Risk severity moderated effectiveness of pain treatment in adolescents

2019 ◽  
Vol 19 (2) ◽  
pp. 287-298 ◽  
Author(s):  
Hanna Vuorimaa ◽  
Leena Leppänen ◽  
Hannu Kautiainen ◽  
Marja Mikkelsson ◽  
Maiju Hietanen ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Acceptance And Commitment Therapy ◽  
Screening Tool ◽  
Pediatric Pain ◽  
Acceptance And Commitment ◽  
Medium Risk ◽  
Pain Frequency ◽  
Risk Patients ◽  
Pain Patients

Abstract Background and aims A targeted pain program may prevent the progression and subsequent occurrence of chronic pain in adolescents. This study tested the effectiveness of a new acceptance and commitment therapy -based pain management intervention, using physical and psychological functions as the outcomes. The objective was also to determine whether Pediatric Pain Screening Tool risk profiles function as outcome moderator in the current sample. A valid screening tool would enable the program development. Methods Thirty-two consecutive adolescent patients (13–17 years old) with idiopathic recurrent musculoskeletal pain completed the study. The intervention comprised acceptance and commitment therapy-oriented multidisciplinary treatment. Pediatric Pain Screening Tool, pain frequency, functional disability, school attendance, physical endurance, depressive symptoms, and catastrophizing coping style were measured before treatment (baseline) and again at 6 and 12 months after the initiation of treatment. To test the effectiveness of the new program, we also determined whether the original risk classification of each patient remained constant during the intervention. Results The intervention was effective for high-risk patients. In particular, the pain frequency decreased, and psychosocial measures improved. In post-intervention, the original risk classification of seven patients in the high-risk category changed to medium-risk. PPST classification acted as a moderator of the outcome of the current program. Conclusions The categorization highlighted the need to modify the program content for the medium-risk patients. The categorization is a good tool to screen adolescent patients with pain. Implications The results support using the Pediatric Pain Screening Tool in developing rehabilitation program for pediatric musculoskeletal pain patients. According to the result, for adolescent prolonged musculoskeletal pain patients the use of ACT-based intervention program is warranted.

Prolonged, widespread, disabling musculoskeletal pain of adolescents among referrals to the Pediatric Rheumatology Outpatient Clinic from the Päijät-Häme Hospital District in southern Finland

2018 ◽  
Vol 18 (4) ◽  
pp. 621-628
Author(s):  
Heini Pohjankoski ◽  
Maiju Hietanen ◽  
Leena Leppänen ◽  
Heli Vilen ◽  
Hannu Kautiainen ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Outpatient Clinic ◽  
Pediatric Rheumatology ◽  
Functional Disability ◽  
Screening Tool ◽  
Screening Tools ◽  
Rapid Screening ◽  
Hospital District ◽  
Pain Patients ◽  
Rheumatology Outpatient

Abstract Background and aims Musculoskeletal pain among adolescents is a problem for the patients and their families and has economic consequences for society. The aim of this study is to determine the incidence of prolonged disabling musculoskeletal pain of adolescents among referrals to a pediatric rheumatology outpatient clinic and describe the patient material. The second aim is to find proper screening tools which identifies patients with a risk of pain chronification and to test whether our patients fit the Pediatric Pain Screening Tool (PPST) stratification according to Simons et al. Methods We selected adolescent patients with disabling, prolonged, musculoskeletal pain and calculated the incidence. Furthermore, after the patient collection, we adjusted our pain patients to PPST. Results The incidence of prolonged musculoskeletal pain patients at our clinic was 42/100,000 patient years (pyrs) (age 13–18; 95% CI: 29–60) during years 2010–2015. A nine-item screening tool by Simons et al. proves to be valid for our patient group and helps to identify those patients who need early, prompt treatment. The functional risk stratification by Simons et al. correlates with our patients’ functional disability. Conclusions and implications In order to prevent disability and to target intervention, it is necessary to have proper and rapid screening tools to find the appropriate patients in time.

scholarly journals Patients’ experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Bendelin ◽  
Pär Björkdahl ◽  
Mimmi Risell ◽  
Karin Zetterqvist Nelson ◽  
Björn Gerdle ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Controlled Trial ◽  
Negative Effects ◽  
Self Help ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Exploratory Approach ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Background Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients’ experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions Adjusting treatment content and format based on participants’ characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT. Trial registration clinicaltrials.gov (NCT01603797). Registered 22 May 2012. Retrospectively registered.

scholarly journals Validity and reliability of the Dutch STarT MSK tool in patients with musculoskeletal pain in primary care physiotherapy

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248616
Author(s):  
Anke G. van den Broek ◽  
Corelien J. J. Kloek ◽  
Martijn F. Pisters ◽  
Cindy Veenhof
Keyword(s):  
Primary Care ◽  
Relative Risk ◽  
High Risk ◽  
Musculoskeletal Pain ◽  
Risk Group ◽  
Validity And Reliability ◽  
Medium Risk ◽  
Risk Patients ◽  
Test Retest Reliability ◽  
Risk Ratios

Objective To evaluate the validity and reliability of the Dutch STarT MSK tool in patients with musculoskeletal pain in primary care physiotherapy. Methods Physiotherapists included patients with musculoskeletal pain, aged 18 years or older. Patients completed a questionnaire at baseline and follow-up at 5 days and 3 months, respectively. Construct validity was assessed by comparing scores of STarT MSK items with reference questionnaires. Pearson’s correlation coefficients were calculated to test predefined hypotheses. Test-retest reliability was evaluated by calculating quadratic-weighted kappa coefficients for overall STarT MSK tool scores (range 0–12) and prognostic subgroups (low, medium and high risk). Predictive validity was assessed by calculating relative risk ratios for moderate risk and high risk, both compared with low risk, in their ability to predict persisting disability at 3 months. Results In total, 142 patients were included in the analysis. At baseline, 74 patients (52.1%) were categorised as low risk, 64 (45.1%) as medium risk and 4 (2.8%) as high risk. For construct validity, nine of the eleven predefined hypotheses were confirmed. For test-retest reliability, kappa coefficients for the overall tool scores and prognostic subgroups were 0.71 and 0.65, respectively. For predictive validity, relative risk ratios for persisting disability were 2.19 (95% CI: 1.10–4.38) for the medium-risk group and 7.30 (95% CI: 4.11–12.98) for the high-risk group. Conclusion The Dutch STarT MSK tool showed a sufficient to good validity and reliability in patients with musculoskeletal pain in primary care physiotherapy. The sample size for high-risk patients was small (n = 4), which may limit the generalisability of findings for this group. An external validation study with a larger sample of high-risk patients (≥50) is recommended.

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