Easily Administered Patient Reported Outcome Measures: Adolescents’ Perceived Functional Changes after Completing an Intensive Chronic Pain Rehabilitation Program

Publication date: Available online 14 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Heidi Kempert, Ethan Benore, Rachel Heines
ObjectiveTo discuss whether patient reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting. Children and adolescents' perception of their abilities is a natural target of rehabilitation therapies. Perceived functioning is often impaired when experiencing chronic pain and is a meaningful goal of rehabilitation therapy. This study examines two patient reported measures administered as part of physical therapy for chronic pain. It was hypothesized that children and adolescents completing an interdisciplinary pain rehabilitation program would report gains in perceived physical functioning from admission to discharge, and that perceived gains in function would be associated with a reduction in pain intensity.DesignThe study was a retrospective data analysis of 109 children and adolescents with chronic pain treated over a single calendar year. Paired t-tests evaluated change in perceived function measures and pain over time. Standardized residual change scores were used in subsequent regression to assess associations between change scores.SettingAn interdisciplinary pediatric pain rehabilitation program that supports children and adolescents with chronic pain by increasing strength, flexibility and endurance, facilitating a return to daily life activities, and using appropriate self-directed coping and pain management skills.Participants109 children and adolescents (ages 8-19, 83% female) with various chronic pain diagnoses that were admitted to a three- to four-week intensive pain rehabilitation program.InterventionsParticipants were involved in physical and occupational therapy for three hours daily, as well as recreation therapy, psychology, school, aquatics, art and music therapy for a total of 8 hours daily. Parents were involved in parent education with therapists from all disciplines in conjunction with their child's programming.Main Outcome MeasuresLower Extremity Functional Scale (LEFS); Upper Extremity Functional Index (UEFI); self-reported pain severity rating on 0-10 numerical rating scale.ResultsData demonstrated significant gains in LEFS and UEFI during the program. Improvement in perceived functioning was significantly correlated with reduction in pain.ConclusionsThe LEFS and UEFI provide a meaningful way to track progress in chronic pain rehabilitation. Using self-perceived measures, children and adolescents noted significant functional improvement, associated with less pain intensity. These findings increase our understanding of the rehabilitation process and point to goals for clinical improvement.



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