Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA.
MGH Institute of Health Professions, Boston, MA, USA.
Disabil Rehabil. 2022 Jan;44(2):194-201. doi: 10.1080/09638288.2020.1762125. Epub 2020 May 14.
To examine the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache using the International Classification of Functioning, Disability and Health model as a conceptual framework for disability assessment.
Children with chronic headache ( = 50; ages 10-19 years; 62% female) attended an intensive interdisciplinary pain treatment program 8 h/day, 5 times/week for 2-7 weeks. Disability measures were administered at admission, discharge, and 6-8 week follow-up. Disability outcomes were analyzed retrospectively. Wilcoxon signed rank tests and Friedman's analyses of variance were used to compare scores across two and three longitudinal time points, respectively.
After rehabilitation, disability reduced on the Headache Impact Test-6 from severe impact at admission to some impact at follow-up ( < 0.001). Median time on the modified Bruce protocol increased from 13.1 min (interquartile range = 12.6-14.1) to 14.4 min (interquartile range = 12.9-16.3), < 0.001, with gains maintained at follow-up. Improvements in pain and disability were associated with improvements in school participation.
Findings of this study support the effectiveness of intensive interdisciplinary pain treatment for improving disability in children with chronic headache.Implication for rehabilitationIntensive interdisciplinary pain treatment is effective for improving pain and disability in children with chronic headaches.Application of the ICF model to disability assessment suggests that children with chronic headaches may experience significant disability, even when standardized assessments of physical capacity are normal.The modified Bruce protocol, Pediatric Evaluation of Disability Inventory - Computerized Adaptive Tests, and Headache Impact Test-6 appear particularly valuable in understanding the nature of disability in children with chronic headaches.
以国际功能、残疾和健康分类（ICF）模型为残疾评估的概念框架，考察强化跨学科疼痛治疗对改善慢性头痛儿童残疾的效果。
50 名慢性头痛儿童（年龄 10-19 岁，62%为女性）参加了强化跨学科疼痛治疗项目，每天 8 小时，每周 5 天，持续 2-7 周。在入院、出院和 6-8 周随访时进行残疾测量。回顾性分析残疾结果。使用 Wilcoxon 符号秩检验和 Friedman 方差分析分别比较两个和三个纵向时间点的评分。
康复后，头痛影响测试-6 的残疾程度从入院时的严重影响降低到随访时的有些影响（ < 0.001）。改良 Bruce 方案的中位时间从 13.1 分钟（四分位距=12.6-14.1）增加到 14.4 分钟（四分位距=12.9-16.3）， < 0.001，随访时仍有获益。疼痛和残疾的改善与学校参与度的提高相关。
本研究结果支持强化跨学科疼痛治疗对改善慢性头痛儿童残疾的有效性。
强化跨学科疼痛治疗对改善慢性头痛儿童的疼痛和残疾有效。
应用 ICF 模型进行残疾评估表明，即使在身体能力的标准化评估正常时，慢性头痛儿童也可能经历显著的残疾。改良 Bruce 方案、儿科残疾评估量表-计算机自适应测试和头痛影响测试-6 在了解慢性头痛儿童残疾的性质方面似乎特别有价值。
