Assessment of Functional Outcomes of an Interdisciplinary Pediatric Pain Rehabilitation Program

Principal Investigator: Cynthia Ward

Pediatric chronic pain can result in functional impairments that may negatively impact ones ability to perform daily activities. Pediatric chronic pain patients may benefit from mutlidisciplinary assessment and recommendations on an outpatient basis, in addition to intensive cognitive behavioral therapy (CBT) in an interdisciplinary inpatient medical setting; however, the effectiveness of inpatient pain rehabilitation programs requires further study (Hechler et al., 2009). A recent consensus statement delivered by McGrath et al. (2008) called for investigators conducting pediatric pain clinical trials to assess outcomes including pain intensity, sleep dysregulation, coping, and physical, role and emotional functioning. Maynard et al. (2009) responded by including some of these domains in their evaluation of the effectiveness of interdisciplinary inpatient pediatric pain rehabilitation retrospective study. Post-treatment findings indicated that patients showed statistically and clinically significant gains in the domains of: (1) functional ability and mobility as assessed by medical record review and the Functional Independence Measure for Children (WeeFIM; Guide for the Uniform Data Set for Medical Rehabilitation for Children, 1998), (2) interdisciplinary assessment of self-care, cognition, and mobility domains.

Goals of rehabilitation research on children with chronic pain include identification of factors that impact functional recovery as well as description of functional outcomes. Prediction and description of outcomes are important for targeting and evaluating rehabilitation interventions, providing education to families and caregivers, and helping prepare for the individual’s future. In addition, this information is important for the design of future prospective studies.

Several factors have been found to be predictors of outcome in children with chronic pain, including etiology, severity of the injury, coping and emotional functioning. However, as outcomes are often described globally and little distinction made between the types of injury, it is difficult to apply this information to individual patients. This project proposes to further evaluate predictors of recovery and functional outcomes in children and adolescents with chronic pain. Potential predictors of outcome to be examined include child and disease factors such as etiology of pain, pain severity, intensity, and location, demographic factors, sleep, the number of medications prescribed for pain management, and the influence of role, physical and emotional functioning. Outcome variables will include measures of cognitive, pain, emotional, sleep, role and motor function prior to inpatient admission, during inpatient rehabilitation and at subsequent follow-up.

The purpose of this invensitgation is to conduct a retrospective record review of children and adolescents who were admitted to the Kennedy Krieger Pediatric Pain Rehabilitation program or seen in the pediatric pain rehabiltiation outpatient clinic from January 1, 2000 through June 30, 2012. Existing demongraphic (within the limits of HIPPA regulations), medical, behavioral and psychological data collected as part of routine clinical care during inpatient stays, outpatient visits, and follow-up visits at Johns Hopkins Hospital and Kennedy Krieger Institute will be extracted. Once these data are collected, we will create a database that is de-identified of all protected health information. No protected health information will be recorded. This de-identified data set will be used to assess the range and most common types of behavioral and psychological problems occurring in this population, the individual, environemtnal and psychosocial predictors of these difficulties, the range of clinical interventions that we have employed clinically and the differential effectiveness of our intervention techniques.