Multi-center improvement in screening for pain that affects activities in adults with cerebral palsy

Descriptions of how centers implement standardized screening for pain and how pain affects activities among adults with cerebral palsy (CP) are lacking.

Improve screening for pain in adults with CP across three centers and examine factors associated with pain that affect activities.

Using the quality improvement (QI) infrastructure of the Cerebral Palsy Research Network (CPRN), we implemented interventions to improve screening at clinic visits for pain that affects activities for adults with CP. Four physicians from three CPRN centers in the United States performed interventions. To track progress, we collected visit data cross sectionally every two weeks. Descriptive statistics, analysis of variance, and logistic regression evaluated relationships in a cohort of visits after screening practices had been established.

Screening improved from 42 % at baseline to over 90 %. After three months of sustained screening, we assessed 423 visits. Pain was reported at 185/423 (44 %) of visits. 100/185 (54 %) reported pain that affected activities. Increasing age, female gender, and greater motor function were associated with pain (p < 0.001) and pain that affects activities (p < 0.01). Females reported pain 3.4 times and pain that affects activity 2.2 times more than males.

QI methodology was successful at improving screening for pain that affects activities in adults with CP. Lower rates of pain were found (44 %) than previous reports, with similar findings about pain affecting activities and associated characteristics. Next steps should include continued screening with improvement in differentiating proxy vs self-report and including other domains of pain important to guide care.