Incidence and risk factors for care-induced pain in adults with physical disability: An observational study

Care facilities for adults with physical disability provide a range of personal, medical care and rehabilitation support involving physical contact. Little is known about pain induced by these physical acts in this setting. This non interventional, observational, prospective, multicentre study aimed to measure the incidence of care-induced pain in adults with physical disability, and aimed to identify risk factors and prevention methods used. The setting was 16 randomly drawn neurological rehabilitation centres (n=5) and long-term care facilities (n=11) in 4 counties of Brittany, France. 163 adults with physical disability were randomly selected (median [IQR] age: 52 [40-62] years; sex ratio: 1.7). The main pathologies were acquired brain injury, cerebral palsy and spinal cord injury. All physical acts performed over 5 days and 1 night were recorded and pain was measured using FLACC-r. Descriptive analyses and a multivariate model predicting FLACC-r intensity were conducted. Of the 5580 acts analysed, 6% were rated as painful and 36% of the participants experienced care-induced pain at least once during the study period. Attendant care was the most frequent and frequently painful class of act. In the multivariate analysis, level of dependency, physical act class and sex predicted FLACC-r intensity (all p<0.01). Pain prevention means were not routinely used (12%). Care-induced pain is frequently experienced by adults with physical disability in neurological rehabilitation centres and long-term care facilities during any act involving direct physical contact and appears to be a lifespan issue. PERSPECTIVE: This study measured an incidence of 6% of pain during usual physical acts in adults with physical disability. Any professional involved should be aware of this risk. Routine pain assessment and prevention are keys to improve practices, therapeutic alliance and quality of life for adults with physical disability.