P21 Feasibility of the Learning and Exercise to Avert Pain (LEAP) programme: an evaluation of a group therapy intervention for young people with chronic musculoskeletal pain
Authors: Wong Hannah , Wheeler Margaret , Nisbet Jennifer , McDonagh Janet , Cuthbert Verna 
Published: September 2019

Abstract

Background
Chronic idiopathic musculoskeletal pain (CIMSKP) has become increasingly recognised as a major cause of morbidity in adolescents. In view of increasing referrals to a paediatric rheumatology centre, the Learning and Exercise to Avert Pain (LEAP) intervention was designed as an approach to pain management within a group setting, led by an occupational therapist and a physiotherapist. It involves 2 hour weekly sessions for 6 weeks and includes education, gym activities and relaxation sessions with routine collection of Pain VAS, CHAQ, Bath Pain questionnaires (adolescent BAPQ and parent BAPQ-p forms) at baseline, end of LEAP and 3 months follow-up. We aim to assess the feasibility and impact of LEAP for adolescents with CIMSKP.

Methods
Young people who had been referred for the LEAP programme were identified (n = 46). Basic demographics and questionnaire scores were collected from electronic patient records and therapy notes. Feasibility was assessed by delivery of programme and percentage completion of questionnaires at three time-points. Semi-structured interviews were conducted with healthcare professionals involved in the programme and analysed using thematic analyses as were any free text comments on the BAPQ from adolescents and parents. Statistical analysis of the outcome data was performed using paired t-tests and SPSS software (v22).

Results
46 adolescents were identified: 85% female, median age 16 years (range 10 to 19). 34 participated in LEAP, 12 received 1:1 therapy. Feasibility of programme delivery was achieved with completion of all six sessions. Completion rates for all 3 measures for adolescents/parents at baseline, end of programme review and follow up were 78.6/71.4%, 64.3/71.4%, and 45.5/36.4% respectively. Adolescent scores indicated a significant increase in impairment in the development subscale scores on BAPQ from baseline to programme end (p = 0.021) although not at follow up. Parent scores for adolescent anxiety and pain-specific anxiety on BAPQ-p increased significantly from end of programme to follow-up (p = 0.017, p = 0.034 respectively). Parents scored higher than adolescents for most outcomes. The qualitative data (available for 11 adolescents, 12 parents) revealed that parents and adolescents appreciated learning coping techniques and gaining a greater understanding of chronic pain. The intervention was perceived to be socially beneficial in particular but imperfect in terms of data collection by the professionals interviewed (n = 2).

Conclusion
Baseline demographics of the LEAP participants echoed current literature. Delivery of the programme was feasible and the programme was positively received by young people, their parents and professionals alike. The increase in adolescent development subscale scores following the programme could represent increased self-reflection and/or peer to peer observations as a result of the group setting but needs longer term follow-up data to clarify further. The increase in parental anxiety highlights the need for a concurrent session for parents. Routine collection of objective measures remains challenging in non-research setting.

Conflicts of Interest
The authors declare no conflicts of interest.