Évaluation d’un programme de réadaptation intensif pour les jeunes souffrant de douleur chronique en Alberta

Abstract: Pediatric chronic pain is an important health concern worldwide. Intensive interdisciplinary pain (IIPT) and multimodal treatment (MMT) are the two main service models. Unfortunately, descriptions of these published interventions lack the details necessary to reproduce them in different contexts, and comparison studies between the models are rare. This study had two main objectives: 1) analyse the theoretical foundation of the IIPT program, and 2) analyse the effects of a day-hospital donor funded IIPT compared to those of an outpatient MMT. To evaluate the IIPT theoretical foundation, a 13-member stakeholder advisory group was recruited, and a logic analysis process was used. To evaluate the effects of the IIPT, six outcome domains were prioritized by the same advisory group using a nominal group technique. An effect analysis was then conducted, using a pre-post study design, collecting data on youth participating in an IIPT and those enrolled in an MMT at the same facility. Interviews using a narrative timeline then followed with a subset of youth and parent participants. The results highlighted the sound theoretical foundation of the IIPT. Furthermore, positive effects were demonstrated in youth participating in both the IIPT and MMT, with each treatment revealing advantages and disadvantages. Merging findings and comparing the results provided an opportunity to gain a deeper understanding of what treatments work, and for whom. Some insight into why these treatment options work and suggestions for intervention improvements also emerged. Not only did this study generate the knowledge pivotal to alleviating the suffering and improving the lives of youth with chronic pain and their families in Alberta, in Canada, and beyond, it set a new standard of patient engagement for evaluation research of complex rehabilitation intervention.La douleur chronique pédiatrique est un enjeu important de santé. Les traitements interdisciplinaires intensifs (TII) et les traitements multimodaux (TMM) sont les deux principaux modèles de services reconnus. Malheureusement, les descriptions de ces interventions sont peu détaillées dans les écrits et les études comparatives sont rares. Cette recherche évaluative comprend deux objectifs principaux: 1) Analyser les fondements théoriques du programme TII, et 2) Analyser les effets du TII et les comparer à ceux d'un TMM. Pour analyser les fondements théoriques du programme TII, un groupe aviseur composé de 13 parties prenantes a été recruté et une analyse logique a été effectuée. Pour évaluer et comparer les résultats et les effets du TII et du TMM, six domaines de résultats ont été priorisés par le groupe aviseur. L’analyse des effets a été réalisée par une collecte de données pré-post auprès de jeunes participants au TII et ceux inscrits au TMM. Par la suite, des entretiens, facilités par des chronologies narratives, ont été menés auprès d’un sous-ensemble de jeunes participants et de leurs parents. Les résultats font ressortir le bien-fondé des TII. Les TII et les TMM ont tous deux des effets positifs sur les jeunes souffrant de douleurs chroniques, chaque traitement ayant des avantages et des désavantages. Les résultats permettent de mieux comprendre quels traitements fonctionnent, et pour qui. Cette étude a généré des connaissances essentielles pour soulager la souffrance et améliorer la qualité de vie des jeunes souffrant de douleur chronique et de leurs familles. Elle a aussi établi une nouvelle norme quant à l’engagement des parties prenantes dans le processus d’évaluation des interventions complexe en réadaptation

Using collaborative logic analysis evaluation to test the program theory of an intensive interdisciplinary pain treatment for youth with pain‐related disability

Abstract : Pediatric pain rehabilitation programs are complex and involve multiple stakeholders. Mapping the program components to its anticipated outcomes (i.e., its theory) can be difficult and requires stakeholder engagement. Evidence is lacking however on how best to engage them. Logic analysis, a theory-based evaluation, which tests the coherence of a program’s theory using scientific evidence and experiential knowledge, may hold some promise. Its use is rare in pediatric pain rehabilitation and few methodological details are available. This article provides a description of a collaborative logic analysis methodology used as the first step in the evaluation of an intensive interdisciplinary pain treatment program designed for youth with pain-related disability. A three-step direct logic analysis process was used. A 13-member expert panel, composed of clinicians, teachers, managers, youth with pain-related disability and their parents were engaged in each step. First, a logic model was constructed through document analysis, expert panel surveys and focus-group discussions. Then, a scoping review, focused on pediatric self-management, building self-efficacy, and fostering participation helped create a conceptual framework. Finally, an examination of the logic model against the conceptual framework by the expert panel followed, and recommendations were formulated. Overall, the collaborative logic analysis process helped raised awareness of clinicians’ assumptions about the program causal mechanism, identified program components most valued by youth and their parents; and recognized the program features supported by scientific and experiential knowledge, detected gaps and highlighted emerging trends. In addition to proving a consumer-focused program evaluation option, collaborative logic analysis methodology holds promise as a novel strategy to engage stakeholders and to translate pediatric pain rehabilitation evaluation research knowledge to key stakeholders

What really matters in pediatric chronic pain rehabilitation? Results of a multi-stakeholder nominal group technique study

Abstract : Purpose: To prioritize outcome domains sensitive to the needs of the various stakeholders involved in rehabilitation programs designed for youth with pain-related disability using the International Classification of Function Child and Youth version. Materials and Methods: A 5-step nominal group technique was conducted with 13 stakeholders, including 2 youth with pain-related disability, 2 parents, 5 clinicians, 2 teachers, and 2 healthcare managers. Once identified by content thematic analysis and International Classification of Function linking, 15 outcome domains were ranked. Priority rank scores were then weighted. Results: Six outcome domains were prioritized: 1) activities of daily living, 2) participation in meaningful activities, 3) social roles and relationships, 4) mood and affect, 5) school engagement, and 6) self-efficacy. Discrepancies in ranking existed; parents and youth attributed importance to pain, sleep, and program satisfaction whereas clinicians and mangers underscored pain–related fear and family functioning. When compared, prioritized domain associated with three PedIMMPACT recommendations, and aligned with the activity and participation components of the International Classification of Function for Child and Youth. Conclusion: These findings emphasize the importance of integrating various perspectives, including those of youth with pain-related disability and other important stakeholders and adopting a broader conceptualization of disability and function when selecting key rehabilitation evaluation outcome for this population

Can a Community of Practice Improve Physical Therapists’ Self-Perceived Practice in Developmental Coordination Disorder?

Abstract : Background. Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists’ self-perceived practice. Purpose. The impact of a CoP on physical therapists’ self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. Design. An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. Methods. Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists’ self-perceived knowledge, skills, and practice. Physical therapists’ sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. Results. Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P < .001) at the end of the CoP compared with the beginning. Few of the factors explored significantly influenced therapists’ self-reported change scores. Limitations. No observational data on practice change was collected. The small sample may have limited the ability to identify factors influencing self-perceived practice changes. Conclusions. The CoP increased physical therapists’ self-perceived knowledge, skills, and practice. More research is needed to explore CoP impact on physical therapist practices and how behavioral changes influence patient outcomes

The computer-based tutorial for a 21-point vision examination (CT21)

The Computer-based Tutorial for a 21 point vision examination (CT21) is an educational program intended to enhance optometry students\u27 knowledge and understanding of a standardized comprehensive vision exam. The program may also be used in conjunction with clinical procedures classes as an educational aid. The entire tutorial is presented in a computerized format for Macintosh computers using CD ROM. Video clips are presented along with questions for students to respond to, thereby enhancing understanding of individual components of a 21 point vision examination. The individualized program allows students to answer questions at their own pace and receive immediate feedback in a non-threatening environment

Youth and parent perceptions on participating in specialized multidisciplinary pain rehabilitation options: A qualitative timeline effect analysis

Background: Little is known about how the specialized treatment journey is perceived by youth with pain-related disability and their parents. Aims: Describe and compare the treatment effects and outcomes as perceived by youth and their parents enrolled in intensive interdisciplinary pain treatment (IIPT) or multimodal treatment (MMT). Methods: Eleven IIPT youth and five parents and three MMT youth and five parents were recruited. All were asked to complete a treatment journey timeline, followed by separately conducted semistructured interviews. Transcribed interviews were analyzed using reflective thematic analysis. Results: The main themes spanned the treatment trajectory. All participants described similar initial struggles (Theme 1). Positive and negative treatment effects associated with acquisitions and disruptions (Theme 2), and outcomes post-discharge related to supports and realities (Theme 3) emerged. Knowledge, skills, and support acquisition during treatment and feeling empowered and confident to self-manage postdischarge were identified as IIPT benefits. However, the change effort and life disruptions required and the difficulty transitioning to real life postprogram were acknowledged as detrimental IIPT impacts. Continuing with life as usual and maintaining supports in daily contexts (e.g., school personnel, friends) were reported MMT benefits. However, the challenges of managing pain, treatment adherence within the competing demands of daily realities, and the lack of support to integrate strategies were emphasized as detrimental MMT impacts. Conclusions: Detailed impacts of two specialized multidisciplinary pain rehabilitation interventions on the lives of youth with pain-related disability and their parents are described. The treatments benefits and previously unexplored detrimental effects are unveiled

Recruitment, use, and satisfaction with a web platform supporting families of children with suspected or diagnosed developmental coordination disorder: A randomized feasibility trial

Objectives. To determine the feasibility of recruiting families of children with suspected or diagnosed developmental coordination disorder (sdDCD) and explore their satisfaction with a web-based intervention Design. A feasibility randomized trial was conducted. Participants were the parents of 5-12-year-old children with sdDCD. The intervention group had access to online resources, group and private forums, and videoconferencing with a therapist. Main outcomes were recruitement and retention rates. Satisfaction was documented through a post-intervention survey and interview. Results. The recruitment rate was seven participants per month (n = 28 participants) and retention rate was 68%. Satisfaction was moderate. No differences in use and satisfaction were observed between groups. Participants formulated recommendations for improving the intervention, including targeting families earlier in the diagnosis process, and pre-scheduling meetings with therapists. Conclusions. This study demonstrated the feasibility of future trials, and highlighted avenues for improvement. Parent involvement during the development of the intervention is discussed at length. Abbreviations: DCD: Developmental Coordination Disorder; sdDCD: suspected or diagnosed Developmental Coordination Disorder; RCT: randomized-controled trial

Participant-generated timelines: a participatory tool to explore young people with chronic pain and parents’ narratives of their healthcare experiences

Visual methods are becoming more evident in health research. Timeline drawings have been used as a participatory tool alongside interviews in life course research. In this article, we describe how a method involving timeline generation can explore patient experiences along a treatment continuum. Grounded in previously published evidence and using specific examples from two studies exploring the experiences of young people treated for chronic pain, we outline the key components of this method. Moreover, we highlight the flexibility of its application and the importance of using a person-centered approach in tailoring the application pragmatically to study population-specific needs and characteristics, while answering the research question. We also reflect on how the dynamic visual display of the timeline and participants’ explanations add perspective and understanding to complex and multidimensional human experiences associated with healthcare treatment. Furthermore, we outline how this method can help capture changes in the meaning and sense-making of these experiences over time, all the while fostering empowerment in study participants. Finally, the key considerations of using the method are outlined. It is our aim that this article provides the details required to inspire others to consider this novel method as a means of capturing the healthcare experiences of young people with other chronic conditions, an important first step in fostering the changes required to improve the quality of healthcare services and research.</p