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No pain, no gain? Children with cerebral palsy and their experience with physiotherapy
Laetitia Houx1, Christelle Pons2, Hélène Saudreau3
1Physical and medical rehabilitation department, CHRU de Brest, France; Paediatric physical and medical rehabilitation department, Fondation ILDYS, Brest, France; Laboratory of medical information processing, Inserm U1101, Brest, France.
Insights
Physiotherapy, especially stretching, causes pain in children with cerebral palsy (CP), leading to dislike of treatment. Understanding pain experiences and coping strategies is crucial for effective CP therapy.
Area of Science:
- Pediatric Rehabilitation
- Pain Management in Neurological Disorders
- Cerebral Palsy Research
Background:
- Physiotherapy can cause pain in children and young adults with cerebral palsy (CP).
- Limited understanding exists regarding children's pain experiences during therapy and its specific causes.
- Knowledge gaps persist concerning effective coping strategies for pain during CP physiotherapy.
Purpose of the Study:
- To investigate the pain experiences of children and young adults with CP during physiotherapy sessions.
- To identify the primary causes of pain experienced during these therapy sessions.
- To analyze the coping strategies employed by both children and therapists to manage pain.
Main Methods:
- A qualitative study utilizing focus groups was conducted.
- Eighteen children and young adults with CP who reported pain during physiotherapy participated.
- Thematic analysis of manually coded transcripts was performed from a phenomenological perspective.
Main Results:
- Physiotherapy, particularly stretching, was confirmed to induce pain in participants.
- Pain led to a dislike of physiotherapy, though some viewed it as a sign of treatment efficacy.
- Distraction techniques and the patient-therapist relationship significantly influenced pain perception and experience.
Conclusions:
- Patients with cerebral palsy (CP) experience pain during physiotherapy, with stretching being a primary cause.
- Beliefs and practices surrounding pain indicate a need for enhanced physiotherapist training.
- Addressing pain experiences is essential for improving the effectiveness and acceptance of physiotherapy in CP management.
Objectives:
Recent studies have shown that physiotherapy can induce pain in children and young adults with cerebral palsy (CP). There is a lack of knowledge of children's pain experiences during therapy sessions and the specific causes of pain. The main objective of this study was to better understand the experience of children and young adults with CP during physiotherapy sessions and to analyse the coping strategies used by children and therapists.
Methods:
Qualitative study with focus groups. Eighteen children/young adults with CP who experienced pain during physiotherapy were interviewed, using focus groups as a source of data collection in a phenomenological perspective. Data collection and analysis were consecutive to ensure that the data saturation point was reached. The transcripts were coded manually using thematic analysis. First, interesting features of the verbatim were coded, then codes were collated into potential themes and then the themes were checked to ensure they worked in relation to the coded extracts. Multiple coding was performed by 3 different researchers, and results were merged at each step.
Results:
This study confirmed that among the 18 children interviewed (mean [SD] age 13.17 [4.02] years, 10 girls), physiotherapy, particularly stretching, induced pain. Participants reported that the experience of pain led to a dislike of physiotherapy, although some believed that the pain was necessary to show that the treatment was effective. The use of distraction techniques and the relationship with the physiotherapist were key elements associated with the perception and experience of pain.
Conclusions:
This study confirmed that patients with CP experience pain during physiotherapy. Stretching seems to be the main source of pain. Beliefs and practices regarding the concept of pain show that physiotherapists need training in this field.
