title: Engagement in multidisciplinary interventions for pediatric chronic pain: parental expectations, barriers, and child outcomes.
abstract: OBJECTIVE
  To examine the adherence to the recommendations of pain treatment among children and adolescents evaluated for a variety of chronic and recurrent pain conditions.
  
  
  METHODS
  Several measures during initial evaluation and after 3 months were collected to assess satisfaction with initial evaluation, adherence to multidisciplinary recommendations, pain ratings, somatic symptoms, functional limitations, and school attendance.
  
  
  RESULTS
  Of the 120 patients who initially enrolled in the study, 70 parents and 57 children participated in 3-month follow-up interviews and reported significantly fewer doctor visits, decreased somatic symptoms, fewer functional limitations, and decreased pain compared with their initial evaluation. Adherence to multidisciplinary recommendations ranged from 46.7% to 100% with the highest level of overall adherence to physical therapy. Factors associated with adherence varied across type of recommendation. For medical recommendations, higher parent-reported patient satisfaction and expectations that medical tests would be beneficial were associated with engagement in medical treatment, whereas parent reports of negative attitude-type barriers and experience with surgery were associated with less frequent engagement in recommended treatment. With regard to physical therapy recommendations, only earlier experience with exercise was associated with better adherence. For psychologic recommendations, familiarity with hypnosis and biofeedback in addition to positive expectations regarding psychologic treatment and biofeedback were all associated with subsequent engagement in psychologic treatment. Lastly, we identified modest associations between functional improvements and adherence to specific recommendations.
  
  
  CONCLUSIONS
  Results of this study support the importance of examining adherence to multidisciplinary interventions among children and adolescents with chronic pain.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Laura.Simons@childrens.harvard.edu
authors.forename: Laura E
authors.initials: LE
authors.lastname: Simons
authors.forename: Deirdre E
authors.initials: DE
authors.lastname: Logan
authors.forename: Laura
authors.initials: L
authors.lastname: Chastain
authors.forename: Madelin
authors.initials: M
authors.lastname: Cerullo
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000523:psychology; D018710:Pain Clinics; D059408:Pain Management; D010147:Pain Measurement; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D010372:Pediatrics; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome