Easily Administered Patient-Reported Outcome Measures: Adolescents' Perceived Functional Changes After Completing an Intensive Chronic Pain Rehabilitation Program

Abstract

Objective: To determine whether patient-reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting by examining 2 patient-reported measures administered as part of physical and occupational therapy for chronic pain.

Design: A retrospective data analysis of 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.

Setting: An 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.

Participants: Children and adolescents (N=109; age range, 8-19y; 83% girls) with various chronic pain diagnoses who were admitted to a 3- to 4-week intensive pain rehabilitation program.

Interventions: Participants were involved in physical and occupational therapy for 3 hours daily, as well as recreation therapy, psychology, school, aquatics, art therapy, 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 measures: Lower Extremity Functional Scale (LEFS), Upper Extremity Functional Index (UEFI), and self-reported pain severity rating on 0-to-10 numerical rating scale.

Results: Data demonstrated significant gains in LEFS and UEFI during the program. Improvement in perceived functioning was significantly correlated with a reduction in pain.

Conclusions: The 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.

Keywords: Adolescent; Chronic pain; Physical therapy specialty; Rehabilitation; Therapeutics.