Multi-center improvement in screening for pain that affects activities in adults with cerebral palsy
Prepared by: AACPDM Digest reviewer/Cherlyn Caneda MSN, C-PNP
Keywords:
- Adults
- Cerebral palsy
- Pain
- Quality improvement Learning health network
Study Type: Quality Improvement with descriptive statistics
Summary: The purpose of this quality improvement study was to standardize pain screening in adults with cerebral palsy across multiple centers to lead to significant improvements in identifying pain that affects daily activities.
Using the QI infrastructure of the Cerebral Palsy Research Network (CPRN) highlighted key demographic factors associated with pain and underscored the potential to enhance clinical care through systematic assessment. Four physicians from three CPRN centers in the United States carried out these interventions. Progress was tracked by collecting visit data cross-sectionally every two weeks. Descriptive statistics, analysis of variance, and logistic regression were used to evaluate relationships in a cohort of visits after the screening practices had been established.
Among 423 assessed visits, 44% reported pain, with over half indicating pain that interfered with activities. Pain was more frequently reported by females, older adults, and those with higher motor function levels. Females reported pain 3.4 times and pain affecting activities 2.2 times more than males. Screening rates for pain that affects activities increased from 42% to over 90% across three centers using quality improvement methods within the Cerebral Palsy Research Network.
Limitations identified in the study include a biased sample due to the hospital-based selection of clinicians who specialize in adult cerebral palsy (CP) and towards adults with CP at Gross Motor Function Classification System (GMFCS) levels IV and V. In addition, the study only assessed one aspect of pain evaluation and did not consider the biopsychosocial model of pain or other important domains such as pain location and type.
However, clinical implications of taking this standardized approach facilitated identification of pain in a large, geographically diverse adult CP population, with findings consistent with prior research. Future efforts should focus on refining screening methods, including differentiating self-report from proxy-report and addressing additional pain domains to guide care.