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Hurtubise K1,2, Camden C1,3
1Université de Sherbrooke, École de Réadaptation, Faculté de Médecine et Science de la Santé, Sherbrooke, Canada, 2University of AalborgCalgary, Department of Psychology, Calgary, Canada, 3McMaster University, CanChild Centre for Childhood Disability Research, Hamilton, Canada
Background: Chronic pain in youth is increasing at alarming rates worldwide, affecting 1 to 4 youth in industrialized countries. For 5% of these youth, the condition is highly disabling and costly. In addition to psychology and medical interventions, physical therapy (PT) is recognized as a key component of paediatric interdisciplinary pain treatment programs. Traditionally designed for youth with complex regional pain syndrome (CRPS), these programs, targeting self-management and participation in age-appropriate activities, have expanded their model to treat highly disabled children with various types of pain. Although strong evidence exists for physical therapy in adults with chronic pain, these same treatments may not be appropriate for the paediatric population.
Purpose: To report findings of a scoping review investigating: ¨What interventions and strategies are used by physical therapists (PTs) in paediatric interdisciplinary pain treatment programs?¨ Therapeutic dose and the theory underpinning these interventions were also explored.
Methods: A three-pronged search strategy and the 6-step methodological framework proposed by Levac et al, 2010 was used. Descriptive statistics and thematic analysis helped analyze the extracted data. Interpretation of the findings was discussed with an advisory committee, including PTs working with these youth.
Results: Only 3 articles specific to PT in interdisciplinary pain treatment programs surfaced. When the search was narrowed to 'interdisciplinary pain treatment programs' only, 21 additional articles were detected; studies describing the same program were eliminated (n= 7). Articles originated from 7 different countries; authors were primarily psychologists (n=10) and physicians (n=4), and included large samples of youth with CRPS. A total of 51 different interventions were emphasized with the most common including strength training (n=10), aerobic activity (n=6), and desensitisation (n= 5); TENS (n=6), contrast baths (n=4) and hydrotherapy (n=4) were the most commonly employed therapeutic modalities. Multiple evidence-based behavioural change techniques (n=16) were detailed in PT authored articles (n=3). The use of group interventions was frequent (63%). The therapeutic dose was reported as a reference to the PT session duration (mean=2-hours daily) and frequency (mean=4-times weekly for 3.5 weeks). The theory underpinning the intervention resided consistently in a biopsychosocial approach, normalization and restorative models, typically with a functional goal-oriented focus. Despite physiotherapists being included within team descriptions, 6 studies failed to specify any PT-specific intervention. Inconsistent use of terminology and poorly described interventions added complexity to data interpretation. Some strategies regularly incorporated in paediatric PT practice were also under-reported or assigned to other disciplines in the literature reviewed.
Conclusion(s): Over the past two decades, PTs working in paediatric interdisciplinary pain programs have evolved, incorporating sensorimotor interventions, behaviour change strategies, and group-based service delivery models in their treatment of the biopsychosocial complexities of youth with disabling chronic pain. However, well-designed studies using detailed intervention protocols, developed and conducted by PTs are needed to investigate the effectiveness and efficiency of these practices within the context of broader paediatric pain populations.
Implications: The complexity of chronic pain in youth requires a biopsychosocial approach, with a focus on self-management and function restoration.Physical therapists´ knowledge and skills are critical to interdisciplinary pain treatment programs designed for these youth.
Keywords: Physical Therapy, Paediatric Chronic Pain, Interdisciplinary pain Treatment Programs
Funding acknowledgements: Supported by the Vanier Doctoral Scholarship Award, Canadian Child Health Clinician Scientist Program, and Pain in Child Health Research Initiative.
Purpose: To report findings of a scoping review investigating: ¨What interventions and strategies are used by physical therapists (PTs) in paediatric interdisciplinary pain treatment programs?¨ Therapeutic dose and the theory underpinning these interventions were also explored.
Methods: A three-pronged search strategy and the 6-step methodological framework proposed by Levac et al, 2010 was used. Descriptive statistics and thematic analysis helped analyze the extracted data. Interpretation of the findings was discussed with an advisory committee, including PTs working with these youth.
Results: Only 3 articles specific to PT in interdisciplinary pain treatment programs surfaced. When the search was narrowed to 'interdisciplinary pain treatment programs' only, 21 additional articles were detected; studies describing the same program were eliminated (n= 7). Articles originated from 7 different countries; authors were primarily psychologists (n=10) and physicians (n=4), and included large samples of youth with CRPS. A total of 51 different interventions were emphasized with the most common including strength training (n=10), aerobic activity (n=6), and desensitisation (n= 5); TENS (n=6), contrast baths (n=4) and hydrotherapy (n=4) were the most commonly employed therapeutic modalities. Multiple evidence-based behavioural change techniques (n=16) were detailed in PT authored articles (n=3). The use of group interventions was frequent (63%). The therapeutic dose was reported as a reference to the PT session duration (mean=2-hours daily) and frequency (mean=4-times weekly for 3.5 weeks). The theory underpinning the intervention resided consistently in a biopsychosocial approach, normalization and restorative models, typically with a functional goal-oriented focus. Despite physiotherapists being included within team descriptions, 6 studies failed to specify any PT-specific intervention. Inconsistent use of terminology and poorly described interventions added complexity to data interpretation. Some strategies regularly incorporated in paediatric PT practice were also under-reported or assigned to other disciplines in the literature reviewed.
Conclusion(s): Over the past two decades, PTs working in paediatric interdisciplinary pain programs have evolved, incorporating sensorimotor interventions, behaviour change strategies, and group-based service delivery models in their treatment of the biopsychosocial complexities of youth with disabling chronic pain. However, well-designed studies using detailed intervention protocols, developed and conducted by PTs are needed to investigate the effectiveness and efficiency of these practices within the context of broader paediatric pain populations.
Implications: The complexity of chronic pain in youth requires a biopsychosocial approach, with a focus on self-management and function restoration.Physical therapists´ knowledge and skills are critical to interdisciplinary pain treatment programs designed for these youth.
Keywords: Physical Therapy, Paediatric Chronic Pain, Interdisciplinary pain Treatment Programs
Funding acknowledgements: Supported by the Vanier Doctoral Scholarship Award, Canadian Child Health Clinician Scientist Program, and Pain in Child Health Research Initiative.
Topic: Paediatrics; Pain & pain management; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of Calgary; Université de Sherbrooke
Ethics committee: Co-jointHealth Research Ethics Board; Comité éthique de recherche du CHUS
Ethics number: REB16-0916; 2017-1543
All authors, affiliations and abstracts have been published as submitted.
