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Outcome Assessment in Children and Adolescents With Chronic Pain: An International Clinical Practice Survey
Jordi Miró1,2,3, Elisabet Sánchez-Rodríguez1,2,3, Mark P Jensen4
1Pediatric Pain Division, Universitat Rovira i Virgili, Tarragona, Spain.
Insights
Clinicians commonly assess paediatric chronic pain using measures like pain intensity and physical functioning. However, global disparities exist, highlighting the need for a standardized core outcome set (COS) for equitable care.
Area of Science:
- Paediatric Pain Management
- Clinical Outcome Assessment
- Global Health Disparities
Background:
- Effective paediatric chronic pain treatment necessitates comprehensive outcome assessment tools.
- Existing core outcome sets (COS) for trials may not be suitable for clinical practice.
- Understanding current clinical assessment practices is crucial for improving care.
Purpose of the Study:
- To identify outcome domains and measures used by clinicians treating paediatric chronic pain.
- To determine which domains are considered mandatory in routine clinical practice.
- To compare outcome prioritisation across different professional disciplines and countries.
Main Methods:
- An online survey was distributed to clinicians treating paediatric chronic pain in 8 languages.
- Data from 193 clinicians across 42 countries were analyzed.
- Statistical tests compared outcome assessment practices based on country income and professional background.
Main Results:
- Pain intensity, pain interference, and physical functioning were the most frequently assessed domains.
- These domains were considered mandatory by over 90% of clinicians.
- Significant variations in assessment practices were observed based on country income and professional background, with lower use of patient-reported outcome measures.
Conclusions:
- Current paediatric chronic pain assessment practices show global and professional disparities.
- There is a clear need for a standardized core outcome set (COS) tailored for clinical settings.
- Implementing a COS will enhance assessment consistency, enable benchmarking, and promote equitable global pain care.
Background:
Effective treatment of paediatric chronic pain requires a robust and comprehensive set of outcome assessment tools to evaluate treatment effectiveness. Although a core outcome set (COS) exists for clinical trials, its practicability and appropriateness for clinical practice is currently unknown. This cross-sectional study led by the IN-ChildPain group aimed to: (1) identify clinical outcome domains and measures used by clinicians treating children and adolescents with chronic pain, (2) determine which domains are considered mandatory in clinical routine and (3) compare prioritisation across disciplines and countries.
Methods:
An online survey, available in eight languages, was conducted eliciting data from clinicians who treat children and adolescents with chronic pain. Percentages of the most commonly used outcomes were calculated, and z-tests were performed to compare study variables based on participants' country income status and professional background.
Results:
A total of 193 clinicians from 42 countries participated. The most commonly assessed domains were pain intensity (84%), pain interference (80%) and physical functioning (79%), with higher assessment rates in high-income countries. Pain intensity and interference were deemed mandatory by 93% of participants, followed by physical functioning (92%). However, only 53% reported using patient-reported outcome measures, with the 0-10 Numeric Rating Scale being the most common (94%). Assessment practices varied as a function of country income level and professional background.
Conclusions:
The findings highlight the need to develop and implement a COS tailored to the needs and resources of clinicians. Such standardisation would enhance consistency in assessment, enable cross-site benchmarking and promote equitable pain care globally.
Significance:
This study provides critical insights into how clinicians assess paediatric chronic pain, highlighting significant global disparities and professional differences in outcome domain prioritisation. By identifying commonly assessed domains, these findings emphasise the need for standardised measures and pave the way for developing a core outcome set tailored to clinical activities. Such an advance is essential for improving the consistency and quality of care for children and adolescents with chronic pain worldwide.
