Care-related pain and discomfort in children with motor disabilities in rehabilitation centres.
BACKGROUND
Pain is one of the symptoms reported most by children with motor disabilities particularly during daily living activities in institutions and during rehabilitation. Despite the care and consideration of professionals, a wide range of motor and cognitive disabilities, limited communication skills, the presence of chronic pain and frequent care interventions place such children at high risk of experiencing induced pain.


OBJECTIVE
We aimed to identify care-related pain and discomfort in children with motor disabilities in rehabilitation centres and the characteristics of children at risk of induced pain. A further aim was to evaluate the validity of a method for the continuous assessment of care-related pain.


METHODS
Patients were recruited from 2 paediatric rehabilitation centres. The level of pain or discomfort experienced during each daily care activity was evaluated for 5 days and 1 night by using the FLACC-r scale and a visual analog scale (VAS) rated by the caregiver (VAS caregiver) and the patient (VAS patient).


RESULTS
We included 32 children (mean age: 8.5±5 years, range: 1-15 years) with 1302 care activities evaluated. Overall, 3.6% of the activities were rated as painful and 11% uncomfortable. The most frequent painful activities were mouth care, transfers standing and dressing. The most frequent uncomfortable activities were passive limb mobilisation, dressing and transfers. Children with neurological disorders were at increased risk of induced pain.


CONCLUSIONS
Children with motor disabilities experienced pain during daily care activities. The methodology we propose is valid and can be used in any type of institution for children with motor disability to evaluate and reduce the frequency of care-related pain.
Physical and rehabilitation medicine department, CHRU de Brest, 2, avenue Foch, Brest, France; Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France; Université de Bretagne Occidentale, 20, rue Duquesne, Brest, France. Electronic address: jean-sebastien.bourseul@chu-brest.fr.
Jean-Sébastien
JS
Bourseul
Physical and rehabilitation medicine department, CHRU de Brest, 2, avenue Foch, Brest, France; Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France; Université de Bretagne Occidentale, 20, rue Duquesne, Brest, France; LaTIM INSERM UMR 1101, 2, avenue Foch, Brest, France.
Sylvain
S
Brochard
Physical and rehabilitation medicine department, CHRU de Brest, 2, avenue Foch, Brest, France; Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France.
Laetitia
L
Houx
Physical and rehabilitation medicine department, CHRU de Brest, 2, avenue Foch, Brest, France; Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France; Université de Bretagne Occidentale, 20, rue Duquesne, Brest, France.
Christelle
C
Pons
Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France.
Mélanie
M
Bué
Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France.
Isabelle
I
Manesse
Pediatric department, CHRU de Brest, 2, avenue Foch, Brest, France; Université de Bretagne Occidentale, 20, rue Duquesne, Brest, France.
Juliette
J
Ropars
Pediatric rehabilitation center, Fondation Ildys, rue de Kérangall, Brest, France.
Dominique
D
Guyader
Pediatric department, CHRU de Brest, 2, avenue Foch, Brest, France; Pain evaluation and treatment center, CHRU de Brest, 2, avenue Foch, Brest, France.
Philippe
P
Le Moine
Université de Bretagne Occidentale, 20, rue Duquesne, Brest, France; Psychological, cognitive and communication research centre, CRPCC - EA 1285, Rennes 2, France.
Amandine
A
Dubois
D000203:Activities of Daily Living; D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019957:Motor Skills Disorders / Q000534:rehabilitation*; D009422:Nervous System Diseases / Q000534:rehabilitation; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000009:adverse effects*; D012047:Rehabilitation Centers; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires
Children; Induced-pain; Motor disability; Rehabilitation