Pain Assessment and Management of Neurologic Impairments by Pediatric Physical Therapists; A Cross-Sectional Survey

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Background: Physical therapists indicated the use of standardized pain assessment instruments like subjective measures, self-reported scales, behavioral and physiological measures to assess pain in children with neurological impairments. Indicators such as diminished attention, retreat, and changes in sleeping and feeding patterns were also reported along with facial expression, sobbing, and vocalizations. Therapists' perspectives on behavioral pain expressions may be significantly different from the perspectives of the children's parents or caregivers. Objective: To determine the methods of pain assessment and management for children with neurologic impairments used by pediatric physical therapists. Methods: A cross-sectional survey in which the data was collected from different public hospitals in Faisalabad, Pakistan. Convenient sampling was applied to recruit physiotherapists for this study and data was gathered through a structured questionnaire after taking their written informed consent. Results: Frequently used behaviors included facial expression, vocalizations, and irritability. Cues that were rarely used included changes in sleeping, withdrawal, eating behaviors, and decreased attention. Physiotherapists prefer to use pain interventions that were supported by research like praise and distraction as well as distress-producing potentially harmful measures such as reassurance and procedural talk. About 84% percent of the respondents used subjective measures to assess pain, 60% used self-report scales, and 32% used behavioral and physiological measures. The results regarding procedural explanation showed that 41.1% of physiotherapists had very often done procedural explanation and 58.9% had often done it. Conclusion: A well-structured practice pattern of pain assessment and treatment of neurologic deficits was observed among pediatric physical therapists. Praise, distraction, and procedural explanation were often used to ease discomfort and pain while doing physiotherapy treatment sessions. Overt signs such as vocalizations, weeping and facial expressions were used to measure pain more often than subtle markers such as lower attention, disengagement, and disturbed sleep and feeding habits.