effects of proxy versus self-reported pain were lower among children at GMFCS level IV (−0.14, 95% CI −0.17 to −0.03) and CFCS level I (−0.09, CI −0.16 to −0.01) and higher at CFCS level III (0.11, CI 0.00-0.22). There were no statistically significant differences in average marginal effects related to age, sex, or the other GMFCS and CFCS levels between proxy and self-reporting. Conclusions: Pain was more often reported by those who self-reported. However, after adjusting for age, sex, CFCS level, and GMFCS level, the proportion of reported pain was almost equal between self and proxy-reporting. Assuming that the self- and proxy-reported groups were not significantly different on relevant factors not controlled for the results indicate that presence of pain is equally reported by children and parents.
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Affiliation(s)
| | - Amanda Burman-Rimstedt
- Skåne University Hospital, Lund University, Lund, Sweden.,Skåne University Hospital, Malmö, Sweden
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Specific Behavioral Responses Rather Than Autonomic Responses Can Indicate and Quantify Acute Pain among Individuals with Intellectual and Developmental Disabilities. Brain Sci 2021; 11:brainsci11020253. [PMID: 33670517 PMCID: PMC7922141 DOI: 10.3390/brainsci11020253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/23/2022] Open
Abstract
Individuals with intellectual and developmental disabilities (IDD) are at a high risk of experiencing pain. Pain management requires assessment, a challenging mission considering the impaired communication skills in IDD. We analyzed subjective and objective responses following calibrated experimental stimuli to determine whether they can differentiate between painful and non-painful states, and adequately quantify pain among individuals with IDD. Eighteen adults with IDD and 21 healthy controls (HC) received experimental pressure stimuli (innocuous, mildly noxious, and moderately noxious). Facial expressions (analyzed with the Facial Action Coding System (FACS)) and autonomic function (heart rate, heart rate variability (HRV), pulse, and galvanic skin response (GSR)) were continuously monitored, and self-reports using a pyramid and a numeric scale were obtained. Significant stimulus-response relationships were observed for the FACS and pyramid scores (but not for the numeric scores), and specific action units could differentiate between the noxious levels among the IDD group. FACS scores of the IDD group were higher and steeper than those of HC. HRV was overall lower among the IDD group, and GSR increased during noxious stimulation in both groups. In conclusion, the facial expressions and self-reports seem to reliably detect and quantify pain among individuals with mild-moderate IDD; their enhanced responses may indicate increased pain sensitivity that requires careful clinical consideration.
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Morse BL, Solodiuk JC, Greco CD, Mauskar S, Hauer J. Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown Source of Pain. Hosp Pediatr 2020; 10:633-640. [PMID: 32660957 DOI: 10.1542/hpeds.2019-0322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Identifying the source of pain for children with medical complexity (MC) is challenging. The purpose of this study was the initial validation of a tool to guide the medical evaluation for identifying the source of pain in children with MC by using differential diagnoses. The tool is entitled Guidelines for Ruling Out and Assessing Source of Pain (GRASP). METHODS A mixed-methods approach that included expert review, focus groups, Web-based surveys, and a trial of the GRASP was used to determine validity as well as perceived clinical utility. RESULTS Focus groups were held with 26 inpatient and outpatient clinicians. Participants consistently responded in support of the GRASP. Participants advised several suggestions for tool organization such as designing the tool as a flow diagram. Seven clinicians participated in Web-based surveys and made specific suggestions for making the GRASP more comprehensive. Six participants trialed the GRASP for 14 children with MC and pain of unknown origin. Overall, participants found that the GRASP was a clinically effective tool for guiding medical evaluation. CONCLUSIONS These results provide preliminary evidence that the GRASP has content and face validity in evaluating the source of pain in children with MC. This tool can be used to systematically guide clinicians through a balanced approach to evaluation with a goal of determining the pain source, preventing harm, and relieving suffering without unnecessary tests.
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Affiliation(s)
- Brenna L Morse
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts;
| | | | | | | | - Julie Hauer
- Boston Children's Hospital, Boston, Massachusetts; and.,Seven Hills Pediatric Center, Groton, Massachusetts
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11
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French HP, Deasy M, Gallagher R, O'Grady A, Doyle F. Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta-Analysis. Pain Pract 2020; 20:792-811. [PMID: 32362057 DOI: 10.1111/papr.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 12/25/2022]
Abstract
Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population-based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into "0 to 3 months" and "3 months and above." Meta-analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.
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Affiliation(s)
| | - Margaret Deasy
- Physiotherapy Department, Sports Surgery Clinic, Santry, Dublin, Ireland
| | | | | | - Frank Doyle
- Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Flanigan M, Gaebler-Spira D, Kocherginsky M, Garrett A, Marciniak C. Spasticity and pain in adults with cerebral palsy. Dev Med Child Neurol 2020; 62:379-385. [PMID: 31602643 DOI: 10.1111/dmcn.14368] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether spasticity measures are related to pain in adults with cerebral palsy (CP). METHOD This cross-sectional study recruited individuals aged 16 to 89 years with a diagnosis of CP. Participants completed the Penn Spasm Frequency Scale (PSFS), Brief Pain Inventory (BPI), and PROMIS Pain Interference measures. The Modified Ashworth Scale (MAS) and Tardieu spasticity angles of six joints were rated and summed to composite MAS and Tardieu scores for each participant. Associations between spasticity and pain measures were evaluated. RESULTS Forty-seven participants (27 females, 20 males) with a mean age of 35 years 7 months (range 18-77y) spanning all Gross Motor Function Classification System (GMFCS) levels were included. Twenty-six participants reported their average pain level on BPI as greater than 0 over the past week (median pain level 4.0). Median PSFS was 1.0 (range 0.0-1.0) and this correlated with average BPI and Pain Interference T scores (median 40.7; ρ=0.33 and ρ=0.31 respectively [both p=0.01]). When adjusted for pain medication use and age, MAS correlated with BPI (ρ=0.30; p=0.04). Other pain and spasticity measures, or GMFCS level, were not significantly related with pain interference or BPI rating. Age was weakly associated with BPI (slope=0.10; p<0.01). INTERPRETATION PROMIS Pain Interference was lower than population-based norms. Patient-rated spasm frequency demonstrated better association with pain levels and interference than physician-rated MAS and Tardieu. WHAT THIS PAPER ADDS Pain was not associated with Gross Motor Function Classification System level. Pain increased with age, as anticipated. Self-reported spasm scores were associated with increased pain in contrast to clinical examination scales. Adjusted, summed spasticity on the Modified Ashworth Scale was associated with pain scores on the Brief Pain Inventory. Although pain is experienced by adults with cerebral palsy, pain did not interfere with activities.
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Affiliation(s)
- Megan Flanigan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatric Rehabilitation, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Masha Kocherginsky
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
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13
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Hägglund G, Czuba T, Alriksson‐Schmidt AI. Back pain is more frequent in girls and in children with scoliosis in the context of cerebral palsy. Acta Paediatr 2019; 108:2229-2234. [PMID: 31218743 PMCID: PMC6899878 DOI: 10.1111/apa.14909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
Aim To investigate the prevalence of general and back pain in children with cerebral palsy and the relationships between scoliosis and back pain. Methods Cross‐sectional register study based on data from the Swedish Cerebral Palsy Follow‐Up Programme. Descriptive analyses and logistic regression to regress age, sex, gross motor function, windswept, hip extension and source of report on the presence of pain. Results The study included 3783 children (58% boys) 1‐18 (mean 10.0) years of age. General pain was reported in 1538 (44% girls, 38% boys) and back pain in 226 (7% girls, 5% boys) children. The proportion of back pain increased from <4% prior to age 12 years to >12% from 16 years of age. Back pain increased from 4% in children without scoliosis to 16% in children with severe scoliosis. Moderate/severe back pain increased from 2% in children without scoliosis to 10% in children with severe scoliosis. Increased odds of reporting back pain were found for age, girls, low gross motor function and children with scoliosis. Conclusion The proportion of children with general pain increased with age and was more frequent in girls. Age, female sex, low gross motor function and scoliosis were significant predictors of back pain.
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Affiliation(s)
- Gunnar Hägglund
- Department of Clinical Sciences Lund Skåne University Hospital Lund University Orthopedics, Lund Sweden
| | - Tomasz Czuba
- Department of Clinical Sciences Lund Lund University Lund Sweden
| | - Ann I. Alriksson‐Schmidt
- Department of Clinical Sciences Lund Skåne University Hospital Lund University Orthopedics, Lund Sweden
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Fairhurst C, Shortland A, Chandler S, Will E, Scrutton D, Simonoff E, Baird G. Factors associated with pain in adolescents with bilateral cerebral palsy. Dev Med Child Neurol 2019; 61:929-936. [PMID: 30508224 DOI: 10.1111/dmcn.14113] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 12/13/2022]
Abstract
AIM We explored factors associated with pain and its severity in a population cohort of young people with bilateral cerebral palsy, comparing parent/carer and young people self-reports. METHOD Of 278 survivors (mean age 16y 8mo, SD 1y 4mo, range 13y 8mo-19y 3mo) from the South Thames in the Study of Hips and Physical Experience cohort of 338 young people with bilateral cerebral palsy, 212 parents/carers and 153 young people completed questionnaires on the presence, severity, timing, site, associated factors, impact, and treatment of pain. RESULTS Seventy per cent of parents/carers reported pain within 3 months, 59% the previous week, and 50% the previous day with 56% reporting 'regularly experienced'. Of young people able to do so, 63% reported pain within 3 months, 50% the previous week, and 42% the previous day, with 48% reporting regular pain. There was strong agreement between the parent/carer and young people, reporting pain severity over the previous 3 months. Pain severity was associated with increased motor impairment and comorbidity, particularly constipation, spasticity, equipment use, and higher emotional score, but not sex, intellectual disability, speech, or maternal education. Multiple sites of musculoskeletal pain were reported in two-thirds of individuals. Pain was associated with voluntary movement in individuals with less motor impairment and with being moved in those with severe motor impairment. Greater pain severity had a negative effect on both physical and psychological quality of life. INTERPRETATION Increasing awareness of the comorbidities in cerebral palsy may aid effective treatment, reducing pain experienced by young people with cerebral palsy. WHAT THIS STUDY ADDS Regular moderate or severe pain is reported in young people with bilateral cerebral palsy (CP) in all Gross Motor Function Classification System levels. Pain is reported more frequently in young people who are non-ambulant. General ill health is strongly associated with severity of pain after controlling for severity of CP, especially constipation. Pain occurs most often in ambulant young people during voluntary activity and in those who are non-ambulant when being moved. There is strong agreement between parents/carers and young people about pain presence and severity.
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Affiliation(s)
- Charlie Fairhurst
- Newcomen Developmental Service, Paediatric Neurosciences, Evelina London, Guy's and St Thomas' NHS Trust, King's Health Partners, London, UK
| | - Adam Shortland
- Faculty of Life Sciences and Medicine, Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Susie Chandler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elspeth Will
- Newcomen Developmental Service, Paediatric Neurosciences, Evelina London, Guy's and St Thomas' NHS Trust, King's Health Partners, London, UK
| | - David Scrutton
- Institute of Child Health, University College, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gillian Baird
- Newcomen Developmental Service, Paediatric Neurosciences, Evelina London, Guy's and St Thomas' NHS Trust, King's Health Partners, London, UK
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Xu N, Matsumoto H, Roye D, Hyman J. Post-Operative Pain Assessment and Management in Cerebral Palsy (CP): A Two-Pronged Comparative Study on the Experience of Surgical Patients. J Pediatr Nurs 2019; 46:e10-e14. [PMID: 30850174 DOI: 10.1016/j.pedn.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/09/2019] [Accepted: 01/29/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study compares the current practice patterns of pain assessment and management between children with and without CP following either posterior spinal instrumentation and fusion (PSIF) or hip osteotomy (HO). METHODS Two cohorts of CP patients were retrospectively identified and matched with non-CP patients based on age, surgical procedure, and approach to post-operative pain management. Sixteen CP patients undergoing PSIF and twenty-two undergoing HO were respectively matched with the same numbers of non-CP patients receiving the same procedures. The frequency of assessments conducted, highest pain scores recorded on each post-operative day (POD), and the amount of adjuvant analgesics administered were collected for POD 0-4. RESULTS Patients with CP were significantly more frequently evaluated for pain post-operatively, tended to have lower pain scores as measured by current scales, and received slightly fewer analgesics. Patients with CP differed from their non-CP counterparts in both frequency and method of post-operative pain assessment. CONCLUSIONS The purpose of this study is to elucidate the current state of post-operative pain assessment and management in children with CP undergoing major orthopaedic surgeries, to improve CP patient/caregiver understanding and expectation of the post-operative experience regarding pain, and to provide recommendations for improving the post-operative care for these patients.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, United States of America
| | - David Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, United States of America
| | - Joshua Hyman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, United States of America.
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16
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Factors Associated with Parents' Adherence to Different Types of Exercises in Home Programs for Children with Disabilities. J Clin Med 2019; 8:jcm8040456. [PMID: 30959749 PMCID: PMC6518115 DOI: 10.3390/jcm8040456] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
There is a lack of knowledge with regard to the adherence to different types of exercises prescribed for children with disabilities. The aim was to examine parents' adherence to prescriptions of different types of home exercises; to identify associated factors related to the parents, the children and the environment, and to assess the relative influence of the behaviour of health professionals. Parents (393) were recruited from 18 early intervention centres. A cross-sectional survey using a self-reported questionnaire was used to examine whether three types of exercises ("flexibility exercises", "neuromotor development training" and "body mechanics and postural stabilisation") were prescribed in their home programs; if the child had received exercises according to a prescription; and items related to the parents, child, environment, and health professionals. The adherence rates were different among the types of exercises. Parents with low perception of barriers and high self-efficacy had a higher adherence to neuromotor development training and postural stabilization, whereas parents with a high level of knowledge increased their odds of adherence to flexibility exercises. Health professionals' behaviour had a distinct influence on the adherence to different exercises. This study suggests the need to specifically consider the types of exercises prescribed in the management of adherence to home programs.
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17
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Marcström A, Hägglund G, Alriksson-Schmidt AI. Hip pain in children with cerebral palsy: a population-based registry study of risk factors. BMC Musculoskelet Disord 2019; 20:62. [PMID: 30736784 PMCID: PMC6368700 DOI: 10.1186/s12891-019-2449-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hip pain is prevalent in children with cerebral palsy (CP). Hip displacement is a known risk factor for hip pain. However, many children do not have displaced hips but still have hip pain and the aetiologies are poorly understood. The aims of this study were to investigate: 1. the prevalence of hip pain related to age, gender, gross motor function, degree of hip displacement and 2. the associations between hip pain and age, gender, gross motor function, degree of hip displacement, ranges of hip and knee motion (ROM) and degree of spasticity in the muscles around the hip. Methods This was a cross-sectional retrospective register study based on data from the Swedish follow-up programme and national healthcare registry CPUP, which includes > 95% of children with CP in Sweden. The participants were born in 2000 or later and 4–16 years of age. Data from the latest examination were used. In Aim 1, the prevalence of hip pain was calculated using frequencies and crosstabs. Differences between groups were calculated using chi-square tests and independent samples t-tests. In Aim 2, associations between hip pain and the variables were analysed using logistic regression. Results The overall prevalence of hip pain was 7%. No significant gender difference was found. Hip pain prevalence increased with age, lower gross motor function and higher degree of hip displacement. The median migration percentage (MP) in painful hips was 26%, compared to 21% in hips where pain was not reported. In the multivariable analysis, significant associations with hip pain were found for MP > 30% and decreased ROM in abduction, flexion and inwards rotation of the hip (p < 0.05). Conclusion Hip displacement was associated with hip pain. However, hip displacement was not present in the majority of painful hips. In addition to hip displacement, decreased ROM was also associated with hip pain. Electronic supplementary material The online version of this article (10.1186/s12891-019-2449-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Marcström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden.
| | - Gunnar Hägglund
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Ann I Alriksson-Schmidt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
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18
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Fox MA, Ayyangar R, Parten R, Haapala HJ, Schilling SG, Kalpakjian CZ. Self-report of pain in young people and adults with spastic cerebral palsy: interrater reliability of the revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale ratings. Dev Med Child Neurol 2019; 61:69-74. [PMID: 30051908 DOI: 10.1111/dmcn.13980] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
AIM People with cerebral palsy (CP) are often unable to express pain owing to cognitive or speech impairments. Reports that rely on observation can be inaccurate, because behaviours such as grimacing, common in people with spastic CP, resemble pain expressions. We examined preliminary validity and reliability of the revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale in people with spastic CP. METHOD Forty-eight young people and adults (35 females, 13 males; mean [SD] age 29y 2mo [13y]) were video-recorded during a standard examination, rating their pain (0-10) afterwards. Two raters completed the r-FLACC using the video recordings. Interrater reliability was assessed with an unconditional cross-classified random-effects model and item response theory approach; Pearson correlations measured agreement between raters and participants. RESULTS Mean (SD) participant (n=48) pain scores were 2.48 (2.5) and mean (SD) r-FLACC scores were 1.46 (1.68). There was moderate agreement between raters (intraclass coefficient 0.41 and 0.57 respectively) but low agreement between participants and raters (r=0.26). There were no significant effects for raters (lay observers, nurses, physicians, and inexperienced raters). INTERPRETATION Results provide mixed support for the interrater reliability of the r-FLACC in people with spastic CP. WHAT THIS PAPER ADDS The revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale can be reliably used by experts and lay raters for people with spastic cerebral palsy (CP). Support is mixed for interrater reliability of the r-FLACC scale used with people with spastic CP.
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Affiliation(s)
- Margaret A Fox
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rita Ayyangar
- Department of Physical Medicine and Rehabilitation, and, Pediatric Palliative Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Heidi J Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Lin E, Durbin J, Guerriere D, Volpe T, Selick A, Kennedy J, Ungar WJ, Lero DS. Assessing care-giving demands, resources and costs of family/friend caregivers for persons with mental health disorders: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:613-634. [PMID: 29498120 DOI: 10.1111/hsc.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 06/08/2023]
Abstract
As mental health (MH) care has shifted from institutional settings to the community, families and friends are responsible for providing the majority of the care at home. The substantial literature on the adverse effects experienced by caregivers has focused mainly on psychological morbidity. Less attention has been paid to how caregivers for persons with MH disorders interact with larger social systems and the impacts of factors such as financial strain, lost time from leisure activities, and the availability of health and social services. We conducted a scoping review of MH and other caregiver questionnaires published between 1990 and 2016 to determine whether they addressed four key domains: caregiver work demands, resource needs, resource utilisation and costs. A range of health and social care databases were searched, including MEDLINE and Health and Psychosocial Instruments. After screening for relevance and quality, our search identified 14 instruments addressing elements related to one or more of our domains. Because these instruments covered only a small portion of our domains, we conducted a second targeted search of the general care-giving literature and consulted with experts, identifying an additional 18 instruments. A total of 32 questionnaires were reviewed, 14 specific to care-giving for mental health problems and 18 for other health conditions. Our search identified instruments or items within instruments that assess constructs in each of our domains, but no one instrument covered them completely. Additionally, some constructs were evaluated in detail and others only addressed by single items. While these instruments are helpful for moving measurement beyond the psychological impacts of care-giving, our results serve only as an initial guide. Additional methodological work is needed to more comprehensively measure the impact of care-giving for individuals with MH disorders and to contribute to the development of more meaningful and effective policies and programmes.
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Affiliation(s)
- Elizabeth Lin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Durbin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tiziana Volpe
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Avra Selick
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Julia Kennedy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna S Lero
- Centre for Families, Work and Well-Being, University of Guelph, Guelph, ON, Canada
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Benromano T, Pick CG, Merick J, Defrin R. Physiological and Behavioral Responses to Calibrated Noxious Stimuli Among Individuals with Cerebral Palsy and Intellectual Disability. PAIN MEDICINE 2017; 18:441-453. [PMID: 27473634 DOI: 10.1093/pm/pnw155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective As individuals with intellectual disability (ID) due to cerebral palsy (CP) are at high risk of experiencing pain, measuring their pain is crucial for adequate treatment. While verbal reports are the gold standard in pain measurements, they may not be sufficient in ID. The aim was to detect behavioral/autonomic responses that may indicate the presence and intensity of pain in individuals with CP and ID, using calibrated stimuli, here for the first time. Subjects Thirteen adults with CP and ID (CPID), 15 healthy controls (HC), and 5 adults with CP with no ID (CPNID). Methods Subjects received pressure stimuli of various intensities. Self-reports (using a pyramid scale), facial expressions (retrospectively analyzed with Facial Action Coding System = FACS), and autonomic function (heart rate, heart rate variability, pulse, galvanic skin response) were analyzed. Results Self-reports and facial expressions but not the autonomic function exhibited stimulus-response relationship to pressure stimulation among all groups. The CPID group had increased pain ratings and facial expressions compared with controls. In addition, the increase in facial expressions along the increase in noxious stimulation was larger than in controls. Freezing in response to pain was frequent in CPID. Conclusions 1) Individuals with CP and ID have increased responses to pain; 2) facial expressions and self-reports, but not autonomic variables can reliably indicate their pain intensity; 3) the pyramid scale is suitable for self-report in this population. Although facial expressions may replace verbal reports, increased facial expressions at rest among these individuals may mask pain, especially at lower intensities.
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Affiliation(s)
- Tali Benromano
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chaim G Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Israel
| | - Joav Merick
- National Institute of Child Health and Human Development, Office of the Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem and Division of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ruth Defrin
- Sagol School of Neuroscience, Tel-Aviv University, Israel.,Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ammaturo DA, Hadjistavropoulos T, Williams J. Pain in Dementia: Use of Observational Pain Assessment Tools by People Who Are Not Health Professionals. PAIN MEDICINE 2017; 18:1895-1907. [PMID: 27837033 DOI: 10.1093/pm/pnw265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Pain is prevalent among older adults but is often underestimated and undertreated, especially in people with severe dementia who have limited ability to self-report pain. Pain in patients with moderate to severe dementia can be assessed using observational tools. Informal caregivers (relatives of seniors with dementia) are an untapped assessor group who often bear the responsibility of care for their loved ones. Our objective was to evaluate the ability of laypeople to assess pain using observational measures originally developed for use by health care professionals. Design We employed a quasi-experimental design and presented videos depicting patients with dementia (portrayed by actors) displaying pain behaviors or during a calm relaxed state (no pain) to long-term care nurses and laypeople. Participants rated the pain behaviors observed in each video by completing two standardized observational measures that had been previously developed for use by long-term care staff. Results As expected, both laypeople and nurses were able to effectively differentiate painful from nonpainful situations using the standardized tools. Both groups were also able to discriminate among gradations of pain (i.e., no pain, mild, moderate, severe) and required comparable amounts of time to complete the assessments. Conclusions We conclude that, as hypothesized, the instruments under study can be used for the assessment of pain by laypeople. This is the first study to validate these instruments for use by laypeople. The use of these tools by laypeople (under the guidance of health professionals) has the potential of facilitating earlier detection and treatment of pain in older adults with dementia who live in community settings.
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Affiliation(s)
- Delaine A Ammaturo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Jaime Williams
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
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Alriksson‐Schmidt A, Hägglund G. Pain in children and adolescents with cerebral palsy: a population-based registry study. Acta Paediatr 2016; 105:665-70. [PMID: 26880375 PMCID: PMC5071732 DOI: 10.1111/apa.13368] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/30/2022]
Abstract
Aim We assessed prevalence and location of pain in a total population of children and adolescents with cerebral palsy (CP) based on the Gross Motor Function Classification System (GMFCS), age and gender. Methods This cross‐sectional study was based on the last assessment of children aged 1–14 years in the combined Swedish follow‐up programme and national quality register programme for CP. All were born 2001–2012 and reported to the registry in 2013–2014. Logistic regression was used to regress age, gender and the GMFCS level on the presence of pain. We also assessed pain sites among GMFCS groups. Results We included 2777 children (57% boys) at a median age of 7 years; 32.4% reported pain, with significantly more girls than boys experiencing pain and significantly more children at GMFCS levels III and V than GMFCS I. Pain frequency increased with age and differences among GMFCS levels were found in the lower extremities and abdomen. Pain in the abdomen and hips was most frequent at GMFCS V, knee pain at level III and foot pain at level I. Conclusion Our results showed that although a lower prevalence than in many other studies, pain constituted a significant problem in children and adolescents with CP.
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Affiliation(s)
- Ann Alriksson‐Schmidt
- Department of Clinical Sciences, Orthopaedics Skåne University Hospital Lund University Lund Sweden
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopaedics Skåne University Hospital Lund University Lund Sweden
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Popkov DA, Zmanovskaya VA, Gubina EB, Leonchuk SS, Butorina MN, Pavlova OL. The results of single-event multilevel orthopedic surgeries and the early rehabilitation used in complex with botulinum toxin treatment in patients with spastic forms of cerebral palsy. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:41-48. [DOI: 10.17116/jnevro20151154141-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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