Differential Risk Factor Profiles in the Prediction of General and Pain-Specific Functional Limitations 12 Months after Major Pediatric Surgery.

Brittany N Rosenbloom,Fiona Campbell,Jennifer Stinson,M Gabrielle Pagé,Lisa Isaac,Joel Katz,P Maxwell Slepian

doi:10.3390/children8050360

Abstract

Pediatric chronic post-surgical pain is a surgical complication associated with various levels of functional limitation. Two commonly used measures of functional limitations in youth are the Functional Disability Inventory (FDI) and the PROMIS Pediatric Pain Interference Scale (PPIS), where the former is general, and the latter, pain specific. The aim of the present study was to prospectively compare pre-surgical youth and parent risk factors for youth functional limitations, assessed by the FDI and PPIS, 12 months after major pediatric surgery. Risk factors for the FDI and PPIS were compared in 79 dyads consisting of youth (58% female, M = 14.56 years; SD = 2.31) undergoing major surgery and one of their parents. The FDI and PPIS were highly correlated prior to surgery (r = 0.698, p < 0.001) and even more so 12 months after surgery (r = 0.807, p < 0.001). Parent pre-surgical anxiety sensitivity and youth pre-surgical functional disability significantly predicted 12-month FDI (F(6,56) = 4.443, p = 0.001, Adjusted R2 = 0.25), whereas parent pre-surgical anxiety sensitivity, trait anxiety, pain anxiety, as well as youth pain-related anxiety and worry significantly predicted 12-month PPIS (F(6,45) = 4.104, p = 0.002, Adjusted R2 = 0.27). Risk factors for 12-month general and pain-specific functional limitations differ by dyad member and type. Functional limitations in youth after surgery are predicted by youth and parent factors, however the risk factors differ between the FDI and the PPIS.

Highlights

Chronic post-surgical pain is a surgical complication reported by 11–54% of children and adolescents after major surgery [1,2,3,4]
Twenty-seven (27) participants were admitted to the intensive care unit (ICU) directly from the operating room and daily pain measures were not obtained, nor was the Actical device secured on the participants’ wrist until they had been moved out of the ICU to a surgical floor
In line with our hypothesis, hierarchical regression analysis showed that the addition of parent factors to Model 3 was significant in predicting both the Pediatric Pain Interference Scale (PPIS) and Functional Disability Inventory (FDI); qualitatively more so for the PPIS than the FDI in that whereas both functional limitation measures were predicted by parent Anxiety Sensitivity Index (ASI), the PPIS was predicted by parent trait anxiety and pain-related anxiety

Summary

Introduction

Chronic post-surgical pain is a surgical complication reported by 11–54% of children and adolescents after major surgery [1,2,3,4]. There is evidence in support of the IFAM model from cross-sectional studies showing bi-directional relationships among child chronic pain-related disability and child and parent, parent-youth dyad, and family variables [9,10]. This relationship has rarely been evaluated longitudinally. A recent systematic review and meta-analysis of youth with chronic pain [10] found only four prospective studies [11,12,13,14] to have evaluated parent and youth factors and their relationship to functional limitations over time using the Functional Disability Inventory (FDI), the Child Activities Limitations Interview (CALI), and the Child Health Assessment Questionnaire (CHAQ). None has evaluated these relationships in the transition of acute to chronic postsurgical pain

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