- Email: [email protected]
Assessment of disability
Abstracts (994) Incidence and nursing management of procedural pain in children J. Emed, F. Filion, J. Rennick, C. Rosmus, H. Patenaude, J. Ellis, C. Shapiro, J. Ritchie, A. Gagnon, C. Johnston; McGill University, Montreal, QC While diagnostic and therapeutic procedures are an integral part of the hospital experience, they can be painful and distressing to children especially as the associated pain is under-treated. The purpose of this survey is to describe the incidence of these procedures in hospitalized children and the frequency with which nurses assess and intervene. Chart audits were conducted using the Pain Management Experience Evaluation in the six participating university-affiliated hospitals. In the sample of 1008 children, 253 underwent one or more procedures, with a total of 392 procedures. In 403 cases of procedural pain, 9.9% had documented pain assessments, 16.6% received analgesics and 1.5% had documented non-pharmacological interventions. An important finding is that nurses under-document their management of procedural pain.
G02 - Assessment of Disability (995) Impact of chronic low back pain on dynamic lifting performance: A comparative study of older adults T. Rudy, J. Slaboda, S. Lieber, D. Weiner, J. Boston; University of Pittsburgh, Pittsburgh, PA An estimated 17 million older adults have experienced at least one episode of low back pain during the past year, and 6 million of these individuals suffer from chronic low back pain (CLBP). The consequences of CLBP are wide ranging, including impaired physical function, depression and anxiety, and increased use of health care resources. Measurement of physical function is critical in the comprehensive assessment of older adults with CLBP. Historically, studies of CLBP in older adults have used a narrow measure of physical function, such as spinal range of motion, isokinetic strength, and postural control. The performance of a functional task, however, requires physical capacity or a combination of these and other physical components to generate whole body movements for a sustained period. Performance differences between older adults with CLBP and a control group were evaluated during a repetitive isodynamic lifting task. Participants ranged in age from 65-84 and were 49 CLBP patients and 49 pain-free control subjects. Performance outcomes included weight lifted and number of lifts completed, and performance style measures described basic dynamic body biomechanics used during each lift. Controls completed significantly more lifts (p ⬍ 0.05) and lifted more weight than CLBP subjects (p ⬍ 0.01). Controls also lifted faster (p ⬍ 0.05), demonstrated less synchrony between hip and knee movements (p ⬍ 0.05), and displayed greater anterior-posterior sway (p ⬍ 0.05). The static and dynamic motion differences found between CLBP subjects and controls as they performed repetitive lifting under a constant load indicate that body motion parameters, in addition to more common strength and endurance measures, are necessary to describe the impact of CLBP on older adults’ lifting abilities. These findings also suggest that CLBP may accelerate the functional decline associated with aging, which can ultimately lead to disability.
107 (996) Four dimensions of the impact of chronic pain: Affective distress, social aspects, pain-related anxiety, and physical coping strategies M. Davidson, P. Davidson, D. Tripp, Y. Borshch; Queen‘s University, Kingston, ON Measures of pain severity by themselves do not provide complete information about the effect of pain on functioning in chronic pain patients. The multi-determined nature of the impact of pain has been demonstrated in the assessment of variables affecting headache pain, and three dimensions underlying the impact of headache pain have been identified (Holroyd, KA, et al., Pain, 1999). Our chronic pain service measures a wide range of pain-related variables including depression, anxiety, pain catastrophizing, disability and coping skills/techniques. To better understand the impact of chronic pain, we attempted to identify the underlying dimensions by examining nine instruments used in chronic pain assessment (Beck Anxiety Inventory; Beck Depression Inventory; Beck Hopelessness Scale; Chronic Pain Coping Inventory; McGill Pain Questionnaire – SF; Multidimensional Pain Inventory – 2; Pain Catastrophizing Scale; Pain Disability Inventory; and Tampa Scale of Kinesiophobia) and the subscales derived from these measures. Forty consecutive chronic pain patients completed this battery and factor analysis was used to identify underlying dimensions in the data. Four factors were identified, labeled as General Affective Distress, Social Aspects of Pain, Pain Related Anxiety, and Physical Coping Strategies. The highest loading variables on each factor were selected as the optimal measure of the associated factor. The results are useful in that they describe the underlying structure of the impact of chronic pain. Further, these results may simplify the assessment of the effect of chronic pain on day-to-day functioning and quality of life.
(997) Assessing fatigue in pediatric chronic pain J. Gold, A. Griffin, M. Carson, M. Joseph; Childrens Hospital of Los Angeles, Los Angeles, CA Pediatric chronic pain is a significant health problem that has implications on school attendance, physical and social activities and psychological distress (Bursch, Walco, & Zeltzer, 1998; McGrath, Dunn-Geier, & Cunningham, 1986; Palermo, 2000). Less understood is the role of fatigue in pediatric chronic pain. The current investigation is a cross-sectional investigation of chronic pain, fatigue and quality of life in children and adolescents who are seeking outpatient pain management services from an urban Childrens Hospital. Twenty-three participants (5 boys and 18 girls) with a mean age of 13.9 (range 8 to 18) were recruited. Participants and their caregivers completed standardized self-report questionnaires and research assistants completed a medical chart review. Participant‘s diagnostic classifications included headaches, fibromyalgia, sickle cell disease, cancer and others. The sample consisted of mostly Caucasian (47.8%) and Latino/a (34.8%) participants. Quality of life was measured with The Pediatric Quality of Life Inventory (PedsQL) (Varni, 1998). The PedsQL consists of 23 self-report items and yields physical, psychosocial and total summary health scores, ranging from 0-100, with higher scores indicating better quality of life. Fatigue was measured using the PedsQL Multidimensional Fatigue Scale (Varni, 1998), an 18-item self-report instrument with higher scores indicating less fatigue. Pain and qualitative data was gathered using a clinic-developed instrument (Bursch & Zeltzer, 2000). Children, 8-12 years, reported an above average mean quality of life (M⫽63.8), physical (M⫽63.4), psychosocial (M⫽64.0) functioning and fatigue (M⫽65.1). Adolescents (13-18 years) endorsed lower overall quality of life (M⫽54.2), physical functioning (M⫽46.8) and fatigue (M⫽54.0), with a relative strength in psychosocial functioning (M⫽59.7). Adolescents appear to report less daily functioning and increased fatigue compared with the younger children. Additional implications of this data will be discussed and recommendations will be made to promote improved quality of life and overall functioning for children, adolescents and families living with chronic pain.
G02 - Assessment of Disability (995) Impact of chronic low back pain on dynamic lifting performance: A comparative study of older adults T. Rudy, J. Slaboda, S. Lieber, D. Weiner, J. Boston; University of Pittsburgh, Pittsburgh, PA An estimated 17 million older adults have experienced at least one episode of low back pain during the past year, and 6 million of these individuals suffer from chronic low back pain (CLBP). The consequences of CLBP are wide ranging, including impaired physical function, depression and anxiety, and increased use of health care resources. Measurement of physical function is critical in the comprehensive assessment of older adults with CLBP. Historically, studies of CLBP in older adults have used a narrow measure of physical function, such as spinal range of motion, isokinetic strength, and postural control. The performance of a functional task, however, requires physical capacity or a combination of these and other physical components to generate whole body movements for a sustained period. Performance differences between older adults with CLBP and a control group were evaluated during a repetitive isodynamic lifting task. Participants ranged in age from 65-84 and were 49 CLBP patients and 49 pain-free control subjects. Performance outcomes included weight lifted and number of lifts completed, and performance style measures described basic dynamic body biomechanics used during each lift. Controls completed significantly more lifts (p ⬍ 0.05) and lifted more weight than CLBP subjects (p ⬍ 0.01). Controls also lifted faster (p ⬍ 0.05), demonstrated less synchrony between hip and knee movements (p ⬍ 0.05), and displayed greater anterior-posterior sway (p ⬍ 0.05). The static and dynamic motion differences found between CLBP subjects and controls as they performed repetitive lifting under a constant load indicate that body motion parameters, in addition to more common strength and endurance measures, are necessary to describe the impact of CLBP on older adults’ lifting abilities. These findings also suggest that CLBP may accelerate the functional decline associated with aging, which can ultimately lead to disability.
107 (996) Four dimensions of the impact of chronic pain: Affective distress, social aspects, pain-related anxiety, and physical coping strategies M. Davidson, P. Davidson, D. Tripp, Y. Borshch; Queen‘s University, Kingston, ON Measures of pain severity by themselves do not provide complete information about the effect of pain on functioning in chronic pain patients. The multi-determined nature of the impact of pain has been demonstrated in the assessment of variables affecting headache pain, and three dimensions underlying the impact of headache pain have been identified (Holroyd, KA, et al., Pain, 1999). Our chronic pain service measures a wide range of pain-related variables including depression, anxiety, pain catastrophizing, disability and coping skills/techniques. To better understand the impact of chronic pain, we attempted to identify the underlying dimensions by examining nine instruments used in chronic pain assessment (Beck Anxiety Inventory; Beck Depression Inventory; Beck Hopelessness Scale; Chronic Pain Coping Inventory; McGill Pain Questionnaire – SF; Multidimensional Pain Inventory – 2; Pain Catastrophizing Scale; Pain Disability Inventory; and Tampa Scale of Kinesiophobia) and the subscales derived from these measures. Forty consecutive chronic pain patients completed this battery and factor analysis was used to identify underlying dimensions in the data. Four factors were identified, labeled as General Affective Distress, Social Aspects of Pain, Pain Related Anxiety, and Physical Coping Strategies. The highest loading variables on each factor were selected as the optimal measure of the associated factor. The results are useful in that they describe the underlying structure of the impact of chronic pain. Further, these results may simplify the assessment of the effect of chronic pain on day-to-day functioning and quality of life.
(997) Assessing fatigue in pediatric chronic pain J. Gold, A. Griffin, M. Carson, M. Joseph; Childrens Hospital of Los Angeles, Los Angeles, CA Pediatric chronic pain is a significant health problem that has implications on school attendance, physical and social activities and psychological distress (Bursch, Walco, & Zeltzer, 1998; McGrath, Dunn-Geier, & Cunningham, 1986; Palermo, 2000). Less understood is the role of fatigue in pediatric chronic pain. The current investigation is a cross-sectional investigation of chronic pain, fatigue and quality of life in children and adolescents who are seeking outpatient pain management services from an urban Childrens Hospital. Twenty-three participants (5 boys and 18 girls) with a mean age of 13.9 (range 8 to 18) were recruited. Participants and their caregivers completed standardized self-report questionnaires and research assistants completed a medical chart review. Participant‘s diagnostic classifications included headaches, fibromyalgia, sickle cell disease, cancer and others. The sample consisted of mostly Caucasian (47.8%) and Latino/a (34.8%) participants. Quality of life was measured with The Pediatric Quality of Life Inventory (PedsQL) (Varni, 1998). The PedsQL consists of 23 self-report items and yields physical, psychosocial and total summary health scores, ranging from 0-100, with higher scores indicating better quality of life. Fatigue was measured using the PedsQL Multidimensional Fatigue Scale (Varni, 1998), an 18-item self-report instrument with higher scores indicating less fatigue. Pain and qualitative data was gathered using a clinic-developed instrument (Bursch & Zeltzer, 2000). Children, 8-12 years, reported an above average mean quality of life (M⫽63.8), physical (M⫽63.4), psychosocial (M⫽64.0) functioning and fatigue (M⫽65.1). Adolescents (13-18 years) endorsed lower overall quality of life (M⫽54.2), physical functioning (M⫽46.8) and fatigue (M⫽54.0), with a relative strength in psychosocial functioning (M⫽59.7). Adolescents appear to report less daily functioning and increased fatigue compared with the younger children. Additional implications of this data will be discussed and recommendations will be made to promote improved quality of life and overall functioning for children, adolescents and families living with chronic pain.