ABSTRACT

Title: Pain Assessment as an Outcome Measure for Physiotherapy Intervention in Children with Cerebral Palsy

Authors:

1. Ajediran I. Bello (Ph.D)
2. Naa Abokailey Mensah (B.Sc)

Address:

Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana

E-mail: iabello@chs.edu.gh

Purpose: The purpose of this study was to assess pain perception among children with Cerebral Palsy (CP) during 8-week [DB1] physiotherapy intervention taking into consideration the frequency and number of treatment sessions. The main objective was to quantify the impacts of physiotherapy on musculoskeletal pain in children with CP.

Relevance: The outcome of this study is expected to provide an insight for quantifying physiotherapy impacts in the management of pain associated with CP. This could become handy during objective assessment and for monitoring pain perception in children with CP.

Participants: The participants for this study were 30 children with CP comprising 16 (53.3%) males and 14(46.7%) females with age range 8 months to 11 years. Participants were grouped under the following age categories: 0-2 years, 3-5 years, 6-8 years and 9 -11 years. They were enrolled into the study at the out-patient units of physiotherapy departments at three referral Hospitals in Accra, Ghana.

Methods: Ethical approval for the study was obtained from the Ethics and Protocol Review Committee of the School of Allied Health Sciences, University of Ghana. Participants were recruited into the study through sample of convenience method. It is an observational study in which children with CP were managed by highly experienced pediatrics physiotherapists who had undergone series of training courses in Bobath and PNF techniques. Paediatrics Pain Profile (PPP) questionnaire was utilized to assess pain behaviour of the children. The questionnaire was administered to the mothers or caregivers of the participants on the first contact (baseline assessment). The mothers or parents were required to respond to the information regarding the pain behaviours of their children as indicated in the questionnaire. Subsequent follow up pain assessments were performed in the fourth and eighth week of the intervention period. The frequency and number of treatment sessions were recorded over eight weeks whilst the type of CP was retrieved from the patients’ folders.

Analysis: Data were analyzed using means, standard deviation and percentage to present the data. Related samples Wilcoxon Signed Rank test was used to compare pain perception among the participants at baseline and at week eight whilst Spearman’s Correlation Coefficient analysis was performed to determine the relationships among the intervening variables. The probability level of statistical significance was set at 0.05.

Results: Majority of the participants, 22(73.3%) presented with Spastic CP whilst 1(3.3%) had Ataxic CP. There was a significant reduction in pain perception between the baseline and week 8 scores. A significant correlation (p<0.001) was also found between pain perception and the types of CP presented. Pain perception and frequency of physiotherapy per week were inversely and insignificantly correlated (r= -0.147, p= 0.437). Similarly, pain perception and number of physiotherapy sessions were not significantly correlated (r= -0.046, p= 0.808).

Conclusion: 8-week physiotherapy had an impact on the pain perception in children with CP and this was not significantly influenced by the frequency and the number of physiotherapy sessions.

Implication: The outcome has policy implication in physiotherapy practice which could be considered in practice guideline development for physiotherapists in the management of children with CP.

Key words: Cerebral Palsy, Pain Perception, Physiotherapy, Pain assessment

[DB1]The adoption of 8-week duration is sequel to the focus of the study i.e. Stiffness-evoked pain and not necessarily the neurological deficits imposed by CP. So, we were of the opinion that changes in pain intensity could be recorded within this time frame.