Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox

Abstract

Purpose: Though high numbers of children with cerebral palsy experience chronic pain, it remains under-recognized. This paper describes an evaluation of implementation supports and adoption of the Chronic Pain Assessment Toolbox for Children with Disabilities (the Toolbox) to enhance pain screening and assessment practices within a pediatric rehabilitation and complex continuing care hospital.

Methods: A multicomponent knowledge translation strategy facilitated Toolbox adoption, inclusive of a clinical practice guideline, cerebral palsy practice points and assessment tools. Across the hospital, seven ambulatory care clinics with cerebral palsy caseloads participated in a staggered roll-out (Group 1: exclusive CP caseloads, March–December; Group 2: mixed diagnostic caseloads, August–December). Evaluation measures included client electronic medical record audit, document review and healthcare provider survey and interviews.

Results: A significant change in documentation of pain screening and assessment practice from pre-Toolbox (<2%) to post-Toolbox adoption (53%) was found. Uptake in Group 2 clinics lagged behind Group 1. Opportunities to use the Toolbox consistently (based on diagnostic caseload) and frequently (based on client appointments) were noted among contextual factors identified. Overall, the Toolbox was positively received and clinically useful.

Conclusion: Findings affirm that the Toolbox, in conjunction with the application of integrated knowledge translation principles and an established knowledge translation framework, has potential to be a useful resource to enrich and standardize chronic pain screening and assessment practices among children with cerebral palsy.

Implications for Rehabilitation

• It is important to engage healthcare providers in the conceptualization, development, implementation and evaluation of a knowledge-to-action best practice product.

• The Chronic Pain Toolbox for Children with Disabilities provides rehabilitation staff with guidance on pain screening and assessment best practice and offers a range of validated tools that can be incorporated in ambulatory clinic settings to meet varied client needs.

• Considering unique clinical contexts (i.e., opportunities for use, provider engagement, staffing absences/turnover) is required to optimize and sustain chronic pain screening and assessment practices in rehabilitation outpatient settings.

Keywords:

• Evaluation studies
• knowledge translation
• pain measurement
• chronic pain
• cerebral palsy
• disabled children
• implementation

Acknowledgements

Evidence to Care is the knowledge translation unit at Holland Bloorview Kids Rehabilitation Hospital. In collaboration with the Chronic Pain Toolbox Working Group, Evidence to Care spearheaded the development, implementation, and evaluation of the Toolbox within the Hospital. We would like to acknowledge project partners, including all healthcare professionals, managers and collaborative practice leaders, engaged in this work for their continued support and commitment. We also thank Dr. Amy McPherson and Joanne Wincentak for their reviews of this manuscript and helpful comments.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Matched funding for this Evidence to Care project was provided by the Holland Bloorview Kids Rehabilitation Hospital Foundation and the Government of Ontario.