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脑瘫伴运动障碍儿童青少年慢性疼痛管理的临床医生观点。

Clinician Perspectives of Chronic Pain Management in Children and Adolescents with Cerebral Palsy and Dyskinesia.

机构信息

Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.

Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

出版信息

Phys Occup Ther Pediatr. 2021;41(3):244-258. doi: 10.1080/01942638.2020.1847236. Epub 2020 Nov 29.

Abstract

AIMS

To explore perspectives of clinicians from interdisciplinary teams on the barriers and facilitators to chronic pain management for children and adolescents with cerebral palsy and dyskinesia.

METHODS

Interdisciplinary focus groups (n = 2) were conducted at two Australian tertiary pediatric hospitals. Twenty-five experienced clinicians took part, including ten physiotherapists, six pediatricians, four rehabilitation physicians, four occupational therapists, and one speech and language therapist. An external moderator conducted the focus groups and data were analyzed using inductive thematic analysis.

RESULTS

Four key themes emerged: "balancing the intersection of pain and dyskinesia," "difficulty communicating between so many providers," "uncertainty surrounding chronic pain education," and "differing priorities." Key barriers were identified including a lack of access to some interdisciplinary team members and formalized guidance for health professionals regarding chronic pain education.

CONCLUSION

Key issues were reported to impact the delivery of coordinated inter-disciplinary chronic pain management at the tertiary level for children and adolescents with cerebral palsy and dyskinesia. In the absence of strong evidence, a strategy for implementing effective chronic pain management for children and adolescents with cerebral palsy and dyskinesia and gaining clinician consensus regarding the best practice management are recommended.

摘要

目的

探讨跨学科团队的临床医生对脑瘫伴运动障碍儿童和青少年慢性疼痛管理的障碍和促进因素的看法。

方法

在澳大利亚的两家三级儿科医院进行了跨学科焦点小组(n=2)。25 名经验丰富的临床医生参加了焦点小组,包括 10 名物理治疗师、6 名儿科医生、4 名康复医生、4 名职业治疗师和 1 名言语治疗师。外部主持人主持了焦点小组,使用归纳主题分析对数据进行分析。

结果

出现了四个主要主题:“平衡疼痛和运动障碍的交叉点”、“在这么多提供者之间沟通困难”、“慢性疼痛教育的不确定性”和“不同的优先事项”。主要障碍包括缺乏对一些跨学科团队成员的访问和针对慢性疼痛教育的专业人员的正式指导。

结论

报告了一些关键问题,这些问题影响了三级医院为脑瘫伴运动障碍的儿童和青少年提供协调的跨学科慢性疼痛管理。在缺乏强有力证据的情况下,建议为脑瘫伴运动障碍的儿童和青少年实施有效的慢性疼痛管理,并就最佳实践管理达成临床医生共识。

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