Continuous assessment of care-related pain in paediatric rehabilitation centres : methodology, relevance and validity
Mr Jean-Sébastien BOURSEULa, Mrs Amandine DUBOISb, Dr Laetitia HOUXa, Dr Christelle PONS-BECQMEURa, Dr Mélanie BUEc, Dr Isabelle MANESSEc, Mrs Dominique GUYADERc, Dr Philippe LE MOINEd, Dr Sylvain BROCHARDa
a Service MPR, CHRU Brest, b Université de Bretagne Occidentale, département de psychologie, CRPCC - EA 1285, c Service MPR Pédiatrique, Fondation Ildys, BREST, d Service Pédiatrie, CHRU Brest
INTRODUCTION: Children with motor disability and loss of independence who require multidisciplinary care are followed in paediatric rehabilitation centres. They undergo many care activities which can be painful. The aim of this study was to evaluate the feasibility, clinical relevance and the validity of a methodological paradigm for the continuous assessment of care-related pain.
METHOD: Two paediatric rehabilitation centres participated in the study. Each week, 1-3 children were randomly selected from each centre. The level of pain or discomfort produced by each care activity was rated using the FLACC-r scale and a visual analogue scale rated by the carer (VAScarer) and the patient (VASpatient) for 5 days and 1 night.
RESULTS: 32 children aged from 1-15 years (med. = 7 years) were included in the study. 1302 care activities were evaluated. 3.6% were rated as painful and 11% as uncomfortable. The most frequently painful activities were mouth care, transfers, standing and dressing. The most frequently uncomfortable activities were passive limb mobilisation and dressing. There was an excellent correlation between the FLACC-r and VAScarer scores (r=0.888 ; p<.05) and a moderate correlation between the FLACC-r and VASpatient scores (r=0.564 ; p<.05).
DISCUSSION: The methodology proposed in this study can be used in any type of institution for children with motor disability wishing to evaluate and reduce the frequency of care-related pain.
Keywords : Pain, Children, Care-related pain, Paediatric Rehabilitation, Care activities