Functionally relevant physical exercises as an objective measure of clinical improvement in pediatric chronic pain.

Abstract

This exploratory study demonstrates the application of functionally relevant physical exercises (FRPE) to objectively assess physical functioning among children with chronic pain. Intensive interdisciplinary pain treatment (IIPT) focuses on functional improvements as a primary outcome. FRPEs aim to enhance clinical assessments and monitoring by providing relevant data for physical and occupational therapies. Children enrolled in three weeks of IIPT provided data for study. They completed two self-report measures of functioning (Lower Extremity Functioning Scale [LEFS] and Upper Extremity Functioning Index [UEFI]), measure of pain intensity, and six separate FRPEs (box carry, box lifts, floor to stand, sit to stand, step ups, and modified six-minute walk test). Data from 207 participants aged 8-20 years old were analyzed. Upon admission, over 91% of children could perform each FRPE at some level to provide clinicians with a baseline assessment of functional strength. Following IIPT, all children were able to complete FRPEs. Overall, children reported statistically significant gains in functioning on all subjective reports and FRPEs (p's < 0.001). Spearman correlations demonstrated that LEFS and UEFI were weakly to moderately correlated to all FRPEs at admission (r's between.43-.64, p's < 0.001 and.36-.50, p's < 0.01 respectively). Correlations between all subjective and objective measures were comparatively lower at discharge. FRPEs appear to serve as good objective measures of strength and mobility for children with chronic pain, measuring variability across patients and change over time, which is unique from subjective data gathered via self-report. Due to face validity and objective measurement of functioning, from a clinical practice perspective, FRPEs provide meaningful information to support initial assessment, treatment planning, and patient monitoring. This study offers initial support for a novel measurement method that is easily administered and replicated to effectively measure functional improvement in children with chronic pain.