Cleveland Clinic Children's Outcomes
Pediatric Pain Rehabilitation Program
Pediatric Pain Program: Functional Outcomes
The Pediatric Pain Rehabilitation Program at Cleveland Clinic Children’s Hospital for Rehabilitation is a unique and innovative program designed for children and adolescents with chronic pain that interferes with normal activities. As a result of their pain, these children do not attend school, interact with peers or participate in normal activities. Our program focuses on helping children manage their pain and restoring their daily activity. The program consists of inpatient and day hospital components; it blends pediatric sub-specialty care, behavioral health, and rehabilitation therapies into an individualized but coordinated manner. The program was a recipient of the American Pain Society Clinical Centers of Excellence in Pain Management award and is the first pediatric interdisciplinary pain rehabilitation program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF).
In 2019, patient and parent satisfaction with the Pediatric Pain Rehabilitation Program were measured with surveys. Additionally, five tools were utilized to assess pediatric functional outcomes related to pain: the Patient-Reported Outcomes Measurement Information System (PROMIS) tool, a pediatric pain intensity scale, the Child Self-Efficacy Scale (CSES), the Bath Adolescent Pain Questionnaire (BAPQ), and the Chronic Pain Acceptance Questionnaire (CPAQ).
- 39 patients (N) had full data at admission and discharge.
- Median age: 15.4 years (standard deviation: 2.23)
- Gender distribution: 84.6% female
- Patients with a psychological comorbidity: 51.4%
- Lag time from referral to admission: 48.6 days
Pain Interference, Fatigue, Anxiety, and Depression
The Patient-Reported Outcomes Measurement Information System (PROMIS) tool was utilized to assess pain interference, fatigue, mobility, anxiety, and depression among patients. This tool was administered to patients upon admission and discharge. PROMIS scores that are higher in numerical value indicate that there is more of the outcome that is being measured (i.e. more fatigue, more depression). A higher score for mobility is preferred, as it indicates improved mobility.
HealthMeasures. (n.d.). PROMIS®. https://www.healthmeasures.net/score-and-interpret/interpret-scores/promis#:~:text=For%20PROMIS%20measures%2C%20higher%20scores,upon%20the%20concept%20being%20measured.
Pain Intensity and Self-Efficacy
To measure patient pain upon admission and discharge, a pediatric pain intensity scale was utilized. A pain score of 0 indicates that a patient has no pain, and a score of 10 indicates that a patient has the worst pain they have experienced.
To measure self-efficacy upon admission and discharge, the Child Self-Efficacy Scale (CSES) was used. The CSES is a 7-item questionnaire that assesses measures such as a patient's ability to make it through a day of school, and a patient's confidence that they can complete their homework when experiencing pain. A lower CSES score indicates greater self-efficacy.
Bursch B, Tsao JC, Meldrum M, Zeltzer LK. Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions). Pain. 2006;125(1-2):35-42. doi:10.1016/j.pain.2006.04.026
Activity Engagement and Pain Willingness
The Chronic Pain Acceptance Questionnaire (CPAQ) was used to assess activity engagement and pain willingness among patients at admission and discharge. Activity engagement refers to a patient's participation in daily activities despite pain. Pain willingness refers to a patient's ability to tolerate pain without making active efforts to treat it. Higher scores indicate better activity engagement and better pain willingness/tolerance.
McCracken, L.M., Vowles, K.E., & Eccleston, C. (2006). Chronic Pain Acceptance Questionnaire-Revised (CPAQ-R). https://www.div12.org/wp-content/uploads/2015/06/Chronic-Pain-Acceptance-Questionniare-Revised.pdf
Worry Related to Pain
The Bath Adolescent Pain Questionnaire (BAPQ) was administered to patients to assess their anxiety/worry related to their pain. A higher score for this measure indicates higher anxiety/worry.
Bath Centre for Pain Research. (2005). Bath Adolescent Pain Questionnaire (BAPQ) scoring instructions [PDF file]. https://www.bath.ac.uk/publications/bapq-scoring-instructions/attachments/bapq-scoring-instructions.pdf