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(551) Use of the Pain Disability Questionnaire (PDQ) to assess self-reported disability in a functional restoration program
Abstracts
The Journal of Pain
S113
(548) Trajectories of child pain and function in intensive interdisciplinary pediatric pain rehabilitation
(550) Functional disability through initial and follow-up evaluations in a multidisciplinary pediatric headache clinic
C Hoffart, R Anderson, D Feltrop, M Wilson, B Dorton, A Chapman, and D Wallace; Children’s Mercy Hospital, Kansas City, MO
A Caruso, E Mahoney, L Lazdowsky, and A LeBel; Boston Children’s Hospital, Waltham, MA
Given the prevalence of pediatric chronic pain, degree of disability, and compromise in quality of life, there is a critical need to identify the natural history of pain and disability. Few studies investigate the effect of interdisciplinary treatment on pain and functional trajectories in children with chronic musculoskeletal pain. We hypothesized function would improve prior to decrease in pain. 22 patients (18 female) aged 11-18 with chronic musculoskeletal pain completed the modified Bruce Treadmill Test, Functional Disability Inventory (FDI-patient), and reported pain using a 100mm Visual Analog Scale (VAS 0-100) at program start, the end of each week, and 19 completed one-month follow-up. One parent from each family completed FDI-parent, a measure of parent perception of pain-related functional limitations. Mean treatment program duration was 3.64 weeks (6 0.9). Patients’ pain worsens before it improves approximately halfway through the program. Pain increased from 61.7 at baseline to 72.1 and 67.5 at the end of weeks 1 (P=0.03) and 2 (P=0.22), respectively, with subsequent significant decrease in pain to 31.9 through post-treatment follow-up (P=0.001). Baseline patient and parent FDI scores correlated (27.6 and 25.5, respectively, r=.861; P< .0001) and demonstrated steady declines at week one and throughout treatment, indicating improved function prior to pain decrease. Patient FDI improved to 13.9 by program end (P<.0001) and continues to improve following treatment to 7.6 (P=.002). Bruce treadmill endurance increased steadily from baseline of 7.11 minutes with continued improvement through program end to 10.4 minutes (P<.0001). Concurrent trajectories of patient outcomes suggest that function improves before pain. Whereas pain gets worse during the first weeks of treatment, patient function increases within the first week. These trajectories may aid in determining the projected course for patients requiring intensive interdisciplinary pain rehabilitation.
This study investigates the perceptions of improvement in physical and psychological disability reported by chronic pediatric headache patients presenting to a multidisciplinary pediatric chronic pain clinic at initial and follow-up examination. To measure the extent of disability corresponding to chronic pain, the Functional Disability Inventory (FDI) serves as a 15-item questionnaire assessing the difficulties experienced by pediatric patients when performing regular activities, such as eating meals or falling asleep. In this study, FDI data was collected from 134 females and males, (65.9% female) ages 4 to 19 years (mean age of 13.3) who completed both initial and follow-up visits; appointments included neurological examination, psychological consultation, feedback and education with a registered nurse, and the option of incorporating integrative therapies. Pearson correlations indicated significant associations between first evaluation total FDI scores and the related constructs of headache frequency (p < .05), duration (p < .000) and severity (p < .000), as well as depressive symptoms (p < .000) captured by the Children’s Depression Inventory. An independent samples t-test demonstrated significant associations between gender and disability on the initial FDI, with females indicating higher difficulties in the sleep categories of remaining awake without a nap (p < .000) and falling asleep at night (p < .000). A paired samples t-test revealed significant improvement in total FDI scores between initial evaluation and follow-up examination: 18.96 and 10.73, respectively (p <.000), as well as a decrease in school absence over 3 months (7.98 days absent at initial evaluation compared to 5.72 days at follow-up, p < .05). Study results suggest that a multidisciplinary approach to treating chronic pediatric headache may result in substantial reductions of children and adolescents’ disabilities, providing support for multidisciplinary chronic pain management centers becoming the gold standard of clinical care.
(549) Relationships among fear of pain and movement, strength test performance, and indicators of hypothalamic pituitary adrenal axis (HPA axis) activity
(551) Use of the Pain Disability Questionnaire (PDQ) to assess self-reported disability in a functional restoration program
E Dannecker and P Hinton; University of Missouri, Columbia, MO
M Hartzell, R Neblett, R Gatchel, and T Mayer; University of Texas at Arlington, Arlington, TX
Two studies were located that tested associations between fear of pain and movement and performance during strength testing. They reported mixed results. In this study, we advance the literature by incorporating measures of Hypothalamic Pituitary Adrenal (HPA) axis activity – cortisol and blood pressure, which we collected directly before upper extremity strength tests. During a single session, healthy, upper-body untrained participants (N = 32, 46.9% women, 78% Caucasian, 24 yrs old (SD = 5.18)) completed measures of fear of pain and movement and pain catastrophizing before two consecutive strength tests using the non-dominant elbow flexors. Immediately before the strength tests, we collected blood pressure readings and saliva via an oral swab for cortisol. We also recorded perceived exertion, pain intensity, pain unpleasantness, and force output during the strength tests. Contrary to our hypotheses, we detected no significant associations among fear of pain and movement and cortisol, blood pressure, perceived effort, pain, or force output. However, systolic and diastolic blood pressure and perceived effort positively correlated with force output (r’s = .49 - .61, p < .01; r’s = .57 - .60, p < .01; r’s = .35 - .42, p < .05). In addition, the total score of the Pain Catastrophizing Scale (PCS) and rumination subscale of the PCS inversely correlated with force output (r’s = -.37 - -.40, p < .04; r’s = -.42 - .46, p < .02). These results support that pain catastrophizing is more strongly related to force output than fear of pain and movement, but none of the psychological constructs were significantly associated with indicators of HPA axis activity. Future studies should test relationships among these variables in samples with clinical pain, conduct alternative types of strength and function tests, and administer other HPA measures such as the corticotropin-releasing hormone challenge test.
Patients accepted into tertiary rehabilitation programs often have severe pain intensity and disability. While there are many options for self-reported disability assessment, the Pain Disability Questionnaire (PDQ), a lesser-known measure, has demonstrated extremely high efficacy. Developed in 2002, the PDQ has high reliability and validity, and predicts post-treatment and oneyear outcomes well. This study seeks to add to current PDQ research and examine new variables. In this prospective cohort study, 1, 657 Chronic Disabling Occupational Musculoskeletal Disorders (CDOMD) patients from 2003-2010 completed functional restoration, consisting of quantitativelydirected exercise progression and multi-modal disability management. Patients were divided into 3 categories based upon pre-treatment PDQ score: mild/moderate disability (n = 233), extreme disability (n = 564), and severe disability (n = 860). PDQ groups were compared on demographic, psychosocial, psychiatric disorder, medication use, and one-year socioeconomic outcomes such as work return and work retention. Patients with severe or extreme PDQ disability scores reported higher pain intensity and self-reported disability, as measured by VAS and the Owestry Disability Index (ODI), more depressive symptoms, and lower health-related quality of life at both pre and post-treatment (p < .001 for all). At pre-treatment, those with extreme disability scores were more likely to have medium to heavy opioid use, Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), or a Cluster A or B personality disorder, as diagnosed by DSM-IV-TR criteria. At one-year after discharge, patients with severe or extreme disability were less likely to have returned to or retained work, and more likely to have additional health care utilization (p # .03). These results suggest that self-reported disability is a major factor in recovery from CDOMDs and that the PDQ relates to many other factors. The PDQ may act as a ‘‘red flag,’’ with those with higher PDQ scores at risk for worse functional restoration outcomes.
The Journal of Pain
S113
(548) Trajectories of child pain and function in intensive interdisciplinary pediatric pain rehabilitation
(550) Functional disability through initial and follow-up evaluations in a multidisciplinary pediatric headache clinic
C Hoffart, R Anderson, D Feltrop, M Wilson, B Dorton, A Chapman, and D Wallace; Children’s Mercy Hospital, Kansas City, MO
A Caruso, E Mahoney, L Lazdowsky, and A LeBel; Boston Children’s Hospital, Waltham, MA
Given the prevalence of pediatric chronic pain, degree of disability, and compromise in quality of life, there is a critical need to identify the natural history of pain and disability. Few studies investigate the effect of interdisciplinary treatment on pain and functional trajectories in children with chronic musculoskeletal pain. We hypothesized function would improve prior to decrease in pain. 22 patients (18 female) aged 11-18 with chronic musculoskeletal pain completed the modified Bruce Treadmill Test, Functional Disability Inventory (FDI-patient), and reported pain using a 100mm Visual Analog Scale (VAS 0-100) at program start, the end of each week, and 19 completed one-month follow-up. One parent from each family completed FDI-parent, a measure of parent perception of pain-related functional limitations. Mean treatment program duration was 3.64 weeks (6 0.9). Patients’ pain worsens before it improves approximately halfway through the program. Pain increased from 61.7 at baseline to 72.1 and 67.5 at the end of weeks 1 (P=0.03) and 2 (P=0.22), respectively, with subsequent significant decrease in pain to 31.9 through post-treatment follow-up (P=0.001). Baseline patient and parent FDI scores correlated (27.6 and 25.5, respectively, r=.861; P< .0001) and demonstrated steady declines at week one and throughout treatment, indicating improved function prior to pain decrease. Patient FDI improved to 13.9 by program end (P<.0001) and continues to improve following treatment to 7.6 (P=.002). Bruce treadmill endurance increased steadily from baseline of 7.11 minutes with continued improvement through program end to 10.4 minutes (P<.0001). Concurrent trajectories of patient outcomes suggest that function improves before pain. Whereas pain gets worse during the first weeks of treatment, patient function increases within the first week. These trajectories may aid in determining the projected course for patients requiring intensive interdisciplinary pain rehabilitation.
This study investigates the perceptions of improvement in physical and psychological disability reported by chronic pediatric headache patients presenting to a multidisciplinary pediatric chronic pain clinic at initial and follow-up examination. To measure the extent of disability corresponding to chronic pain, the Functional Disability Inventory (FDI) serves as a 15-item questionnaire assessing the difficulties experienced by pediatric patients when performing regular activities, such as eating meals or falling asleep. In this study, FDI data was collected from 134 females and males, (65.9% female) ages 4 to 19 years (mean age of 13.3) who completed both initial and follow-up visits; appointments included neurological examination, psychological consultation, feedback and education with a registered nurse, and the option of incorporating integrative therapies. Pearson correlations indicated significant associations between first evaluation total FDI scores and the related constructs of headache frequency (p < .05), duration (p < .000) and severity (p < .000), as well as depressive symptoms (p < .000) captured by the Children’s Depression Inventory. An independent samples t-test demonstrated significant associations between gender and disability on the initial FDI, with females indicating higher difficulties in the sleep categories of remaining awake without a nap (p < .000) and falling asleep at night (p < .000). A paired samples t-test revealed significant improvement in total FDI scores between initial evaluation and follow-up examination: 18.96 and 10.73, respectively (p <.000), as well as a decrease in school absence over 3 months (7.98 days absent at initial evaluation compared to 5.72 days at follow-up, p < .05). Study results suggest that a multidisciplinary approach to treating chronic pediatric headache may result in substantial reductions of children and adolescents’ disabilities, providing support for multidisciplinary chronic pain management centers becoming the gold standard of clinical care.
(549) Relationships among fear of pain and movement, strength test performance, and indicators of hypothalamic pituitary adrenal axis (HPA axis) activity
(551) Use of the Pain Disability Questionnaire (PDQ) to assess self-reported disability in a functional restoration program
E Dannecker and P Hinton; University of Missouri, Columbia, MO
M Hartzell, R Neblett, R Gatchel, and T Mayer; University of Texas at Arlington, Arlington, TX
Two studies were located that tested associations between fear of pain and movement and performance during strength testing. They reported mixed results. In this study, we advance the literature by incorporating measures of Hypothalamic Pituitary Adrenal (HPA) axis activity – cortisol and blood pressure, which we collected directly before upper extremity strength tests. During a single session, healthy, upper-body untrained participants (N = 32, 46.9% women, 78% Caucasian, 24 yrs old (SD = 5.18)) completed measures of fear of pain and movement and pain catastrophizing before two consecutive strength tests using the non-dominant elbow flexors. Immediately before the strength tests, we collected blood pressure readings and saliva via an oral swab for cortisol. We also recorded perceived exertion, pain intensity, pain unpleasantness, and force output during the strength tests. Contrary to our hypotheses, we detected no significant associations among fear of pain and movement and cortisol, blood pressure, perceived effort, pain, or force output. However, systolic and diastolic blood pressure and perceived effort positively correlated with force output (r’s = .49 - .61, p < .01; r’s = .57 - .60, p < .01; r’s = .35 - .42, p < .05). In addition, the total score of the Pain Catastrophizing Scale (PCS) and rumination subscale of the PCS inversely correlated with force output (r’s = -.37 - -.40, p < .04; r’s = -.42 - .46, p < .02). These results support that pain catastrophizing is more strongly related to force output than fear of pain and movement, but none of the psychological constructs were significantly associated with indicators of HPA axis activity. Future studies should test relationships among these variables in samples with clinical pain, conduct alternative types of strength and function tests, and administer other HPA measures such as the corticotropin-releasing hormone challenge test.
Patients accepted into tertiary rehabilitation programs often have severe pain intensity and disability. While there are many options for self-reported disability assessment, the Pain Disability Questionnaire (PDQ), a lesser-known measure, has demonstrated extremely high efficacy. Developed in 2002, the PDQ has high reliability and validity, and predicts post-treatment and oneyear outcomes well. This study seeks to add to current PDQ research and examine new variables. In this prospective cohort study, 1, 657 Chronic Disabling Occupational Musculoskeletal Disorders (CDOMD) patients from 2003-2010 completed functional restoration, consisting of quantitativelydirected exercise progression and multi-modal disability management. Patients were divided into 3 categories based upon pre-treatment PDQ score: mild/moderate disability (n = 233), extreme disability (n = 564), and severe disability (n = 860). PDQ groups were compared on demographic, psychosocial, psychiatric disorder, medication use, and one-year socioeconomic outcomes such as work return and work retention. Patients with severe or extreme PDQ disability scores reported higher pain intensity and self-reported disability, as measured by VAS and the Owestry Disability Index (ODI), more depressive symptoms, and lower health-related quality of life at both pre and post-treatment (p < .001 for all). At pre-treatment, those with extreme disability scores were more likely to have medium to heavy opioid use, Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), or a Cluster A or B personality disorder, as diagnosed by DSM-IV-TR criteria. At one-year after discharge, patients with severe or extreme disability were less likely to have returned to or retained work, and more likely to have additional health care utilization (p # .03). These results suggest that self-reported disability is a major factor in recovery from CDOMDs and that the PDQ relates to many other factors. The PDQ may act as a ‘‘red flag,’’ with those with higher PDQ scores at risk for worse functional restoration outcomes.