Development and Clinimetric Properties of the Dutch Pediatric Neurophysiology of Pain Questionnaire in Healthy Children
Condition: Surveys and Questionnaires; Child; Pain; Knowledge; Validation
Study type: Observational

Summary: 
      The scientific objective of this research implies developing and examining the clinimetric
      properties of the Dutch Pediatric Neurophysiology of Pain Questionnaire (PedNPQ) in healthy
      children.

      A total study sample of 60 healthy children (30 from 2nd and 3rd primary school) will be
      included to measure test-retest reliability of the Pediatric Neurophysiology of Pain
      Questionnaire (PedNPQ). Children will be asked to fill in the questionnaire twice, with a
      time interval of 48 hours (assessment T0 and T1).

      In order to assess concurrent validity of the PedNPQ, 30 children (15 from 2nd and 3rd
      primary school) as well as their parent will receive a pediatric Pain Neuroscience Education
      (PNE) session. It is hypothesized that if the developed PedNPQ is valid, children who
      received PNE will perform better than children receiving no PNE.

      To reduce the participant's workload, all assessments will be done immediately after the
      school hours or during recreation, in the primary school of the participant.
    

Detailed description: 
      Pain is a common and daily experience among children that is usually short-term, causing
      little to moderate discomfort. Yet, a substantial number of children experience chronic pain.
      Persistent pain periods mainly affect the children's school attendance and participation in
      recreational activities, possibly leading to academic impairments and social exclusion. Even
      worse is the children's greater predisposition to develop chronic pain into adulthood.
      Considering these disadvantages, children suffering from chronic pain should be treated as
      fast as possible and in the most optimal way. The existing literature on management in
      children with chronic pain encourages a multidisciplinary approach involving physical therapy
      and psychological interventions (i.e. cognitive behavioural therapy).

      Recently, the application of Pain Neuroscience Education (PNE) as an intervention on its own,
      as well as in combination with another form of therapy (such as physiotherapy or cognitive-
      behavioural therapy) is receiving growing interest in the pediatric field of chronic pain.
      PNE aims to make people understand how their pain is produced and enables them to integrate
      this understanding into their everyday lives and subsequent treatment components. This
      innovative education style has shown to be effective in various adult chronic pain
      populations, by improving the patients' pain coping strategies and health status, and
      changing their pain beliefs. Although, no study examined the effectiveness of PNE in the
      context of chronic pediatric pain. The hypothetical efficacy of pediatric PNE is based on
      previous findings in adult research that a better understanding of the nature of the illness
      results in improved patient outcomes. When children do not understand the origin of their
      pain, they might develop irrational beliefs and fears (including catastrophizing) about their
      pain, sustaining the vicious circle of chronic pain. Indeed, the information and context in
      which children perceive their pain, has been shown to modulate pain expectations and
      emotional response to pain. Since research findings showed that even parental beliefs about
      the aetiology of the child's pain influences the child's pain outcomes, the role of parents
      as 'pain modulators' might not be underestimated. Therefore, parents should be involved
      during PNE.

      Before and subsequent to providing children and their parents with PNE, it might be
      interesting to assess their previous knowledge and the change in knowledge about the
      neurophysiology of pain. To date, this aspect can be evaluated in adults by using the
      Neurophysiology of Pain Questionnaire (NPQ), a questionnaire developed and published by
      Moseley et al.. This instrument assesses the patients' reconceptualization of pain, and is
      validated in English and in Dutch. The questionnaire consists of 19 items and was originally
      based on examination papers of postgraduate medicine students. Various studies have used the
      NPQ to evaluated pain-related knowledge in adult chronic pain populations, such as chronic
      low back pain, chronic fatigue syndrome and chronic whiplash associated disorder.
      Additionally, previous research suggested the use of the NPQ in a study protocol to evaluate
      the effectiveness of brief education in the prevention of chronic low-back pain in an at-risk
      population. Noteworthy, the NPQ is also commonly used in clinical practice as a guideline for
      clinicians during educational sessions about chronic musculoskeletal pain. Previous research
      has proven adequate clinimetric properties of the English and Dutch version. One study, using
      a Rash analysis to evaluate the clinimetric properties of the NPQ in an adult chronic spinal
      population, found the NPQ to have (1) an acceptable internal consistency to assess
      individuals, (2) to be effective in targeting the ability of a typical group of chronic pain
      patients, (3) to be a unidimensional scale and (4) to have good test-retest reliability.
      Examination of the Dutch version showed fair reliability when retesting occurred within 24
      hours, acceptable test-retest reliability and one dimensionality of the questionnaire. To
      conclude, the NPQ has proven to be a reliable and valid measurement instrument for
      determining the understanding and knowledge of neurophysiology of pain in adult chronic pain
      populations and healthcare professionals.

      Based on this evidence in adults, it may be valuable to develop and examine the clinimetric
      properties of a Dutch Pediatric Neurophysiology of Pain Questionnaire (PedNPQ) to determine
      pain knowledge gaps in children.
    

Intervention name(s): Pain Neuroscience Education
Intervention type(s): Other
Intervention description(s): Children as well as their parents will receive a +/- 1h one-on-one educational session about the neurophysiology of pain, adjusted to the child's comprehension status. Parents will be present in the PNE session too. The PNE program for children contains two sections: (1) The healthy pain system and its function, divided in subsections each consisting of a specific neurophysiological pain concept (i.e. central nervous system anatomy, nociception and nociceptive pathways, up- and down-regulation of the nervous system) and (2) adaptations of the pain system following persistent pain. To ensure interaction between therapist and child, an interactive board game was developed and used throughout the full educational session.
Observational model: Other
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Healthy children will be recruited via announcements in several schools. Children will be
        eligible for study participation if they meet the inclusion and exclusion criteria.
      
Keywords: Pain Neuroscience Education