Pain Prevalence, Distribution, Effect on Activities of Daily Life in Patients With Adolescent Cerebral Palsy

Study Overview
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Brief Summary
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Pain is the most common secondary condition in patients with CP and the most important factor associated with reduced health-related quality of life. Pain in adolescents with CP is reported approximately 50-75%. Despite being a condition that can be seen with such a high prevalence, it is difficult for researchers and clinicians to capture this subjective perception in CP, as the individual may be a small child, may be cognitively impaired, visually impaired, or have communication difficulties. For these reasons, unrecognized pain can have negative effects on quality of life and participation in daily living activities, both as a result of limited mobility resulting from pain itself and fear-driven avoidance of specific activities. Self-report of pain is appropriate for individuals with CP without cognitive impairment. However, depending on the severity of communication impairment, self-report may be limited or even impossible to obtain in individuals with severe CP. In the case of individuals with CP, self-report supplemented with parent report, when possible, is the recommended strategy. The aims of this study: (i) to explore what is known about the prevalence, location, intensity and the effect of pain on daily lives of adolescents with CP; (ii) to demonstrate the relation between pain, clinical and sociodemographic characteristics; (iii) to compare self-reports of pain with mothers'reports of their child's pain.

Detailed Description
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The investigators will record demographical data including age, gender, height (cm), weight (kg), body mass index (BMI), school type, type of family (core or combined family) of the children and socioeconomic status of the family, mothers' age and educational level. The subtypes of CP will be classified, using the Swedish classification, into spastic (tetraplegia, diplegia and hemiplegia), ataxic, dyskinetic and mixed. Severity of CP will be determined based on the Gross Motor Functional Classification System. It will be questioned in which situations the pain occurred in the previous week (at rest from spasms, at rest from splints, on feeding, on moving, on dressing, at night, on exercise, on other treatments, on botulinum toxin application) and record as yes/no. The pain questionnaire described by Doralp et al (14) will be used both for the self-evaluation of adolescents with CP' pain and for mothers to evaluate their children's pain. Participants will be asked to respond to the initial question Over the past month, have you experienced physical pain? (yes or no). Those responding yes will be asked Please indicate how severe your pain was over the past month, on average, with response options from 1 (very little pain) to 10 (extremely painful). They will be asked to indicate How much the pain gets in the way of your daily activities over the past month from a low of 1 (does not get in the way at all) to 10 (unable to carry out activities because of the pain). Finally, they will be asked to indicate the body regions in which they experienced pain.

Official Title
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Pain Prevalence, Distribution, Effect on Activities of Daily Life in Patients With Adolescent Cerebral Palsy and a Comparion of the Mother-child Report

Conditions
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Cerebral Palsy

Intervention / Treatment
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* Other: Circumstances of pain
* Other: Pain Questionnaire
* Other: Gross Motor Functional Classification System
* Other: The subtypes of Cerebral palsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for patients: adolescents, aged 8 to 18 years with a diagnosis of cerebral palsy able to understand and answer the questions Exclusion Criteria for patients: previous interventional procedures, such as surgery within the last one month using painkillers having concomittan diagnosed 'Autism Spectrum Disorder' or 'Attention Deficit Hyperactivity Disorder' or another neuromuscular disorder Inclusion Criteria for their mothers: primary caregivers who spend most of their time with their children do not work outside the home Exclusion Criteria for their mothers: not primary caregivers who spend most of their time with their children work outside the home

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| adolescent cerebral palsy<br>Demographical data, the subtypes of CP, Gross Motor Functional Classification System level, circumstances of pain, pain questionnaire will be analyzed. | Other: Circumstances of pain<br>* It will be questioned in which situations the pain occurred in the previous week (at rest from spasms, at rest from splints, on feeding, on moving, on dressing, at night, on exercise, on other treatments, on botulinum toxin application) and record as yes/no.<br>Other: Pain Questionnaire<br>* Participants will be asked to respond to the initial question Over the past month, have you experienced physical pain? (yes or no). Those responding yes will be asked Please indicate how severe your pain was over the past month, on average, with response options from 1 (very little pain) to 10 (extremely painful). They will be also asked to indicate How much the pain gets in the way of your daily activities over the past month from a low of 1 (does not get in the way at all) to 10 (unable to carry out activities because of the pain). Finally, they will be asked to indicate the body regions in which they experienced pain.<br>Other: Gross Motor Functional Classification System<br>* Severity of CP will be determined based on the Gross Motor Functional Classification System (GMFCS). GMFCS is a standardised measure that classifies gross motor functions in children with CP. Children in level I are very independent in motor functions while those in level V are the least independent<br>Other: The subtypes of Cerebral palsy<br>* The subtypes of CP will be classified, using the Swedish classification, into spastic (tetraplegia, diplegia and hemiplegia), ataxic, dyskinetic and mixed<br>|
| adolescent cerebral palsy's mother<br>pain questionnaire will be analyzed. | Other: Pain Questionnaire<br>* Participants will be asked to respond to the initial question Over the past month, have you experienced physical pain? (yes or no). Those responding yes will be asked Please indicate how severe your pain was over the past month, on average, with response options from 1 (very little pain) to 10 (extremely painful). They will be also asked to indicate How much the pain gets in the way of your daily activities over the past month from a low of 1 (does not get in the way at all) to 10 (unable to carry out activities because of the pain). Finally, they will be asked to indicate the body regions in which they experienced pain.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gross Motor Functional Classification System level | GMFCS is a standardised measure that classifies gross motor functions in children with CP. Children in level I are very independent in motor functions while those in level V are the least independent . | Through study completion, an average of 1 month | 
| Pain distribution | It will be questioned in which situations the pain occurred in the previous week (at rest from spasms, at rest from splints, on feeding, on moving, on dressing, at night, on exercise, on other treatments, on botulinum toxin application) | Through study completion, an average of 1 month | 
| The pain questionnaire | Participants will be asked to respond to the initial question Over the past month, have you experienced physical pain? (yes or no). Those responding yes will be asked Please indicate how severe your pain was over the past month, on average, with response options from 1 (very little pain) to 10 (extremely painful). They will be also asked to indicate How much the pain gets in the way of your daily activities over the past month from a low of 1 (does not get in the way at all) to 10 (unable to carry out activities because of the pain). Finally, they will be asked to indicate the body regions in which they experienced pain. | Through study completion, an average of 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cerebral palsy, adolescent, pain, parent report, self report