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Longitudinal Analysis of Patient-Reported Outcomes From an Interdisciplinary Pediatric Pain Rehabilitation Program
Ethan Benore1, Erin E Webster1, Lu Wang2
1Cleveland Clinic - Pediatric Behavioral Health, Cleveland, OH, USA.
Insights
Intensive interdisciplinary pain rehabilitation treatment (IIPT) improved functioning in children with chronic headache and migraine. Significant improvements in daily, emotional, and family functioning, and reduced school absences were observed post-treatment.
Area of Science:
- Pediatric neurology
- Pain management
- Rehabilitation medicine
Background:
- Chronic headache and migraine significantly impair children's physical, social, emotional, and academic functioning.
- Intensive interdisciplinary pain rehabilitation treatment (IIPT) is a potential intervention for severely impaired children.
- Limited data exist on the long-term effects of IIPT across multiple time points.
Purpose of the Study:
- To evaluate the recovery trajectory of children undergoing IIPT for chronic headache.
- To determine if physical and psychosocial functioning improve before pain reduction.
Main Methods:
- Retrospective analysis of patient-reported outcomes from 135 children (2008-2014).
- Data analyzed across 5 time points, including up to 1-year post-discharge.
- Utilized linear mixed models to assess changes in functioning and pain.
Main Results:
- Statistically significant improvements in daily functioning, emotional functioning, family functioning, and reduced school absences over 12 months (P ≤ .01).
- Quality of life improved during the program but not post-discharge.
- Pain reduction was significant 12 months after discharge, not during treatment.
Conclusions:
- Children with chronic headache and migraine show linear improvement in functioning after IIPT.
- Further research is needed to refine methodologies for analyzing IIPT response.
- Functional gains are achieved, with pain reduction following initial improvements in functioning.
Background:
Many children suffering from chronic headache and migraine present with comorbid functional disability, including physical, social, emotional, and academic activities. For children severely impaired by headache, intensive interdisciplinary pain rehabilitation treatment (IIPT) can improve functioning. However, there are limited data evaluating children's response to rehabilitation across several time points.
Objective:
This study aims to evaluate the trajectory of recovery for children undergoing IIPT for chronic headache, as well as to examine the proposed assumption that physical and psychosocial functioning improves prior to a reported reduction in pain.
Methods:
A retrospective analysis of patient-reported outcomes in a clinical database of 135 children admitted to an IIPT program between the years 2008 and 2014 was analyzed. Available data across 5 separate time points (up to 1-year post-discharge) were reviewed.
Results:
One hundred and thirty-five children of mean age 15.2 (SD = 2.2) and 74% female provided data for review. Linear mixed model demonstrated a statistically significant improvement in pain-specific measures of functioning, including daily functioning (change estimate = -14.53) emotional functioning (change estimate = -14.63), family functioning (change estimate = -5.78), and school absences (change estimate = -11.47) over a 12-month period (all P's ≤ .01). A more general measure of quality of life improved during the program, based upon child (change estimate = +10.07) and parent report (change estimate = +15.31); although these gains did not continue to improve post-discharge. As expected, although children did not report a reduction in pain during rehabilitation (change estimate = +0.07), they did report a significant drop in perceived pain in the 12 months following discharge from the program (change estimate = -2.12, P ≤ .01).
Conclusions:
Children with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain-specific patient-reported outcomes over time; however, there remains a need for improved methodology in analyzing response to IIPT programs.
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